{"hospital_name": "Memorial Hermann Specialty Hospital Kingwood L L C", "last_updated_on": "2026-04-14", "version": "3.0.0", "pid": "1549934232", "rid": "12659", "location_name": ["Memorial Herman Surgical Hospital Kingwood"], "hospital_address": ["300 Kingwood Medical Dr, Kingwood, TX 77339"], "type_2_npi": ["1366532228"], "license_information": {"license_number": "008591", "state": "TX"}, "attestation": {"attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Geoffrey Vines"}, "standard_charge_information": [{"description": "(AYR)/SODUM CHLORIDE 0.65% NASAL GEL 15GM", "code_information": [{"code": "MED0793", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "(AYR)/SODUM CHLORIDE 0.65% NASAL GEL 22.5GM", "code_information": [{"code": "MED0306", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "00409-7241-01 - epinephrine 1. mg Soln", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0165", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "00409-7241-01 - epinephrine 1. mg Soln", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0165", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "00641-6027-25 - fentaNYL 50 mcg/mL Soln", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3010", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "00641-6027-25 - fentaNYL 50 mcg/mL Soln", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3010", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "1 ADMN RSV MONOC ANTB IM NJX", "code_information": [{"code": "96381", "type": "CPT"}], "standard_charges": [{"minimum": 176.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1 BOD TEMP >=35.5", "code_information": [{"code": "G9773", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1 EM CORE SESSION", "code_information": [{"code": "G9873", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1 MED VISIT IN 24MO", "code_information": [{"code": "G9247", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1 OR NO CT SINUS W/IN 90D DX", "code_information": [{"code": "G9354", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1.8 X 150MM KWIRE LANCET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5042.51/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "10G IVAS ELITE BALLOON SYSTEM", "code_information": [{"code": "808-015-800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4461.03, "discounted_cash": 1561.36, "setting": "both", "billing_class": "facility"}]}, {"description": "10MM X 10MM X 10MM DYNACLIP BONE FIXATION SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3000-00-101010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 980.0, "setting": "both", "billing_class": "facility"}]}, {"description": "11G IVAS ELITE BALLOON KIT", "code_information": [{"code": "808-115-800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4595.0, "discounted_cash": 1608.25, "setting": "both", "billing_class": "facility"}]}, {"description": "12 Lead EKG 93005", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "1554967", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "gross_charge": 375.0, "discounted_cash": 131.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "12 Lead EKG w/o interp 93005", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "1558406", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "gross_charge": 445.0, "discounted_cash": 155.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}, {"minimum": 242.59, "maximum": 8450.0, "gross_charge": 475.0, "discounted_cash": 166.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "12MM CORE 15-20MM 5962152", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5962152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9233.7, "discounted_cash": 3231.8, "setting": "both", "billing_class": "facility"}]}, {"description": "15X12MM ENDCAP PARALLEL 12MM CORE 5962520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5962520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2303.7, "discounted_cash": 806.3, "setting": "both", "billing_class": "facility"}]}, {"description": "18MM 2 HOLE CASCADIA CAYMAN SPINE PLATE 7908-42F183", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7908-42F183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5356.0, "discounted_cash": 1874.6, "setting": "both", "billing_class": "facility"}]}, {"description": "18MM X 18 MM X 18MM STAPLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "500-18-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4738.0, "discounted_cash": 1658.3, "setting": "both", "billing_class": "facility"}]}, {"description": "1DOSE MENIG VAC BTWN 11 & 13", "code_information": [{"code": "G9414", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}], "standard_charges": [{"minimum": 905.9, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 905.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1423.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1423.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1423.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS MODERATE 55", "code_information": [{"code": "99222", "type": "CPT"}], "standard_charges": [{"minimum": 613.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 613.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 964.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 964.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 964.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS SF/LOW 40", "code_information": [{"code": "99221", "type": "CPT"}], "standard_charges": [{"minimum": 454.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 454.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 714.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 714.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 714.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE HIGH MDM 50", "code_information": [{"code": "99306", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE MODERATE MDM 35", "code_information": [{"code": "99305", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE SF/LOW MDM 25", "code_information": [{"code": "99304", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 4382.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST PSYC COLLAB CARE MGMT", "code_information": [{"code": "99492", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST/SBSQ PSYC COLLAB CARE", "code_information": [{"code": "99494", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 NO WL", "code_information": [{"code": "G9877", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 WL", "code_information": [{"code": "G9879", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "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": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 WL", "code_information": [{"code": "G9878", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 13-15 WL", "code_information": [{"code": "G9882", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 16-18 WL", "code_information": [{"code": "G9883", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 19-21 WL", "code_information": [{"code": "G9884", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 22-24 WL", "code_information": [{"code": "G9885", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2+ ANTIPSY SCHIZ", "code_information": [{"code": "G0032", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2+ BENZO SEIZ", "code_information": [{"code": "G0033", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2.0 SPEEDTIP C-SNAP SCREW 11MM HD6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5417.11/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 737.0, "discounted_cash": 257.95, "setting": "both", "billing_class": "facility"}]}, {"description": "2.0 X 12 SNAP-OFF SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "M10-20412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1339.0, "discounted_cash": 468.65, "setting": "both", "billing_class": "facility"}]}, {"description": "2.0/2.3 SCREWDRIVER BLADE HD6 AO", "code_information": [{"code": "A-2611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 184.1, "setting": "both", "billing_class": "facility"}]}, {"description": "2.0MM ALLOMATE INSTRUMENT SYSTEM", "code_information": [{"code": "KIT-ABS-I20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "2.0MM CORTICAL BONE PIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CBP-ABS-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "2.0MM DRILL SHORT WITH AO QUICK CONNECT 71174910", "code_information": [{"code": "71174910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 581.04, "discounted_cash": 203.36, "setting": "both", "billing_class": "facility"}]}, {"description": "2.3 DRILL NOVASTEP", "code_information": [{"code": "XD13010030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 928.0, "discounted_cash": 324.8, "setting": "both", "billing_class": "facility"}]}, {"description": "2.3X12MM LOCKING SCREWS.CROSS-PIN.SELF-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23012E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "2.3X18MM BONE SCREWSCROSSPINSELFTAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23018E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "2.3X20MM BONE SCREWSCROSSPINSELFTAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23020E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "2.4MM TI CONDYLAR PLATE 8 HOLES/57MM - RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "2.4MM TI CORTEX SCREW SLF-TPNG WITH T8 STARDRIVE RECESS 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "2.5CC BIO4 VIABLE BONE MATRIX 3102-2102", "code_information": [{"code": "C9354", "type": "HCPCS"}, {"code": "3102-2102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4378.0, "discounted_cash": 1532.3, "setting": "both", "billing_class": "facility"}]}, {"description": "2.8 DRILL BIT QC 135 45 CALIBRATION", "code_information": [{"code": "3.133.106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "2.8MM PERCUTANEOUS DRILL BIT F/LCP PL QC/200MM/100MM CALIB", "code_information": [{"code": "324.214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 584.0, "discounted_cash": 204.4, "setting": "both", "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 144.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 91.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 144.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 144.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 144.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 51.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 51.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "22MM X 70MM TUBE STERILE 304-2207", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-2207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 788.0, "discounted_cash": 275.8, "setting": "both", "billing_class": "facility"}]}, {"description": "22MM X 80MM TUBE STERILE 304-2208", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-2208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 788.0, "discounted_cash": 275.8, "setting": "both", "billing_class": "facility"}]}, {"description": "26MM X 90MM TUBE STERILE 304-2609", "code_information": [{"code": "304-2609", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 788.0, "discounted_cash": 275.8, "setting": "both", "billing_class": "facility"}]}, {"description": "2D TEE W OR W/O FOL W/CON,IN", "code_information": [{"code": "C8925", "type": "HCPCS"}], "standard_charges": [{"minimum": 3002.42, "maximum": 4718.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,CO", "code_information": [{"code": "C8923", "type": "HCPCS"}], "standard_charges": [{"minimum": 3002.42, "maximum": 4718.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,FU", "code_information": [{"code": "C8924", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.96, "maximum": 2646.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1683.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2646.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2646.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2646.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90650", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3 COMP FOOT EXAM COMPLETED", "code_information": [{"code": "G9226", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3 HOLE MALE POST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-3-MP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "3-D RADIOTHERAPY PLAN", "code_information": [{"code": "77295", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2076.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1187.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1866.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1866.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1866.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 625.39, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 666.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3.0MM BC SUTURETAK W/SUTURETAPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1934BCT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1001.0, "discounted_cash": 350.35, "setting": "both", "billing_class": "facility"}]}, {"description": "3.0X13MM - CANNULATED 45803013", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45803013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "3.0X16MM - CANNULATED 45803016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45803016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5 X 34MM SCREW T15 LP CORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110017734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5 X 36MM SCREW T15 LP CORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110017736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5 X 38MM R3CON LOCKING PLATE SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 680.0, "discounted_cash": 238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM L-D FIB 107MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72822007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3142.0, "discounted_cash": 1099.7, "setting": "both", "billing_class": "facility"}]}, {"description": "35MM FIXED PERCUTANEOUS SCREW PALISADE (STERILE PACKED)", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "670-4035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "3D ECHO IMG CGEN CAR ANOMAL", "code_information": [{"code": "93319", "type": "CPT"}], "standard_charges": [{"minimum": 114.97, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 180.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 180.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 180.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D PRINT OF 3D SURFACE SCAN", "code_information": [{"code": "D0396", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76376", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 91.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 91.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 91.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 39.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 42.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76377", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 101.28, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 108.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D VOL IMG&RCNSTJ BRST/AX", "code_information": [{"code": "694T", "type": "CPT"}], "standard_charges": [{"minimum": 138.57, "maximum": 217.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D radiodensity-value bone imaging, algorithm derived, from previous magnetic resonance examination of the same anatomy", "code_information": [{"code": "G0566", "type": "HCPCS"}], "standard_charges": [{"minimum": 683.73, "maximum": 1074.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 683.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1074.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1074.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1074.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3XL TED HOSE. REGULAR LENGHT KNEE 7472LF", "code_information": [{"code": "7472LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.42, "discounted_cash": 7.15, "setting": "both", "billing_class": "facility"}]}, {"description": "3d anatomical segmentation imaging for preoperative planning, data preparation and transmission, obtained from previous diagnostic computed tomographic or magnetic resonance examination of the same anatomy", "code_information": [{"code": "C8001", "type": "HCPCS"}], "standard_charges": [{"minimum": 384.78, "maximum": 604.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 384.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 604.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 604.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 604.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "4 EM CORE SESSIONS", "code_information": [{"code": "G9874", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "4.0 CANELLOUS SCREW FULLY THREADED STAINLESS STEEL 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "345422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "4.0 X 28MM HEADLESS SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH4028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "4.5MM X 45MM INNATE IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINN924545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3968.0, "discounted_cash": 1388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "40-75Y W/TYPE 1/2 W/LDL-C RS", "code_information": [{"code": "G9676", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "4VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90649", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "5 X 50MM SELFTAP CANC SCR TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71755050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 849.0, "discounted_cash": 297.15, "setting": "both", "billing_class": "facility"}]}, {"description": "5% WL MAINTND FROM BSLINE WT", "code_information": [{"code": "G9888", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "5-HOLE VARIAX DISTAL LATERAL FIBULA PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1585.0, "discounted_cash": 554.75, "setting": "both", "billing_class": "facility"}]}, {"description": "5.0MM TI LOCKING SCREW SELF-DRILLING 75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "414.836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "6.0 44-56MM CONNECTOR 11-56", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Nov-56", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "60MM TRIDENT ACETABULAR SHELL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "702-04-60G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "6X11X14MM 5740106", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "5740106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2310.0, "discounted_cash": 808.5, "setting": "both", "billing_class": "facility"}]}, {"description": "73040 CPT Add On", "code_information": [{"code": "73040", "type": "CPT"}, {"code": "35312824", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 516.0, "discounted_cash": 180.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 211.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 211.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 261.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 191.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 265.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 320.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 247.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 263.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "73525 CPT Add On", "code_information": [{"code": "73525", "type": "CPT"}, {"code": "35312820", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1547.0, "discounted_cash": 541.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 635.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 635.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 783.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 574.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 796.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 960.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 233.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 248.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "77002 CPT Add On", "code_information": [{"code": "77002", "type": "CPT"}, {"code": "42949243", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1573.0, "discounted_cash": 550.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 645.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 645.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 796.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 584.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 326.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 810.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 976.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 210.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 223.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "85014 Hematocrit Price", "code_information": [{"code": "85014", "type": "CPT"}, {"code": "34208647", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 149.0, "discounted_cash": 52.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 55.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "9 EM CORE SESSIONS", "code_information": [{"code": "G9875", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "9VHPV VACCINE 2/3 DOSE IM", "code_information": [{"code": "90651", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "<50% TOTAL PT OUTPT RA ENCTS", "code_information": [{"code": "M1008", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "<6YR NEW ONSET HD ACHE", "code_information": [{"code": "G2193", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ">55 YRS TEMP HD ACHE", "code_information": [{"code": "G2192", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ">= 2 SAME HI-RSK MED NOT ORD", "code_information": [{"code": "G9368", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ">= 2 SAME HI-RSK MED ORD", "code_information": [{"code": "G9367", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ">=2 SAME HI-RSK MED W/O DIAG", "code_information": [{"code": "M1209", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ">=2 SAME MEDS TBL4 NOT ORD", "code_information": [{"code": "M1210", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ">=50% TOTAL PT OUTPT RA ENCT", "code_information": [{"code": "M1007", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ">=86Y NO HX COLO CA/RSN SCOP", "code_information": [{"code": "G9659", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified", "code_information": [{"code": "M1379", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD IMAG W/US, CT OR MRI", "code_information": [{"code": "G9455", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD PAD 5INX9IN STERILE LATEX-FREE", "code_information": [{"code": "C-ABP59S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD PAD 8INX10IN, STERILE, LATEX-FREE", "code_information": [{"code": "C-ABP810S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMINAL PAD 5 X 9\" PRM21450", "code_information": [{"code": "PRM21450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ABDOMINAL PARACENTESIS-INITIAL 49080", "code_information": [{"code": "49080", "type": "CPT"}, {"code": "1479859", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1334.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1334.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMINO-VAGINAL VESICAL NECK SUSPENSION 51845", "code_information": [{"code": "51845", "type": "CPT"}, {"code": "1479861", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMINOPLASTY 15847", "code_information": [{"code": "15847", "type": "CPT"}, {"code": "1479860", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABG KIT 3CC LUER LOCK ASPIRATOR", "code_information": [{"code": "603CH", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1203.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1203.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1203.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 40787.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25955.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATION CONDYLOMA LASER PREMALIGNANT 17004", "code_information": [{"code": "17004", "type": "CPT"}, {"code": "1479864", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATION CYST KIDNEY LAPAROSCOPIC 50541", "code_information": [{"code": "50541", "type": "CPT"}, {"code": "1479865", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATION SOFT TISSUE INFERIOR TURB. UNI/BILATERAL ANY METHOD INTRAMURAL 30802", "code_information": [{"code": "30802", "type": "CPT"}, {"code": "1725809", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATION SOFT TISSUE OF INFERIOR TURBINATES; UNILATERAL OR BILATERAL 30801", "code_information": [{"code": "30801", "type": "CPT"}, {"code": "26145119", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.42, "maximum": 8450.0, "gross_charge": 1036.0, "discounted_cash": 362.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 501.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATION TUMOR BLADDER LASER 51020", "code_information": [{"code": "51020", "type": "CPT"}, {"code": "1479867", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATOR 90 APOLLORF X90 ASPIRATING", "code_information": [{"code": "AR-9821", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR APOLLO RF I90 ASPIRATING 90 AR-9831", "code_information": [{"code": "AR-9831", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 651.0, "discounted_cash": 227.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR SURG 45DEG SM JOINT COOLCUT", "code_information": [{"code": "AR-9809SJ-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 132.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 395.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}], "standard_charges": [{"minimum": 395.76, "maximum": 1713.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO Group by Blood Center 86900", "code_information": [{"code": "86900", "type": "CPT"}, {"code": "634326", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 1013.0, "discounted_cash": 354.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 376.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [{"code": "770", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5412.65, "maximum": 9292.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5412.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7741.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8515.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9292.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION WITHOUT D&C", "code_information": [{"code": "779", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6441.9, "maximum": 11059.14, "estimated_discounted_cash": 15446.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6441.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9213.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10134.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11059.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABS SHORT FIXED-DEVICE 5MM/1-USE 20TACK ABSTACK20S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABSTACK20S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 986.0, "discounted_cash": 345.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSCESS DRAINAGE UNDER X-RAY", "code_information": [{"code": "75989", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 438.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 438.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 438.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 135.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 143.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABSORABLE HEMOSTATIC SURGICEL ORIGINAL 4INX8 IN 1952S", "code_information": [{"code": "1952S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.59, "discounted_cash": 68.11, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN POWDER (SURGIFOAM) KIT 1GM", "code_information": [{"code": "MED0002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN POWDER; 1GM ENVELOPE", "code_information": [{"code": "MED0003", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN SPONGE (SURGIFOAM) SIZE 100", "code_information": [{"code": "MED0004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN SPONGE (SURGIFOAM) SIZE 12-7", "code_information": [{"code": "MED0001", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ABX PRES W/IN 10 DYS OF SYMP", "code_information": [{"code": "G9505", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABX REG PRESCRIBED", "code_information": [{"code": "G9498", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACC SM 115MM 5 CBL TROCH GRIP 71340004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71340004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4375.0, "discounted_cash": 1531.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESS SHEATH UROPASS 13/15FR X 38CM", "code_information": [{"code": "61338BX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESSORY AVETA FLUID MANAGEMENT 205-072", "code_information": [{"code": "205-072", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESSORY AVETA WASTE MANAGEMENT 205-224", "code_information": [{"code": "205-224", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESSORY HANDPIECE FOR HYDRODEBRIDER SYS", "code_information": [{"code": "1914001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 819.0, "discounted_cash": 286.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESSORY HOLSTER FOR BOVIE PENCIL", "code_information": [{"code": "E2400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESSORY W/CAP AVENTA WASTE MANAGEMENT 205-2036", "code_information": [{"code": "205-2036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESSORY W/CAP AVETA WASTE MANAGEMENT 205-2001", "code_information": [{"code": "205-2001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCUFILL 3CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4985.0, "discounted_cash": 1744.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCY PAIN ENS BOOT GLOBAL 37500301", "code_information": [{"code": "37500301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "ACE ARB ARNI", "code_information": [{"code": "G2092", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACE-I/ARB RX", "code_information": [{"code": "M1200", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACE/ARB NOT RX'D; DOC REAS", "code_information": [{"code": "G8474", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY NOT RX'D", "code_information": [{"code": "G8475", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY RX'D", "code_information": [{"code": "G8473", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERMAL MATRIX SIMPLIDERM HYDRATED SIZE 4 X 7CM; 0.90MM SD.090.0407", "code_information": [{"code": "SD.090.0407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9466.0, "discounted_cash": 3313.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ACELLULAR DERMAL REPLACEMENT FACIAL/GENITALIA/HANDS/FEET 15175", "code_information": [{"code": "15175", "type": "CPT"}, {"code": "1480608", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1067.0, "maximum": 8450.0, "gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1067.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACELLULAR TISSUE-LIQUID ALLOGRAFT AMNIOPUR MEDIUM .50ML", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PF-010050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETABULAR CUP CLUSTER HOLE 58H 58MM DIA 940-02-58H", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "940-02-58H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETABULAR LINER G7 32MM SIZE C NEUTRAL E1 ANTIOXIDANT INFUSED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "10000847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 247.0, "discounted_cash": 86.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETABULAR SHELL R3 3 HOLE 50MM 71335550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4283.0, "discounted_cash": 1499.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETAZOLAMIDE 500 MG INJ (DIAMOX)", "code_information": [{"code": "MED0005", "type": "CDM"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETIC ACID 0.25% TOP SOL 1000 ML", "code_information": [{"code": "MED0006", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETONE ASSAY", "code_information": [{"code": "82010", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINE INTRAOCULAR 1% KIT 2 ML (MIOCHOL-E)", "code_information": [{"code": "MED0007", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 178.0, "discounted_cash": 62.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACHILIES TENDON WITHOUT BONE BLOCK 809", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5974.0, "discounted_cash": 2090.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ACHILLES STIP FF AT189FF", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AT189FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ACHILLES STRIP FF PASCO 23.3CM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PS189FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8652.0, "discounted_cash": 3028.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ACHILLES TENDON 319X12X37X17X32MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "901-Tendon", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ACHILLES TENDON PRESHAPED 11MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ATP-111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6386.0, "discounted_cash": 2235.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ACHILLES TENDON WITH BONE BLOCK 24.0CM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "AT290FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8652.0, "discounted_cash": 3028.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}], "standard_charges": [{"minimum": 406.87, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 406.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 639.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 639.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 639.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACL GUIDE FRAME HANDLE ASSEMBLY", "code_information": [{"code": "AR-1510H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1277.0, "discounted_cash": 446.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC IMMITANCE TESTING", "code_information": [{"code": "92570", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC REFL THRESHOLD TST", "code_information": [{"code": "92568", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACROMIOPLASTY OR ACROMINECTOMY PARTIAL 23130", "code_information": [{"code": "23130", "type": "CPT"}, {"code": "1479868", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 50.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 83.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 130.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 130.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 130.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 46.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 46.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 134.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 221.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 348.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 348.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 348.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 125.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 125.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 120.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 199.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 313.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 313.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 313.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 112.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 112.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIFLIP CINCH #2 LOOP W/NEEDLES 11183SB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11183SB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ACTIGRAPHY TESTING", "code_information": [{"code": "95803", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL 15 MIN", "code_information": [{"code": "97810", "type": "CPT"}], "standard_charges": [{"minimum": 138.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL ADDL 15M", "code_information": [{"code": "97811", "type": "CPT"}], "standard_charges": [{"minimum": 114.44, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL 15 MIN", "code_information": [{"code": "97813", "type": "CPT"}], "standard_charges": [{"minimum": 149.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL ADDL 15M", "code_information": [{"code": "97814", "type": "CPT"}], "standard_charges": [{"minimum": 125.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 125.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [{"code": "289", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9998.02, "maximum": 17164.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9998.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14299.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15729.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17164.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [{"code": "288", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16335.29, "maximum": 28043.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16335.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23362.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25699.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28043.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC", "code_information": [{"code": "290", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6246.63, "maximum": 10723.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6246.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8934.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9827.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10723.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE CHRONIC OBSTRUCT", "code_information": [{"code": "G9681", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE CONGESTIVE HEART", "code_information": [{"code": "G9680", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE PNEUMONIA", "code_information": [{"code": "G9679", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE SKIN INFECTION", "code_information": [{"code": "G9682", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE URINARY TRACT INF", "code_information": [{"code": "G9684", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE FLUID/ELECTRO DISORDER", "code_information": [{"code": "G9683", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE GI BLOOD LOSS IMAGING", "code_information": [{"code": "78278", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1365.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2146.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2146.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2146.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 643.09, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 684.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 73.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 121.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 191.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 191.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 68.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 68.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "835", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12857.64, "maximum": 22073.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12857.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18389.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20228.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22073.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "834", "type": "MS-DRG"}], "standard_charges": [{"minimum": 36815.53, "maximum": 63203.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36815.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52654.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57919.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63203.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "836", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7138.4, "maximum": 12254.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7138.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10209.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11230.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12254.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITH CC/MCC", "code_information": [{"code": "121", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7242.42, "maximum": 12433.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7242.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10358.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11394.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12433.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "122", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3926.58, "maximum": 6740.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3926.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5615.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6177.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6740.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [{"code": "281", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5660.84, "maximum": 9718.26, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5660.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8096.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8905.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9718.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [{"code": "280", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9774.77, "maximum": 16780.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9774.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13980.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15378.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16780.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC", "code_information": [{"code": "282", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4416.87, "maximum": 7582.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4416.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6317.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6948.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7582.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [{"code": "284", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4400.44, "maximum": 7554.47, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4400.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6293.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6922.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7554.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [{"code": "283", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11342.97, "maximum": 19473.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11342.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16222.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17845.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19473.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC", "code_information": [{"code": "285", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3009.26, "maximum": 5166.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3009.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4303.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4734.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5166.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE NURSING FACILITY CARE", "code_information": [{"code": "G9685", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE PVD", "code_information": [{"code": "M1337", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE VENOUS THROMBUS IMAGE", "code_information": [{"code": "78456", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1189.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1869.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1869.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1869.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 566.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 603.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE VITREOUS HEMORRHAGE", "code_information": [{"code": "M1333", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTRAK FUSION DEVICE 22.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ATF-220-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1366.0, "discounted_cash": 478.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 66.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 66.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 66.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPT BEHAVIOR TX PHYS/QHP", "code_information": [{"code": "97155", "type": "CPT"}], "standard_charges": [{"minimum": 120.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER CATH UROLOCK II", "code_information": [{"code": "M0067301401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER CHANNEL ENDOGATOR STRL DISP", "code_information": [{"code": "100136", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER CHECK FLO 9FR TROCAR CUT CHECK FLO VALVE W/ SIDE ARM AND STPCCK", "code_information": [{"code": "50805", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.53, "discounted_cash": 25.04, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER HND SWITCHING COMPATIBLE W/ HBC05 HC325 HDH05 HK105 HP054 DISP", "code_information": [{"code": "HSA08", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER IRR Y-OPSY UPPER USE W/ ENDOGATOR TUBING SYS DEFENDO DISP", "code_information": [{"code": "100303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.1, "discounted_cash": 5.29, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER LUER LOCK BLUE BLOOD TRANSFER MALE", "code_information": [{"code": "364902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER MULTI BAG IRRIGATION Y TUBING DYONICS LF", "code_information": [{"code": "7204483", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER NEBULIZER CRITICAL CARE 033 AQUAPAK LF STRL", "code_information": [{"code": "31-33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER PRECISION M8 15CM M365SC9218150", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "M365SC9218150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER PROSTHESIS SHOULDER HEMI RSP MONOBLOCK STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "510-99-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5449.0, "discounted_cash": 1907.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER TOURNIQUET 36IN DL HOSE", "code_information": [{"code": "60181210100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER TRIAL PRECISION S8 15CM LEAD", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "SC-9208-15E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER TRIATHLON 6MM OFFSET TOTAL KNEE SYS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5570-S-060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1358.0, "discounted_cash": 475.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER VIAL RECONSTITUTION DEV", "code_information": [{"code": "2B8071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.03, "discounted_cash": 3.86, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTIVE BEHAVIOR TX BY TECH", "code_information": [{"code": "97153", "type": "CPT"}], "standard_charges": [{"minimum": 120.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTOR EXTENTION VANTA EMBSNV20", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "EMBSNV20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1850.0, "discounted_cash": 647.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTOR SELF SEALING", "code_information": [{"code": "27550-CKU/10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADDL SUPL MATRL&STAF TM PHE", "code_information": [{"code": "99072", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOIDECTOMY AGE 12 OR OVER 42831", "code_information": [{"code": "42831", "type": "CPT"}, {"code": "1479869", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOIDECTOMY SECONDARY AGE 12 OR OVER 42836", "code_information": [{"code": "42836", "type": "CPT"}, {"code": "10973076", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOIDECTOMY UNDER AGE 12 42830", "code_information": [{"code": "42830", "type": "CPT"}, {"code": "1479870", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOIDECTOMY; SECONDARY YOUNGER THAN AGE 12 42835", "code_information": [{"code": "42835", "type": "CPT"}, {"code": "4376154", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 4", "code_information": [{"code": "90476", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 7", "code_information": [{"code": "90477", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADHERE TX ASSESS AT LST ANN", "code_information": [{"code": "G8851", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADHESIVE MASTISOL 2/3CC VIAL FRN052348Z", "code_information": [{"code": "FRN052348Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ADHESIVE MED SURG SPARE MED A PRECISION BOSTON SCIENTIFIC", "code_information": [{"code": "SC-4320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ADHESIVE MINI TOPICAL DERMABOND .36ML DHVM12", "code_information": [{"code": "DHVM12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.0, "discounted_cash": 40.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ADHESIVE SKIN 0.7 ML TOPICAL HIGH VISCOSITY 2-OCTYL CYANOACRYLATE DERMABOND", "code_information": [{"code": "DHV12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ADHESIVE SKIN DERMABOND ADVANCED 0.7 DNX6", "code_information": [{"code": "DNX6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ADIT MDD DYS REM 12 MNTHS", "code_information": [{"code": "G9509", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJACENT TISSUE TRANSFER FACE 10 SQ CM OR LESS GENITALIA/HANDS/FEET 14040", "code_information": [{"code": "14040", "type": "CPT"}, {"code": "1479872", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJACENT TISSUE TRANSFER FACE DEFECT 10.1 SQ CM TO 30.0 SQ CM GENITALIA/HANDS/FEET 14041", "code_information": [{"code": "14041", "type": "CPT"}, {"code": "1479873", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJACENT TISSUE TRANSFER FACIAL 10SQ CM OR LESS EYELIDS/NOSE/EARS/LIPS 14060", "code_information": [{"code": "14060", "type": "CPT"}, {"code": "1479874", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJACENT TISSUE TRANSFER FACIAL DEFECT 10.1 SQ CM TO 30.0 SQ CM EYELIDS/EARS/LIPS 14061", "code_information": [{"code": "14061", "type": "CPT"}, {"code": "1479875", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJACENT TISSUE TRANSFER SCALP/ARMS/LEGS 10 SQ CM OR LESS 14020", "code_information": [{"code": "14020", "type": "CPT"}, {"code": "1479877", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJACENT TISSUE TRANSFER SCALP/ARMS/LEGS 10.1 SQ CM TO 30.0 SQ CM 14021", "code_information": [{"code": "14021", "type": "CPT"}, {"code": "1479878", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJACENT TISSUE TRANSFER TRUNK 10 SQ CM OR LESS 14000", "code_information": [{"code": "14000", "type": "CPT"}, {"code": "1479879", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJACENT TISSUE TRANSFER TRUNK 10.1-30.0 SQ CM 14001", "code_information": [{"code": "14001", "type": "CPT"}, {"code": "1479880", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJUNCTIVE PROCEDURE", "code_information": [{"code": "D9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJUSTABLE DRILL SIZE 2.3MM 7601-90009", "code_information": [{"code": "7601-90009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ADJUSTMENT EXTERNAL FIXATOR 20693", "code_information": [{"code": "20693", "type": "CPT"}, {"code": "1479881", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJUSTMENT GASTRIC BAND", "code_information": [{"code": "S2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJV TRTMT CHEMO HER2", "code_information": [{"code": "G2206", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADL PT MJ DEP DS NO RS 12 MO", "code_information": [{"code": "M1020", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADL PT MJ DEP DS RS 12 PHQ<5", "code_information": [{"code": "M1019", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM IV CHEMO 1ST HOME VISIT", "code_information": [{"code": "G0090", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.75, "maximum": 247.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 157.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 247.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 247.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 247.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM IV DRUG 1ST HOME VISIT", "code_information": [{"code": "G0088", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.26, "maximum": 126.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 80.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 126.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 126.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 126.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM IV INFUSION DRUG IN HOME", "code_information": [{"code": "G0068", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.26, "maximum": 126.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 80.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 126.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 126.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 126.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM OF CHEMO DRUG IN HOME", "code_information": [{"code": "G0070", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.75, "maximum": 247.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 157.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 247.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 247.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 247.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM OF SOC DTR ASSESS 5-15 M", "code_information": [{"code": "G0136", "type": "HCPCS"}], "standard_charges": [{"minimum": 120.57, "maximum": 189.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM SQ INFUSION DRUG IN HOME", "code_information": [{"code": "G0069", "type": "HCPCS"}], "standard_charges": [{"minimum": 186.37, "maximum": 292.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 186.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 292.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 292.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 292.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM SUBQ DRUG 1ST HOME VISIT", "code_information": [{"code": "G0089", "type": "HCPCS"}], "standard_charges": [{"minimum": 186.37, "maximum": 292.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 186.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 292.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 292.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 292.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 1ST", "code_information": [{"code": "M0249", "type": "HCPCS"}], "standard_charges": [{"minimum": 1984.5, "maximum": 3118.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1984.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 2ND", "code_information": [{"code": "M0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 1984.5, "maximum": 3118.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1984.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN ECG CONTRAST AGENT", "code_information": [{"code": "93352", "type": "CPT"}], "standard_charges": [{"minimum": 151.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 151.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 237.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 237.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 237.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "G0010", "type": "HCPCS"}], "standard_charges": [{"minimum": 228.88, "maximum": 359.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 228.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HOME SLEEP APNEA TEST", "code_information": [{"code": "D9956", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN INFLUENZA VIRUS VAC", "code_information": [{"code": "G0008", "type": "HCPCS"}], "standard_charges": [{"minimum": 104.91, "maximum": 164.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 104.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 164.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 164.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 164.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "G0009", "type": "HCPCS"}], "standard_charges": [{"minimum": 211.37, "maximum": 332.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMISSION TO MCCM", "code_information": [{"code": "G9480", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIT W/IN 180D REQ REMOV", "code_information": [{"code": "G9410", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIT W/IN 180D REQ SURG REV", "code_information": [{"code": "G9412", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMN RSV MONOC ANTB IM CNSL", "code_information": [{"code": "96380", "type": "CPT"}], "standard_charges": [{"minimum": 176.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMN SARSCOV2 VACC 1 DOSE", "code_information": [{"code": "90480", "type": "CPT"}], "standard_charges": [{"minimum": 176.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADR DEP THRPY PRESCRIBED", "code_information": [{"code": "G9894", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [{"code": "614", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14536.55, "maximum": 24955.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14536.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20790.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22869.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24955.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "615", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9580.73, "maximum": 16447.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9580.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13702.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15072.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16447.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL CORTEX & MEDULLA IMG", "code_information": [{"code": "78075", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1880.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2956.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2956.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2956.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 872.21, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 927.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENALINE EPINEPHRINE HCL TOPICAL SOLUTION 1MG/ML 30ML", "code_information": [{"code": "MED0008", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 182.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}], "standard_charges": [{"minimum": 1535.36, "maximum": 2414.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1535.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2414.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2414.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2414.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1879.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1879.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADT 180 DYS PHARMTHRY OUD", "code_information": [{"code": "M1034", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADT NO 180 DYS PHARMTHRY OUD", "code_information": [{"code": "M1036", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADT PD OUT MAT PR 180 DYS TX", "code_information": [{"code": "M1035", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADT TKNG PHARMTHRY FOR OUD", "code_information": [{"code": "M1032", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADV CARE HEART DX MVP", "code_information": [{"code": "G0055", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADV DEM CRGVR LIMITED", "code_information": [{"code": "G9917", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADV RHEUM PT CARE MVP", "code_information": [{"code": "G0053", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADVANCING CANCER CARE MVP", "code_information": [{"code": "M0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADVNCD CARE PLAN 30 MIN", "code_information": [{"code": "99497", "type": "CPT"}], "standard_charges": [{"minimum": 346.36, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 346.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADVNCD CARE PLAN ADDL 30 MIN", "code_information": [{"code": "99498", "type": "CPT"}], "standard_charges": [{"minimum": 333.75, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 333.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 524.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 524.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 524.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP HEARING STATUS DETER I&R", "code_information": [{"code": "92651", "type": "CPT"}], "standard_charges": [{"minimum": 242.61, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP NEURODIAGNOSTIC I&R", "code_information": [{"code": "92653", "type": "CPT"}], "standard_charges": [{"minimum": 236.18, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 236.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 371.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 371.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 371.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP SCR AUDITORY POTENTIAL", "code_information": [{"code": "92650", "type": "CPT"}], "standard_charges": [{"minimum": 78.11, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 78.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 122.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 122.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 122.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP THRSHLD EST MLT FREQ I&R", "code_information": [{"code": "92652", "type": "CPT"}], "standard_charges": [{"minimum": 320.74, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 320.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 504.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 504.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 504.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEQUALIS ASCEND FLEX STANDARD PTC HUMERAL STEM SIZE 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF602A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS FLEX REVIVE 1.5IN OSTEOTOME FLAT 38MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ARS743201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS FLEX REVIVE 3IN OSTEOTOME FLAT 76MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ARS743202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS FLEX REVIVE 5IN OSTEOTOME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ARS743203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS FLEX REVIVE ASSEMBLY SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ARS655101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1770.0, "discounted_cash": 619.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS FLEX REVIVE LOCKING CAP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ARS655200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 826.0, "discounted_cash": 289.1, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS FLEX REVIVE PTC PROXIMAL BODY 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ARS741703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8850.0, "discounted_cash": 3097.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS PERFORM GLENOID CORTILOC- L60 DWE423", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2200.0, "discounted_cash": 770.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS PERFORM GLENOID CORTILOC- M40 DWE413", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS PERFORM GLENOID CORTILOC- S40 DWE403", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS PERFORM GLENOID KEELED- L50 DWE522", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS PERFORM GLENOID PEGGED- S40 DWE303", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "AEQUALIS PERFORM REVERSED STANDARD GLENOSPHERE 42MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "AEROSOL INHALATION TREATMENT", "code_information": [{"code": "94642", "type": "CPT"}], "standard_charges": [{"minimum": 811.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 811.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEROSOL MASK ADULT 22MM CONN 1083", "code_information": [{"code": "1083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLEX 1MM THICKNESS 40 X 70 MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AFLEX401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3739.32, "discounted_cash": 1308.76, "setting": "both", "billing_class": "facility"}]}, {"description": "AFRIN SPRAY 0.05% 30ML", "code_information": [{"code": "MED0421", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "AFTERCARE WITH CC/MCC", "code_information": [{"code": "949", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6751.52, "maximum": 11590.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6751.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9656.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10621.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11590.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITHOUT CC/MCC", "code_information": [{"code": "950", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4502.64, "maximum": 7729.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6439.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7083.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7729.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "560", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6545.31, "maximum": 11236.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6545.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9361.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10297.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11236.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "559", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11346.62, "maximum": 19479.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11346.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16228.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17850.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19479.33, "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": 4820.17, "maximum": 8275.03, "estimated_discounted_cash": 19697.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4820.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6893.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7583.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8275.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT REPAIRING COLLAGEN COATED FIBERTAPE", "code_information": [{"code": "AR-7237-7B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AHI OR RDI INITIAL DX", "code_information": [{"code": "G8842", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}], "standard_charges": [{"minimum": 1210.54, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1210.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1210.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 4210.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2677.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4210.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4210.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4210.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI PSOR MRNA 50-100 GEN ALG", "code_information": [{"code": "258U", "type": "CPT"}], "standard_charges": [{"minimum": 5292.0, "maximum": 15037.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9562.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5292.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5292.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}], "standard_charges": [{"minimum": 23.72, "maximum": 548.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 548.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 548.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AICD GENERATOR PROCEDURES", "code_information": [{"code": "245", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32956.48, "maximum": 56578.09, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 49208.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 49208.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 38885.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32956.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47134.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51848.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56578.09, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD LEAD PROCEDURES", "code_information": [{"code": "265", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20472.34, "maximum": 35145.92, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20472.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29279.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32207.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35145.92, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIMING GUIDES 1.5MM PDG-AIM-015", "code_information": [{"code": "PDG-AIM-015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.22, "discounted_cash": 25.63, "setting": "both", "billing_class": "facility"}]}, {"description": "AIMING GUIDES 2.0MM PDG-AIM-020", "code_information": [{"code": "PDG-AIM-020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AIRWAR GUEDEL 80 MM GREEN DISP DYND60605", "code_information": [{"code": "DYND60605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY 70MM WHITE SOFT GUEDEL", "code_information": [{"code": "DYNJGUED70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.13, "discounted_cash": 2.85, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY 90MM CTHGD PE ADLT BRMN 2 CHNL PHRNG LF DISP", "code_information": [{"code": "1149", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY 90MM CTHGD PE ADLT BRMN 2 CHNL PHRNG LF DISP", "code_information": [{"code": "1149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY AIRWAY LMA UNIQUE SURE SEAL LARYNGEAL WITH MASK UP TO 50 ML CUFF SILICONE SIZE 5 CLEAR DISPOS", "code_information": [{"code": "105300-000050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.45, "discounted_cash": 9.61, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY CATH-GUIDE 100 MM 1167", "code_information": [{"code": "1167", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY CATH-GUIDE 70 MM 1169", "code_information": [{"code": "1169", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY CATH-GUIDE 80 MM 1168", "code_information": [{"code": "1168", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY COLOR CODED BLACK 60MM", "code_information": [{"code": "122660", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY GUEDEL 100 MM RED DISP DYND60607", "code_information": [{"code": "DYND60607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY GUEDEL 110MM XL ORANGE AIRWAY MANAGEMENT ANES LF ADLT DISP", "code_information": [{"code": "DYND60609", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY GUEDEL 50 MM NS 122750A", "code_information": [{"code": "122750A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY GUEDEL 50MM BLUE ORAL AIRWAY MANAGEMENT", "code_information": [{"code": "1155", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY GUEDEL 90MM MED YELLOW AIRWAY MANAGEMENT ANES LF ADLT DISP", "code_information": [{"code": "DYND60606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY GUEDEL BLUE 50MM SIZE 0 122650", "code_information": [{"code": "122650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY GUEDEL DISP 100MM WITH COLOR CODE", "code_information": [{"code": "311100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY GUEDEL DISP 60MM WITH COLOR CODE 122760A", "code_information": [{"code": "122760A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY GUEDEL WHITE 70MM SIZE 2 122670", "code_information": [{"code": "122670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY LMA UNIQUE SURE SEAL LARYNGEAL WITH MASK UP TO 50 ML CUFF SILICONE SIZE 3 CLEAR DISPOSABLE/SN", "code_information": [{"code": "105300-000030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.45, "discounted_cash": 9.61, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY LMA UNIQUE SURE SEAL WITH MASK UP TO 50 ML CUFF SILICONE SIZE 4 CLEAR DISPOSABLE/SNGLE USE LA", "code_information": [{"code": "105300-000040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.82, "discounted_cash": 10.09, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY MSK SZ 2 LARYNGEAL STD NO SYRNG AND LUBE LMA UNIQUE DISP", "code_information": [{"code": "125020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY MSK SZ 2.5 LARYNGEAL STD NO SYRNG AND LUBE LMA UNIQUE DISP", "code_information": [{"code": "125025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY MSK SZ 3 LARYNGEAL STD NO SYRNG AND LUBE LMA UNIQUE DISP", "code_information": [{"code": "125030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY MSK SZ 4 CLR LARYNGEAL WITHOUT SYRNG AND LUBE UNIQUE STANDARD STRL ADLT D", "code_information": [{"code": "125040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY MSK SZ 5 CLR LARYNGEAL WITHOUT SYRNG AND LUBE UNIQUE STANDARD STRL ADLT D", "code_information": [{"code": "125050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 24FR ARGYLE LF STRL", "code_information": [{"code": "8888247015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 26FR ROBERTAZZI ROUNDED TIP TRUMPET DESIGN MEDIPRENE LF", "code_information": [{"code": "123126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 26FR TUBE ARGYLE STRL", "code_information": [{"code": "8888247023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 28FR ARGYLE STRL", "code_information": [{"code": "8888247031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 32FR ARGYLE STRL", "code_information": [{"code": "8888247056", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 36 FR ADJ FLANGE BEVELED TIP PVC STRL", "code_information": [{"code": "123336", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 9MM X 12MM", "code_information": [{"code": "340090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASOPHARYNGEAL 26FR PVC SOFT SATIN SMOOTH", "code_information": [{"code": "321065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ORAL 9MM PINK MED DENTAL", "code_information": [{"code": "H-1113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ORAL GUEDEL 10MM SZ 5 RED", "code_information": [{"code": "1226100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ORAL GUEDEL 80MM SZ 3 122680", "code_information": [{"code": "122680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ORAL GUEDEL 90MM SZ 4 YELLOW", "code_information": [{"code": "122690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 10 CM PINK ANESTHESIA", "code_information": [{"code": "H-1114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 70MM WHT GUEDEL COLOR CODED BITE BLOCK SEMI RIGID NON TOXIC PO", "code_information": [{"code": "1157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 90MM YELLOW GUEDEL COLOR CODED BITE BLOCK SEMI RIGID NON TOXIC", "code_information": [{"code": "1159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY SILICONE W/PILOT BALLOON SZ 2 HUD300000020", "code_information": [{"code": "HUD300000020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAYINTUBATION 80MM WHT OVASSAPIAN FOR USE W/ FIBEROPTIC ENDOSCOPE", "code_information": [{"code": "BD6075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWY RESIST BY OSCILLOMETRY", "code_information": [{"code": "94728", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AJCC BR CA STG I: T1 MIC/T1A", "code_information": [{"code": "G9704", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AJCC BR CA STG IB", "code_information": [{"code": "G9705", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AJCC MEL CNR STG 0 - IIC", "code_information": [{"code": "G8944", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AJCC STG BRT CA DX II OR III", "code_information": [{"code": "G9831", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN HUMAN 25% IV SOL 50 ML", "code_information": [{"code": "MED0424", "type": "CDM"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 136.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 136.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 136.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 48.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 48.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SCREENIN", "code_information": [{"code": "H0003", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0008", "type": "HCPCS"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0011", "type": "HCPCS"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG SCREENING", "code_information": [{"code": "H0049", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUB MISUSE ASSESS", "code_information": [{"code": "G2011", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.71, "maximum": 117.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV 15-30MN", "code_information": [{"code": "G0396", "type": "HCPCS"}], "standard_charges": [{"minimum": 149.41, "maximum": 234.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV >30 MIN", "code_information": [{"code": "G0397", "type": "HCPCS"}], "standard_charges": [{"minimum": 290.84, "maximum": 457.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 290.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 457.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 457.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 457.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BIOMARKERS 1OR 2", "code_information": [{"code": "80321", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BIOMARKERS 3/MORE", "code_information": [{"code": "80322", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCON SN60WF 10.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 10.5D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCON SN60WF 19.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 19.5D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCON SN60WF 20.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 20.5D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCON SN60WF 23.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 23.0D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCON SN60WF 24.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 24.0D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCON SN60WF 25.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 25.0D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCON SN6AT3 - 13.00", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 13.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 880.0, "discounted_cash": 308.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCON SN6AT3 16.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 16.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCON SN6AT3 18.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCON SN6AT3 19.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCON SN6AT3 22.5D", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 22.5D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCON SN6AT4 25.50", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 25.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 193.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 320.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 503.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 503.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 503.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 180.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 180.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALEXIS O RETRACTOR SMALL C8401", "code_information": [{"code": "C8401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 183.0, "discounted_cash": 64.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ALGOVITA POCKET PROGRAMMER", "code_information": [{"code": "4100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3372.0, "discounted_cash": 1180.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALGOVITA POCKET PROGRAMMER", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "4100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3080.0, "discounted_cash": 1078.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALGOVITA PROGRAMMER CHARGER", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "4200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4069.0, "discounted_cash": 1424.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ALGOVITA SPINAL CORD STIMULATION SYSTEM PADDLE LEAD KIT", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3000-60", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8652.0, "discounted_cash": 3028.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALGOVITA SPINAL CORD STIMULATION SYSTEM STIMULATOR 2X12", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "2412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31887.0, "discounted_cash": 11160.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIF 14MM 8 DEGREESE ALLOGRAFT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ALIF-1408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIGN RADIAL STEM 10MM X 0MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ALN-RST-1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4738.0, "discounted_cash": 1658.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ALKALOIDS NOS", "code_information": [{"code": "80323", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALL-POLY PEGGED GLENOID E-PLUS SIZE 54MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "521-07-254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2358.0, "discounted_cash": 825.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLEN COMFORT MASK", "code_information": [{"code": "A-70310-A5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLEN WRENCH 2.5MM 900-AL-25", "code_information": [{"code": "900-AL-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 679.0, "discounted_cash": 237.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLEN WRENCH 3.0MM 900-AL-30", "code_information": [{"code": "900-AL-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 679.0, "discounted_cash": 237.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITH MCC", "code_information": [{"code": "915", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10338.06, "maximum": 17747.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10338.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14785.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16264.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17747.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [{"code": "916", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4005.05, "maximum": 6875.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4005.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5728.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6300.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6875.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLERGY PATCH TESTS", "code_information": [{"code": "95044", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4008.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6299.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6299.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6299.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGY/IMMUNOLOGY SS", "code_information": [{"code": "G0060", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 71.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 71.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOAID CARTLLAGE MATRIX 1CC ACM0100M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ACM0100M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3360.0, "discounted_cash": 1176.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOAID NAIL ALLOGRAFT 2.8MM X 18MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ANA-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLODERM 2 X 4 141408", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "141408", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 913.0, "discounted_cash": 319.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLODERM MEDIUM 1.6 +/- 0.4MM 141808", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "141808", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1504.0, "discounted_cash": 526.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 1CC BIO4 DEMINERALIZED BONE MATRIX STERILE", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3102-2101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2085.0, "discounted_cash": 729.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 2.3 X 18MM ALLOAID BIONAIL ANA-118", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ANA-118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4522.0, "discounted_cash": 1582.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 2.7MM X 18MM STRAIGHT TENFUSE PIP", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "TFF-27018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2802.0, "discounted_cash": 980.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 2.7X16MM NAIL STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TFN-2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3904.0, "discounted_cash": 1366.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 2.7X16MM TENFUSE NAIL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "TRN-2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3631.0, "discounted_cash": 1270.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 2.7X18 PIP", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "TFF-2718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3904.0, "discounted_cash": 1366.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 2.7X18A PIP", "code_information": [{"code": "L8658", "type": "HCPCS"}, {"code": "TFF-2718A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3904.0, "discounted_cash": 1366.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 4CC PRODENSE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "87SR0404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3537.0, "discounted_cash": 1237.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 5CC BIO4 DEMINERALIZED BONE MATRIX STERILE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3102-2105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7725.0, "discounted_cash": 2703.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACF 11X14 7MM 70507", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACF 11X14 7MM 71507", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACHILIES TENDON W BONE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ACT-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4540.0, "discounted_cash": 1589.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACHILLES 10MM PRESHAPED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "53031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5552.0, "discounted_cash": 1943.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACHILLES 11MM TENDON BLOCK", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "453004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5974.0, "discounted_cash": 2090.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACHILLES TENDON W/BONE BLOCK 23.0 CM ACT-002", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ACT-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4017.0, "discounted_cash": 1405.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ALLOAID AMNIOTIC 4X6CM AAC0406M", "code_information": [{"code": "V2790", "type": "HCPCS"}, {"code": "AAC0406M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1050.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ALLOAID NAIL 2.3 X 18MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ANA-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4522.0, "discounted_cash": 1582.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ALLOAID PIP 2.5MM X 16MM STRAIGHT APA-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "APA-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1796.0, "discounted_cash": 628.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ALLOPATCH PLIABLE DERMAL MATRIX 4 X 4CM WC0404", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "WC0404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1669.0, "discounted_cash": 584.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ALLOPURE 12 X 38MM EVANS BONE WEDGE 86660012", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "86660012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8754.0, "discounted_cash": 3063.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT AMINOGEN C PLACENTAL TISSUE MATRIX", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "HTC100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT AMNIO 2.5 X 2.0 AG2520F", "code_information": [{"code": "V2790", "type": "HCPCS"}, {"code": "AG2520F", "type": "CDM"}, {"code": "810", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT AMNION PATCH 4 X 4CM VGM040400S", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "VGM040400S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT AMNIOTIC FLOGRAFT XL 1ML", "code_information": [{"code": "Q4139", "type": "HCPCS"}, {"code": "FGT-10300", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 7442.0, "discounted_cash": 2604.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ARTHOFLEX DECELLULARIZED DERMIS 2.5 X 3.0CM 2MM THICKNESS AFLEX202", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AFLEX202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2995.2, "discounted_cash": 1048.32, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT AUTOGRAFT 12 X 15 X 5MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "77102054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT BIOFIX FLOW HUMAN AMNIOTIC TISSUE 0.5CC", "code_information": [{"code": "Q4139", "type": "HCPCS"}, {"code": "BFA050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6077.0, "discounted_cash": 2126.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT BONE 10CC GRANULES<2MM", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "12600501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3440.0, "discounted_cash": 1204.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT BONE CHIPS 1-4MM 15CC CB-15G", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "CB-15G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 684.0, "discounted_cash": 239.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT CARTIFORM 10MM DISC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ABS-1101-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7210.0, "discounted_cash": 2523.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT CARTIFORM 20MM DISC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ABS-1101-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT CARTILAGE 1CC BIOCARTILAGE IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "1850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1586.0, "discounted_cash": 555.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT CERVICAL 12MM X 14MM X 5MM 4-DEG", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "77101054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT CERVICAL HERO 14 X 11 7 DEG 7 MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "1411-707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT CONEXA 5X10", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "BCP051010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6584.0, "discounted_cash": 2304.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT COTTON WEDGE 5MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4202-0005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.0, "discounted_cash": 1438.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT DBM EVOLVED 10CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "32610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT DBM STRIP 50 X 20 X 5MM OSDBM502005", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "OSDBM502005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT DBM+ PUTTY 10CC OBS-10C", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "OBS-10C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4285.0, "discounted_cash": 1499.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT DERMAPURE 3 X 4CM DECELLULARIZED", "code_information": [{"code": "Q4152", "type": "HCPCS"}, {"code": "30400HD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2121.5, "discounted_cash": 742.53, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT DERMAPURE 4 X 6CM DECELLULARIZED", "code_information": [{"code": "Q4152", "type": "HCPCS"}, {"code": "40600HD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3910.2, "discounted_cash": 1368.57, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT DERMAPURE DECELLULARIZED DERMAL 4X6CM(UNSTRETCHED) 040600HDMESH", "code_information": [{"code": "Q4152", "type": "HCPCS"}, {"code": "40600HDMESH", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 5888.0, "discounted_cash": 2060.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT DERMASPAN ACD 40 X 40 X 0.5-0.9MM ASEPTIC", "code_information": [{"code": "Q4126", "type": "HCPCS"}, {"code": "48-0700404", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT DERMIS ON DEMAND FREEZE DRIED DOD15453", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "DOD15453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1390.0, "discounted_cash": 486.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT EPIFIX 40MG AMNIOTIC MEMBRANE MICRONIZED CHORION INJ", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "EI-5050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1539.0, "discounted_cash": 538.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT FASCIA LATA X LARGE 794", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "794", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5974.0, "discounted_cash": 2090.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT FASCIA LATA XL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.0, "discounted_cash": 1438.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT FQL09571 PRESUTURED QUAD TENDON FQL", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "FQL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5088.0, "discounted_cash": 1780.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT FRESH TIB DISTAL FS/A LT 32747002", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "32747002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT GACILLIS TENDON SINGLE STRAND 22CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "44317002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT GRACILIS TENDON", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "53761", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3245.0, "discounted_cash": 1135.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT GRAFT JACKET 5X10", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "8600-5X10", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4466.0, "discounted_cash": 1563.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT GRAFTJACKET NOW 2 X 4CM 1-2MM STANDARD 86202X04", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "86202X04", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4294.0, "discounted_cash": 1502.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT GRAFTON PUTTY SIZE 6CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "T50106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT HAMMERTOE 2.3MM X 19MM 0 PRESERVE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "P01-H00-2319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT HAMMERTOE 2.8MMX 21MM 0 DEGREESE PRESERVE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "P01-H00-2821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT KERECIS OMEGA3 WOUND 3X3.5CM 5020017177A", "code_information": [{"code": "Q4158", "type": "HCPCS"}, {"code": "5020017177A", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1835.0, "discounted_cash": 642.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT MEMBRANE 4CM X 4CM AMNIOTIC AMBIOCHOICE IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ABC-5440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8034.0, "discounted_cash": 2811.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT MEMBRANE AMNIOFIX", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "A15200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12640.0, "discounted_cash": 4424.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT NAIL 2.7MM X 18MM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TFN-2718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3032.0, "discounted_cash": 1061.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT NUCEL INJECT 2.0CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "NC-1002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5490.0, "discounted_cash": 1921.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT NUSHIELD 6 X 6 CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "NO-1660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9764.0, "discounted_cash": 3417.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT OVATION LARGE 1CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "MBS-2-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5603.0, "discounted_cash": 1961.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT OVATION SMALL 0.35CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "MBS-2-007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1597.0, "discounted_cash": 558.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PERONEOUS TENDON 311010 311010", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "311010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.0, "discounted_cash": 1438.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PIP 10MM X 10MM FUSEFORCE IMP", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "FFS-1010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3631.0, "discounted_cash": 1270.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PIP 2.5MM X 16MM ANGLED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "APA-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1796.0, "discounted_cash": 628.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PIP 2.7MM X 18MM STRAIGHT IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "TSF-2718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3032.0, "discounted_cash": 1061.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PIP 2.9MM X 19MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "APA-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1796.0, "discounted_cash": 628.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PLACENTAL DERIVED 100MG PRO100", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PRO100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PLIF 9 X 23 9MM 85009", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "85009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT POSTERIOR TIBIALIS TENDON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "311007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5758.0, "discounted_cash": 2015.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PRE-SHAPED QUAD QDT-101", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "QDT-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6386.0, "discounted_cash": 2235.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PROCENTA PLACENTAL DERIVED 100MG PC100", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PC100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PURAFORCE 8CM X 4CM 550-008", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "550-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4635.0, "discounted_cash": 1622.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PUTTY 10CC GENIN", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "HP-10P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4046.0, "discounted_cash": 1416.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PUTTY BIOACTIVE BONE OSTEOFUSE STD 15G", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "OF003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6242.0, "discounted_cash": 2184.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PUTTY BIOACTIVE BONE OSTEOFUSE STD 3.75G", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "OF001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2068.0, "discounted_cash": 723.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT PUTTY DBM CANCELLOUS 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3102-1205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4064.0, "discounted_cash": 1422.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT RESTORIGIN MATRIX PATCH MEDIUM 4 X 4CM RSX-AC-0404", "code_information": [{"code": "Q4191", "type": "HCPCS"}, {"code": "RSX-AC-0404", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT SKIN 2IN X 3IN CRYOPRESERVED WOUND CARE THERASKIN", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "102TSL", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2892.0, "discounted_cash": 1012.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT SPEEDGRAFT 8.5 X 120IN", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "SPD-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4738.0, "discounted_cash": 1658.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT SPONGE 20 X 50 X 5MM STERISORB OSTEOCONDUCTIVE STRIP", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "74850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TALUS FROXEN LEFT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "450326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7397.0, "discounted_cash": 2588.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON ANTERIOR TIBIALIS DOUBLE STRAND FROZEN", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "41517000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4017.0, "discounted_cash": 1405.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON LATERAL ANKLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCON", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2518.0, "discounted_cash": 881.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON SEMITENDINOSIS 4.0 - 5.0MM L 220MM AT392FF", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AT392FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON TIBIALIS ANT IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "447-13808-LA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9750.0, "discounted_cash": 3412.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENDON TIBIALIS POST IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "41617000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4017.0, "discounted_cash": 1405.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENFUSE 2.0X15MM ANGLED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "TFF-2015A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3631.0, "discounted_cash": 1270.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENFUSE 2.7 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TFN-2722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2616.0, "discounted_cash": 915.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TENFUSE ANGLED 2.7MM X 18MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "TNF-2718A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3904.0, "discounted_cash": 1366.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TIBIALIS ANT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "53721-TT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5346.0, "discounted_cash": 1871.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TIBIALIS TENDON POSTERIOR FF 0.90 X 27.0 CM PS841FF", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PS841FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8755.0, "discounted_cash": 3064.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TISSUE .6 X 23.5 PERONEUS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "53721-PL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3698.0, "discounted_cash": 1294.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TISSUE 50MM X 80MM MED SOFT FASCIA LATA", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 573.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TISSUE 9MM X 72MM FROZEN GRAFT GRAFTLINK IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "FGL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5088.0, "discounted_cash": 1780.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TISSUE MATRIX AMNIOGEN-C PLACENTAL\\", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "HTC200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11845.0, "discounted_cash": 4145.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT TISSUE PLACENTAL MATRIX", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "HTA100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5665.0, "discounted_cash": 1982.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT WEDGE 6 X 24 X 14MM COTTON EVANS IMMUNE PRIVILEGED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3102-1900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5597.0, "discounted_cash": 1958.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOPURE PLUS 10MM EVANS 86661000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "86661000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4349.48, "discounted_cash": 1522.32, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOPURE PLUS 12MM EVANS 86661200", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "86661200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3792.0, "discounted_cash": 1327.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOPURE PLUS 6MM COTTON 86660006", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "86660006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3490.56, "discounted_cash": 1221.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOPURE PLUS 8MM EVANS 86660800", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "86660800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4302.0, "discounted_cash": 1505.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOWRAP 2 X 4 DS WET", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3102-2004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5768.0, "discounted_cash": 2018.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALS 2", "code_information": [{"code": "A0433", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS DEFIBRILLATION SUPPLIES", "code_information": [{"code": "A0392", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ESOPHAGEAL INTUB SUPPLS", "code_information": [{"code": "A0396", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS IV DRUG THERAPY SUPPLIES", "code_information": [{"code": "A0394", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ROUTINE DISPOSBLE SUPPLS", "code_information": [{"code": "A0398", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS1-EMERGENCY", "code_information": [{"code": "A0427", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALTIVATE ANATOMIC ALL POLY PEGGED GLENOID SIZE 50 E PLUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "521-07-250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2358.0, "discounted_cash": 825.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTIVATE ANATOMIC GUIDE WIRE 2.4MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "804-07-338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTIVATE ANATOMIC OFFSET HUMERAL HEAD 54X20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-54-320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTIVATE ANATOMIC SHORT HUMERAL STEM 14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-14-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTIVATE ANATOMIC, ALL-POLY PEGGED GLENOID, SIZE 38, E-PLUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "521-07-238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2358.0, "discounted_cash": 825.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTIVATE ANATOMIC, CANNULATED CENTER DRILL, 4.8MM", "code_information": [{"code": "804-07-149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTIVATE ANATOMIC, OFFSET HUMERAL HEAD, 40X16", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-40-316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTIVATE GUIDE WIRE 2.4 X 228 MM 804-09-098", "code_information": [{"code": "804-09-098", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 599.87, "discounted_cash": 209.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ALYS BRN NPGT PRGRMG 15 MIN", "code_information": [{"code": "95983", "type": "CPT"}], "standard_charges": [{"minimum": 228.88, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 228.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS BRN NPGT PRGRMG ADDL 15", "code_information": [{"code": "95984", "type": "CPT"}], "standard_charges": [{"minimum": 200.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 200.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS CPLX CN NPGT PRGRMG", "code_information": [{"code": "95977", "type": "CPT"}], "standard_charges": [{"minimum": 241.58, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 241.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS NPGT W/O PRGRMG", "code_information": [{"code": "95970", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS SMPL CN NPGT PRGRMG", "code_information": [{"code": "95976", "type": "CPT"}], "standard_charges": [{"minimum": 181.16, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 284.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 284.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 284.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AM SURGICAL BLADE 5 PK STERL AM SURGICAL CE AM96BLD5", "code_information": [{"code": "AM96BLD5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1100.0, "discounted_cash": 385.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SOFTWARE", "code_information": [{"code": "93784", "type": "CPT"}], "standard_charges": [{"minimum": 239.99, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 239.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 377.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 377.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 377.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW A/R", "code_information": [{"code": "93788", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW I&R", "code_information": [{"code": "93790", "type": "CPT"}], "standard_charges": [{"minimum": 84.23, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 84.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW REC ONLY", "code_information": [{"code": "93786", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMBULANCE 02 LIFE SUSTAINING", "code_information": [{"code": "A0422", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULANCE RESPONSE/TREATMENT", "code_information": [{"code": "A0998", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULANCE WAITING 1/2 HR", "code_information": [{"code": "A0420", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINES VAGINAL FLUID QUAL", "code_information": [{"code": "82120", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINIOTIC MEMBRANE CORD 3CM X 6CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "P01-AMC-0306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7334.0, "discounted_cash": 2566.9, "setting": "both", "billing_class": "facility"}]}, {"description": "AMINO ACID SINGLE QUAL", "code_information": [{"code": "82127", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS MULT QUAL", "code_information": [{"code": "82128", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS QUAN 6 OR MORE", "code_information": [{"code": "82139", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS QUANT 2-5", "code_information": [{"code": "82136", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 78.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 78.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 78.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS SINGLE QUANT", "code_information": [{"code": "82131", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIO LIQUID 1.0ML", "code_information": [{"code": "Q4139", "type": "HCPCS"}, {"code": "RGN-AFL-100RT", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNIO LIQUID 1.0ML STERILE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ALB-0100S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNIO PATCH 4X4CM STERILE MATRIX", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "CAP040400S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS DIAGNOSTIC", "code_information": [{"code": "59000", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS THERAPEUTIC", "code_information": [{"code": "59001", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC FLUID SCAN", "code_information": [{"code": "82143", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMO LENS 31.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000 31.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "AMO LENS 5.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000 5.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOX W/WO CLAV RX", "code_information": [{"code": "G9315", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMOXIC NOT PRESC AS 1ST LINE", "code_information": [{"code": "G9313", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 3OR 4", "code_information": [{"code": "80325", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 5 OR MORE", "code_information": [{"code": "80326", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPULES NOZIN NASAL SANITIZER", "code_information": [{"code": "201101101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25920", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25922", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27590", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27591", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27592", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LOWER LEG AT KNEE", "code_information": [{"code": "27598", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE UPPER ARM & IMPLANT", "code_information": [{"code": "24931", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION ARM LOWER THROUGH RADIUS/ULNA 25900 IO", "code_information": [{"code": "25900", "type": "CPT"}, {"code": "1479888", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FINGER OR THUMB PRIMARY OR SECONDARY 26951", "code_information": [{"code": "26951", "type": "CPT"}, {"code": "1479890", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FINGER OR THUMB PRIMARY OR SECONDARY W/FLAP 26952", "code_information": [{"code": "26952", "type": "CPT"}, {"code": "1479891", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24925", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24930", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25907", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25909", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25924", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25929", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25931", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27594", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27596", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27886", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOOT TRANSMETATARSALS 28805", "code_information": [{"code": "28805", "type": "CPT"}, {"code": "1479893", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "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": 16964.27, "maximum": 29123.44, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16964.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24262.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26688.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29123.44, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": 29295.73, "maximum": 50293.49, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29295.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 41899.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46089.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50293.49, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": 9686.57, "maximum": 16629.43, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9686.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13853.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15239.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16629.43, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "475", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13360.09, "maximum": 22935.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13360.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19107.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21018.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22935.96, "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": 24794.92, "maximum": 42566.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24794.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 35462.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39008.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 42566.71, "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": 7058.1, "maximum": 12117.01, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7058.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10094.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11104.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12117.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION METACARPAL W/FINGER OR THUMB 26910", "code_information": [{"code": "26910", "type": "CPT"}, {"code": "1479900", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION METATARSAL W/TOE-SINGLE 28810", "code_information": [{"code": "28810", "type": "CPT"}, {"code": "1479901", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27888", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27889", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25905", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25915", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF HAND", "code_information": [{"code": "25927", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27290", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27295", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27880", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27881", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "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": 12347.27, "maximum": 21197.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12347.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17659.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19425.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21197.2, "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": 24126.39, "maximum": 41419.03, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24126.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34505.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37956.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41419.03, "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": 7927.37, "maximum": 13609.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7927.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11337.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12471.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13609.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF MIDFOOT", "code_information": [{"code": "28800", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24900", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24920", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION PENIS W/BILATERAL PELVIC LYMPHADENECTOMY 54135", "code_information": [{"code": "54135", "type": "CPT"}, {"code": "1479902", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3259.41, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 3259.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION PENIS-COMPLETE 54125", "code_information": [{"code": "54125", "type": "CPT"}, {"code": "1479903", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION PENIS-PARTIAL 54120", "code_information": [{"code": "54120", "type": "CPT"}, {"code": "1479904", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION PENIS-RADICAL 54130", "code_information": [{"code": "54130", "type": "CPT"}, {"code": "1479905", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3259.41, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 3259.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION TOE AT INTERPHALANGEAL JOINT 28825", "code_information": [{"code": "28825", "type": "CPT"}, {"code": "1479909", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION TOE AT METATARSALPHALANGEAL JOINT 28820", "code_information": [{"code": "28820", "type": "CPT"}, {"code": "1479910", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION-LEG-THROUGH TIBIA AND FIBULA SECONDARY CLOSURE OR SCAR REVISION 27884", "code_information": [{"code": "27884", "type": "CPT"}, {"code": "1482053", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMVISC PLUS 1.6% 0.8ML", "code_information": [{"code": "MED0754", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANABOLIC STEROID 1 OR 2", "code_information": [{"code": "80327", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANABOLIC STEROID 3 OR MORE", "code_information": [{"code": "80328", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [{"code": "348", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8200.49, "maximum": 14078.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8200.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11728.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12901.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14078.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [{"code": "347", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14992.77, "maximum": 25738.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14992.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21442.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23587.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25738.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "349", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5957.08, "maximum": 10226.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5957.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8519.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9371.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10226.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL PRESSURE RECORD", "code_information": [{"code": "91122", "type": "CPT"}], "standard_charges": [{"minimum": 678.65, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 678.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1066.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1066.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1066.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}], "standard_charges": [{"minimum": 160.52, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 160.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 252.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 252.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 252.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 1 OR 2", "code_information": [{"code": "80329", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 3-5", "code_information": [{"code": "80330", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 6/MORE", "code_information": [{"code": "80331", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS NERVE", "code_information": [{"code": "88356", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 184.45, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 196.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS TUMOR", "code_information": [{"code": "88358", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 135.63, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 144.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYZE PACEMAKER SYSTEM", "code_information": [{"code": "93724", "type": "CPT"}], "standard_charges": [{"minimum": 149.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYZE SP INF PUMP W/REPROG", "code_information": [{"code": "62368", "type": "CPT"}], "standard_charges": [{"minimum": 92.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 92.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAPLSMA PHGCYTOPHLM AMP PRB", "code_information": [{"code": "87468", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANASTOMOSIS/ARTERY-AORTA", "code_information": [{"code": "33606", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANASTOMOSIS;FACIAL-PHRENIC 64870", "code_information": [{"code": "1479917", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ANATOMIC PROXIMAL BODY SZ 14 135 DEGREE UNITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1100-50-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2373.0, "discounted_cash": 830.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ANBX 30 PRIOR TO EPISODE", "code_information": [{"code": "G9703", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCA SCREEN EACH ANTIBODY", "code_information": [{"code": "86036", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCA TITER EACH ANTIBODY", "code_information": [{"code": "86037", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR 1.7MM TRUSHOT W/Y-KNOT SHALLOW ALL-SUTURE YSTN0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "YSTN0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 896.0, "discounted_cash": 313.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 1.8 QFIX MINI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72290123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1370.0, "discounted_cash": 479.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 2.5 X 7MM NANO SWIVELOCK AR-8998T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8998T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 227.64, "discounted_cash": 79.67, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 2.5MM X 2 USP #0 SUTURE MORPHIX XT SUTURE 1000-05-025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-05-025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1617.0, "discounted_cash": 565.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 2.5MM X 7.5MM WITH TWO 2-0 BIGHTFORCE SUTURE AND TAPERED 1/2 CIRCLE NEEDL HERCULES FT SUTURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A20 SP225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1194.0, "discounted_cash": 417.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 3.2MM DRAW TIGHT SUTURE 11289", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1061.0, "discounted_cash": 371.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 3.5 X 13.5 MM DX SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8979P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1252.0, "discounted_cash": 438.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 3.5MM #0 SUTURE GRAVITY", "code_information": [{"code": "86TAN035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 733.0, "discounted_cash": 256.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 3.5MM PITON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SMK000101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 341.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 3.5MM X 10.5MM WITH TWO #0 BIGHTFORCE SUTURE AND TAPERED 1/2 CIRCLE NEEDL HERCULES FT SUTURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A20 SP235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 820.0, "discounted_cash": 287.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 3.9MM BC ACHILLES PARS/ AMSS CC AR-9929BC-CP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9929BC-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5959.2, "discounted_cash": 2085.72, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 4.5X20MM LATERAL TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LA-4520-TI", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 865.0, "discounted_cash": 302.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 4.75MM ARGO KNOTLESS SELF PUNCHING LATERAL ROW SPK475", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPK475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 317.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 4.75X19.1MM WITH WHIT/BLACK TIGERTAPE LOOP AND BLUE #2 SUTURE BIOCOMPOSITE KNOTLESS SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324KBCCTT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1148.44, "discounted_cash": 401.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 5.0MM HEALICOIL KNOTLESS PK SUTURE 72205137", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72205137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1339.0, "discounted_cash": 468.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 6.5MM HEALIX ADVANCE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 954.0, "discounted_cash": 333.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 6.5MM TF ULTRA 2 ULTRABRAID AND NEEDLES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 220.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR 8MM CO-BD 2 93CM 1PK QUICKDRAW BELAY 86800105", "code_information": [{"code": "86800105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1099.0, "discounted_cash": 384.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR ALPHAVENT KNOTLESS 4.75MM BIOCOMPOSITE 3911-856-547", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3911-856-547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR ARGO KNOTLESS 4.75MM WITH 1MM HIFI RIBBON K475", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 317.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR BC KNOTLESS SWIVELOCK W/TAPE 4.75MM AR-2324KBCCT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324KBCCT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.04, "discounted_cash": 402.16, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR BC SWIVELOCK 3.9 X 17.9MM AR-2326BCC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2326BCC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 867.2, "discounted_cash": 303.52, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR BONE 3.0 DOUBLE LOADED SUTURETAPE AR-8934BCST-2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8934BCST-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1029.8, "discounted_cash": 360.43, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR BONE SELF BUNCHING KL 1.8 FIBERTAK SHOULDER AR-3636", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 983.0, "discounted_cash": 344.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR BONE SP FBRTAK RC TGRTPE WH/BLK&STTPE WH/BL AR-3652SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3652SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1018.96, "discounted_cash": 356.64, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR C AVS CAGE 4 DEG 14MM X 16MM X 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48323084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4200.0, "discounted_cash": 1470.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR CAGE 7X14X16MM 4D 48233074", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48233074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR CITREFIX IMPLANT 4.5MM X 24MM 30-110-7045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-110-7045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1836.0, "discounted_cash": 642.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR CITREFIX XPRESS IMPLANT SYSTEM 4.5 X 24MM 70-810-4524", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-810-4524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3848.0, "discounted_cash": 1346.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR DISP KIT 2.5 X 7MM NANO SWIVELOCK AR-8998DS", "code_information": [{"code": "AR-8998DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.03, "discounted_cash": 71.41, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR FIBERTAK RC DBLOAD TAPE BL/W BLK/W AR-3632SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3632SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1164.0, "discounted_cash": 407.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR FIBERTAK RC SOFT SP 2.6 FBRTPE BLK/BLUE & STTPE BLU AR-3652TTSP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3652TTSP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 367.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR FIBERTAK RC SOFT SP 2.6 FBRTPE BLUE & STTPE WH/BLK AR-3652TSP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3652TSP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 367.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR FISTULA NEEDLE 1/2 CIRCLE CUTTING EDGE", "code_information": [{"code": "1832-7D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR HEALICOIL KNOTLESS REGULAR STRAIGHT 72205136", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72205136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2328.0, "discounted_cash": 814.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR HERCULES FT SUTURE 4.5MM X 13.5MM A20 SP245", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A20 SP245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1194.0, "discounted_cash": 417.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR ICONIX 1.4MM W/1.2MM XBRAID TT SUTURE TAPE W/NEEDLES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3910-500-212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR ICONIX 2 NDLS 2.3MM 2.0MM XBRAID INTELLIBRAID TECH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3910-500-222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 980.0, "discounted_cash": 343.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR ICONIX KNOTLESS 1.4MM WITH XBRAID S (BLACK/WHITE) 3911-714-521", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3911-714-521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR ICONIX KNOTLESS 1.4MM WITH XBRAID S (BLUE/BLACK) 3911-714-520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3911-714-520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR ICONIX KNOTLSS 1.4MM XB 3911-714-522", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3911-714-522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR INSTRUMENT KIT SIZE 2.5MM HERCULES FT A02 S0002", "code_information": [{"code": "A02 S0002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1102.9, "discounted_cash": 386.02, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR INSTRUMENT KIT SIZE 3.5MM HERCULES FT A02 S0003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A02 S0003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1194.0, "discounted_cash": 417.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR JUGGERKNOT RIGID #1 W/ DRILL BIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110005307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 742.0, "discounted_cash": 259.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR JUGGERKNOT RIGID #2 W/ DRILL BIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110005315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 742.0, "discounted_cash": 259.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR JUGGERKNOTLESS SOFTW/ INSERTER 2.1MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110005198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 743.0, "discounted_cash": 260.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR KNOTLESS 2.9MM QUATTRO LINK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CM-9129", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR KNOTLESS 4.5MM QUATTRO LINK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CM-9145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 680.0, "discounted_cash": 238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR KNOTLESS FIBERTAK 1.8 SOFT WITH SUTURE #3 AR-3637", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3637", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3577.2, "discounted_cash": 1252.02, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR KOPIS KNOTLESS F-31-14520 F-31-14520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "F-31-14520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1372.0, "discounted_cash": 480.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR MPFL FASTTHREAD ANCHOR AR-1360FT-BC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1360FT-BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4325.16, "discounted_cash": 1513.81, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR MULTIFIX 5.5MM S-ULTRA KNOTLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72290001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR OMEGA 4.75MM PEEK KNOTLESS ANCHOR SYSTEM SINGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3910-500-471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 867.0, "discounted_cash": 303.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR OMEGA 4.75MM PEEK KNOTLESS DOUBLE DOUBLE 3910-500-472", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3910-500-472", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR OPEN HARD BONE HEALIX KIT 222358", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1040.0, "discounted_cash": 364.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR OSSIO FIBER 4.75 MM WITH BLUE/BLACK TAPE OF1034755S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1034755S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1490.0, "discounted_cash": 521.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR PEEK ZIP #2 5.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3910-200-030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 516.0, "discounted_cash": 180.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR Q-FIX 2.8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "25-2800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1408.0, "discounted_cash": 492.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SERRATED 6.0 X 20MM 865-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "865-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SIZE 2 BIOWICK X UHMWPE SUTURE CM-6255", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CM-6255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2397.0, "discounted_cash": 838.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SOFT FIBER TAK2.6 KNOTLESS SELF PUNCHING. 1.7MM FIBER TAPE BL #2 SUTURE (WHT & BLK) AR-3653", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3653TTSP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.04, "discounted_cash": 402.16, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SOFT FIBER TAK2.6 KNOTLESS SELF PUNCHING. 1.7MM FIBER TAPE BL&BL #2 SUTURE (WHT & BLK) AR-3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3653TSP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.04, "discounted_cash": 402.16, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SOUBLE LOADED SWIVEL LOCK BIOCOMPOSITE AR-1593-BC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1593-BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1619.0, "discounted_cash": 566.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR STIMULATION 90DEG TWIST TO LOCKINTO PLACE HIGHLY RADIOPAQUE SWIFT LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 244.0, "discounted_cash": 85.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 1.5MM BLUE WHT SOFT MAXBRAID JUGGERKNOTINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "912031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 492.0, "discounted_cash": 172.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 10.7MM LEN 2.9MM DIA SHOUDLER PUSHLOCK BIOCOMPOSITE STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1923BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 10MM LEN 3.5 DIA CORKSCREW FULLY THREADED NDL TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1915FT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 294.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 15MM X 5.5MM FULLY THREADED BETA TRI CALCIUM PHOSPHATE POLY L LACTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1927BCF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 696.0, "discounted_cash": 243.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 18.5MM LEN 4.5 DIA FOR SUT BRIDGE LAT ROW PUSHLOCK SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1922PSM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 266.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 19.5MM X 3.5MM LIMB BIO-PUSHLOCK STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1926B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 742.0, "discounted_cash": 259.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 2.3MM MICRO CORKSCREW FULLY THREADED W/ 2-0 FIBER WIRE AND 2 TAPERED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1318FT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 617.88, "discounted_cash": 216.26, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 2.5MM BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-04-1125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 846.0, "discounted_cash": 296.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 2.5MM MORPHIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-04-125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1617.0, "discounted_cash": 565.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 2.5MM W/ SZ 2 SUT MORPHIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-03-225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 2.5MM X 7MM POLYETHER ETHER KETONE PUSHLOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8825P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 742.0, "discounted_cash": 259.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 2.9MM DOUBLE-LOADED NUMBER 2 MAXBRAID SUT ARTHROSCOPIC AND MINI OPEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110005096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 2.9MM SOFT POLYESTER JUGGERKNOT DISP", "code_information": [{"code": "912057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 650.0, "discounted_cash": 227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 2.9MM X 12.5MM SHOULDER ARTHROSCOPIC BIOCOMPOSITE PUSHLOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2923BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 867.2, "discounted_cash": 303.52, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 2MM W/ 2 SZ 3-0 DURABRAID SUTS MINITAC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7210303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 196.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 2MM W/ 2 ULTRABRAID SUTS SZ 2-0 AND NDLS MINITAC TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 3.5MM BIOCOMPOSITE SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2325BCC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1290.0, "discounted_cash": 451.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 3.5MM FXTN SYS W/ NDLS MORPHIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-04-235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1339.0, "discounted_cash": 468.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 3.5MM X 8MM PRELOADED ULTRA HIGH MOLECULAR WT BRAIDED POLYETHLENE W/", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-03-235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1341.0, "discounted_cash": 469.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 3MM X 12.7MM BIOCOMPOSITE KNOTLESS SUTTAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1938BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 3MM X 14MM BIOCOMPOSITE W/ 2 NUMBER 2 FIBERWIRE SUTTAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1934BCF-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 943.0, "discounted_cash": 330.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 3MM X 14MM BIOCOMPOSITE W/ NUMBER 2 TIGERTAIL SURTURETAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1934BCFT-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1001.0, "discounted_cash": 350.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 3MM X 14MM BIOCOMPOSITE W/ NUMBER 2 TIGERTAIL SUTTAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1934BCFT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 958.0, "discounted_cash": 335.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 3MM X 14MM SM JOINT BETA TRICALCIUM PHOSPHATE POLY L LACTIC ACID W/ O", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8934BCNF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 958.0, "discounted_cash": 335.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 4.5MM BIOCRYL RAPIDE W/ ORTHOCORD HEALIX ADVANCE BR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 995.0, "discounted_cash": 348.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 4.5MM KNOTLESS SLF PUNCHING QUATTRO LINK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CM-9145SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 694.0, "discounted_cash": 242.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 4.5MM PRELOADED W/ 2 USP BRAIDED POLYEHTYLENE NUMBER 2 SUTS MORPHIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-03-245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 4.75 X 24.5MM BIO COMPOSITE SWIVELOCK SLF PUNCHING VENTED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324BCM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 910.56, "discounted_cash": 318.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 4.75MM X 19.1MM CLOSED EYELET BIOCOMPOSITE SWIVELOCK C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324BCC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 867.2, "discounted_cash": 303.52, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 4.75MM X 19.1MM CLOSED EYELET BIOCOMPOSITE SWIVELOCK C STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324BCCS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1163.0, "discounted_cash": 407.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 4.75MM X 19.1MM CLOSED EYELET VENTED BIOCOMPOSITE W/ BLUE FIBERTAPE L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324BCCT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1018.96, "discounted_cash": 356.64, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 4.75MM X 19.1MM CLOSED EYELET VENTED BIOCOMPOSITE W/ WHT BLACK FIBERT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324BCCTT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 203.8, "discounted_cash": 71.33, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5IN W/ 3 ORTHOCORD SUT AND NDL HEALIX ADVANCE BR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 982.0, "discounted_cash": 343.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM 3 SUT ORTHOCORD PEEK HEALIX ADVANCE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 336.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM BIOCRYL RAPIDE W/ ORTHOCORD AND NDL HEALIX ADVANCE BR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 983.0, "discounted_cash": 344.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM BIOCRYL RAPIDE W/ ORTHOCORD HEALIX ADVANCE BR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 956.0, "discounted_cash": 334.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM DIA SM JOINT SHLDR HEALIX BIOCRYL RAPIDE TRICALCIUM PHOSPHATE O", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM FULLY THREADED PEEK OPTIMA POLYMER W/ THREE ULTRABRAID NUMBER 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72203380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM FULLY THREADED W/ 2 SZ 2 HIFI SUTS AND NDLS CROSSFIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CFP-5502N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 208.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM KNOTLESS BIODEGRADABLE SOFT TISSUE HEALIX ADVANCE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1112.0, "discounted_cash": 389.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM KNOTLESS SURG QUATTRO LINK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CM-9155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 680.0, "discounted_cash": 238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM RESORBABLE W/ 2 ULTRABRAID BLUE SUT HEALICOIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72203706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM RESORBABLE W/ THREE ULTRABRAID BLUE COBRAID BLACK SUT HEALICOIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72203707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM SECONDARY ROW FOOTPRINT ULTRA PACK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 686.0, "discounted_cash": 240.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM X 15MM FULLY THREADED BIOCOMPOSITE W/ 2 NUMBER 2 FIBERWIRE AND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1927BCNF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 718.0, "discounted_cash": 251.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5.5MM X 19.1MM BIOCOMPOSITE CLOSED EYELET SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2323BCC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1163.0, "discounted_cash": 407.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 5MM W/ ORTHOCORD SUT FASTIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 995.0, "discounted_cash": 348.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 6.25MM X 19.1MM TENODESIS CLOSED EYELET BIOCOMPOSITE SWIVELOCK STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1662BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 888.88, "discounted_cash": 311.11, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 6.5MM ORTHOCORD HEALIX ADVANCE BR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 995.0, "discounted_cash": 348.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 6.5MM PEEK W/ 3 ORTHOCORD SUT HEALIXINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 891.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 6.5MM RC W/ ORTHOCORD WITHOUT NDL FASTIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222994", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 208.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 6.5MM W/ 2 #2 HIFI SUT W/ NDL CROSSFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CFP-6502N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 208.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 6.5MM W/ ORTHOCORD SUT HEALIX ADVANCE BR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 983.0, "discounted_cash": 344.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 6.5MM W/ ORTHOCORD SUT HEALIX BRINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 7MM X 19.1MM TENODESIS BIO COMPOSITE SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1662BCC-7", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1861.0, "discounted_cash": 651.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 7MM X 19.5MM TENODESIS CLOSED EYELET BIOCOMPOSITE SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1662BC-7", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 896.0, "discounted_cash": 313.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 8.5MM LEN 2.4MM DIA BIOCOMPOSITE SUTTAK MINI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1322BCNF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 8MM X 19.5MM TENODESIS CLOSED EYELET BIOCOMPOSITE SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1662BC-8", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 896.0, "discounted_cash": 313.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT 8MM X 19.5MM TENODESIS PEEK SWIVELOCKINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1662PSL-8", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT BIO REPLACEABLE W/ DS ORTHOCORD LUPINE BR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1077.0, "discounted_cash": 376.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT KNOTLESS SHLDR SM JOINT ROTATOR CUFF POLYETHER ETHER KETONE W/ ORTHOC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1170.0, "discounted_cash": 409.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT MINI SM JOINT SHLDR NITINOL ARCS W/ NUMBER 2/0 ORTHOCORD V5 QUICKANCH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 886.0, "discounted_cash": 310.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT PEEK VERSALOK W/ORTHOCORD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1032.0, "discounted_cash": 361.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT SM JOINT POLY L LACTIDE ACID ABSORBL POLYMER W/ NUMBER 2/0 ORTHOCORD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1244.0, "discounted_cash": 435.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT SM JOINT SHLDRINSTABILITY MAXILLOFACIAL W/ NUMBER 2 ETHIBOND EXCEL V5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1096.0, "discounted_cash": 383.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT SM JOINTFT ANJLE HND WRIST W/ NUMBER 2-0 ORTHOCORD RB-1 W/ 2 MM DRILL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1007.0, "discounted_cash": 352.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT SM JOINTINSTABILITY SHLDR NITINOL ARCS W/ ORTHOCORD CP 2 NDL GII QUIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222983", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1154.0, "discounted_cash": 403.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT SURG ANULEX IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FB-201-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3449.0, "discounted_cash": 1207.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT SZ 2 2.9MM BLUE WHT SOFT DOUBLE LOADED NUMBER 2 MAXIBRAID JUGGERKNOT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "912029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUT TENODESIS SWIVELOCK PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-7324PSL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 943.08, "discounted_cash": 330.08, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE 3 BR HEALIX ADVANCE PERMACORD 6.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 896.0, "discounted_cash": 313.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE 4.5MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SMT000415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1123.0, "discounted_cash": 393.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE 4.75MM WITH NEEDLES BLACK/WHITE TAPE BLUE #2 OF1034753S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1034753S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1490.0, "discounted_cash": 521.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE BR 3 HEALIX ADVANCE W/ PERMACORD 5.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1344.0, "discounted_cash": 470.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE ENDO 1.3MM SZ4 MICROFIX QUICKANCHOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1007.0, "discounted_cash": 352.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE FIBER FORCE #2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3910-900-021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE HEALICOIL PK 4.5MM W/ULTRATAPE SUTURE COBRAID BLUE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72203982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 711.0, "discounted_cash": 248.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE HEALIX ADVANCE W/ PERMACORD 5.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 966.0, "discounted_cash": 338.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE HEALIX DYNACORD 222006", "code_information": [{"code": "222006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1395.03, "discounted_cash": 488.26, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE KNOTLESS 5.5MM 72205135", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72205135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 367.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE QUATTRO GL2 2.9MM WITH TWO SIZE 2 FORCE FIBER SUTURES", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CM-9329GL2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 752.0, "discounted_cash": 263.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE REELX STT 4.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3910-600-062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 710.0, "discounted_cash": 248.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE SZ 2 36IN FORCE FIBER NEEDLE VIOLET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SMSB0122N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 199.0, "discounted_cash": 69.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR TIGHT-N 5.5 208881", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "208881", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR TWINFIX ULTRA TI W 2 #2 ULTRABRAID 5.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 220.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR TWIST 4.5MM PEEK NEEDLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 865.0, "discounted_cash": 302.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR WITH #2 SUTURE 3.5MM MORPHIX XT 1000-05-235", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-05-235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1150.0, "discounted_cash": 402.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHORS BONE 3 W ARTHRO DEL SYS ADVNCD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2300.0, "discounted_cash": 805.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANDROLOGY INFERTILITY ASSMT", "code_information": [{"code": "255U", "type": "CPT"}], "standard_charges": [{"minimum": 31.39, "maximum": 49.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 45.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 45.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANDROSTANEDIOL GLUCURONIDE", "code_information": [{"code": "82154", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 44.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 73.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 115.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 115.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 115.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 41.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 41.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES C HYST FLWG NEURAXIAL", "code_information": [{"code": "1969", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN DELIVERY ONLY", "code_information": [{"code": "1961", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN HYSTERECTOMY", "code_information": [{"code": "1963", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES COMP CTRLD HYPOTENSION", "code_information": [{"code": "99135", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES COMP EMERGENCY COND", "code_information": [{"code": "99140", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES COMP TOT BDY HYPTHRM", "code_information": [{"code": "99116", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR CRV/THRC", "code_information": [{"code": "1937", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR LMBR/SAC", "code_information": [{"code": "1938", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES DX SHOULDER ARTHROSCOPY", "code_information": [{"code": "1622", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES END, 1 TEMP >35.5(95.9)", "code_information": [{"code": "G9771", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR DIPHRG HRNA", "code_information": [{"code": "756", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR LMBR&VNT&/DEHS", "code_information": [{"code": "752", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR OMPHALOCELE", "code_information": [{"code": "754", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR UPR ABD NOS", "code_information": [{"code": "750", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES INCOMPL/MISSED AB PX", "code_information": [{"code": "1965", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES INDUCED ABORTION PX", "code_information": [{"code": "1966", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD GSTR PX MO", "code_information": [{"code": "797", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD LVR TRNSPL", "code_information": [{"code": "796", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD NOS", "code_information": [{"code": "790", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PNCRTECT", "code_information": [{"code": "794", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES LWR INTST NDSC NOS", "code_information": [{"code": "811", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES LWR INTST SCR COLSC", "code_information": [{"code": "812", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES MEDIASCPY & DX THORSCPY", "code_information": [{"code": "528", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES MEDSCPY&THORSCPY 1 LUNG", "code_information": [{"code": "529", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT CRV/THRC", "code_information": [{"code": "1941", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT LMBR/SAC", "code_information": [{"code": "1942", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT CRV/THRC", "code_information": [{"code": "1939", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT LMBR/SAC", "code_information": [{"code": "1940", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES PT EXTEME AGE<1 YR&>70", "code_information": [{"code": "99100", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES PX MAJ ABD BLOOD VESSEL", "code_information": [{"code": "770", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANSTHOR W/VENT", "code_information": [{"code": "626", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANTHOR W/O VENT", "code_information": [{"code": "625", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD ARTRL", "code_information": [{"code": "1924", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD CARD", "code_information": [{"code": "1925", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD TIPS", "code_information": [{"code": "1931", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD VEIN", "code_information": [{"code": "1930", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD CRAN VEIN", "code_information": [{"code": "1933", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD HRT/CRAN", "code_information": [{"code": "1926", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD TH VEIN", "code_information": [{"code": "1932", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX ERCP", "code_information": [{"code": "732", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX NOS", "code_information": [{"code": "731", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES UPR LWR GI NDSC PX", "code_information": [{"code": "813", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES URGENT HYSTERECTOMY", "code_information": [{"code": "1962", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES VAGINAL DELIVERY ONLY", "code_information": [{"code": "1960", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES XTRNL CEPHALIC VERSION", "code_information": [{"code": "1958", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES/ANALG CS DLVR NEURAXIAL", "code_information": [{"code": "1968", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMEN VESSEL SURG", "code_information": [{"code": "880", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "700", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "730", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "800", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "820", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ACHILLES TENDON SURG", "code_information": [{"code": "1472", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH AMNIOCENTESIS", "code_information": [{"code": "842", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT KNEE", "code_information": [{"code": "1404", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT PELVIS", "code_information": [{"code": "1140", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF FEMUR", "code_information": [{"code": "1232", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF PENIS", "code_information": [{"code": "932", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ANKLE REPLACEMENT", "code_information": [{"code": "1486", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ANKLE/FT ARTHROSCOPY", "code_information": [{"code": "1464", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ANORECTAL SURGERY", "code_information": [{"code": "902", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ARM-LEG VESSEL SURG", "code_information": [{"code": "1656", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ARTHROSCOPY OF HIP", "code_information": [{"code": "1202", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BICEPS TENDON REPAIR", "code_information": [{"code": "1716", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BIOPSY OF NOSE", "code_information": [{"code": "164", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BIOPSY OF THYROID", "code_information": [{"code": "322", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER STONE SURG", "code_information": [{"code": "870", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER SURGERY", "code_information": [{"code": "910", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER TUMOR SURG", "code_information": [{"code": "912", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BLEEDING CONTROL", "code_information": [{"code": "916", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BLEPHAROPLASTY", "code_information": [{"code": "103", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BODY CAST PROCEDURE", "code_information": [{"code": "1130", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BONE ASPIRATE/BX", "code_information": [{"code": "1112", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN 4-9 PERCENT", "code_information": [{"code": "1952", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN EACH 9 PERCENT", "code_information": [{"code": "1953", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN LESS 4 PERCENT", "code_information": [{"code": "1951", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/O PUMP", "code_information": [{"code": "566", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/PUMP", "code_information": [{"code": "567", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CARDIAC ELECTROPHYS", "code_information": [{"code": "537", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CARDIOVERTER/DEFIB", "code_information": [{"code": "534", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CAT OR MRI SCAN", "code_information": [{"code": "1922", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CATHETERIZE HEART", "code_information": [{"code": "1920", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST DRAINAGE", "code_information": [{"code": "524", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST LINING BIOPSY", "code_information": [{"code": "522", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST PROCEDURE", "code_information": [{"code": "520", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST SURGERY", "code_information": [{"code": "540", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST WALL REPAIR", "code_information": [{"code": "472", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CLEFT PALATE REPAIR", "code_information": [{"code": "172", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH COLLAR BONE BIOPSY", "code_information": [{"code": "454", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CORNEAL TRANSPLANT", "code_information": [{"code": "144", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CORRECT HEART RHYTHM", "code_information": [{"code": "410", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CRAN SURG HEMOTOMA", "code_information": [{"code": "211", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CRANIAL SURG NOS", "code_information": [{"code": "210", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH DX ARTERIOGRAPHY", "code_information": [{"code": "1916", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH DX ELBOW ARTHROSCOPY", "code_information": [{"code": "1732", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH DX KNEE ARTHROSCOPY", "code_information": [{"code": "1382", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH DX WRIST ARTHROSCOPY", "code_information": [{"code": "1829", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH EAR EXAM", "code_information": [{"code": "124", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH EAR SURGERY", "code_information": [{"code": "120", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ELBOW AREA SURGERY", "code_information": [{"code": "1710", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ELBOW REPLACEMENT", "code_information": [{"code": "1760", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ELECTROSHOCK", "code_information": [{"code": "104", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ESOPHAGEAL SURGERY", "code_information": [{"code": "500", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH EYE EXAM", "code_information": [{"code": "148", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FACE/SKULL BONE SURG", "code_information": [{"code": "190", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FACIAL BONE SURGERY", "code_information": [{"code": "192", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FAT LAYER REMOVAL", "code_information": [{"code": "802", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL ARTERY SURG", "code_information": [{"code": "1272", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL EMBOLECTOMY", "code_information": [{"code": "1274", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FOR LIVER BIOPSY", "code_information": [{"code": "702", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FOREQUARTER AMPUT", "code_information": [{"code": "1636", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FX REPAIR PELVIS", "code_information": [{"code": "1173", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH GENITALIA SURGERY", "code_information": [{"code": "920", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD NERVE SURGERY", "code_information": [{"code": "222", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD VESSEL SURGERY", "code_information": [{"code": "216", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD/NECK/PTRUNK", "code_information": [{"code": "300", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG <1 YR", "code_information": [{"code": "561", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/ARREST", "code_information": [{"code": "563", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/O PUMP", "code_information": [{"code": "560", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART/LUNG TRANSPLNT", "code_information": [{"code": "580", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HERNIA REPAIR < 1 YR", "code_information": [{"code": "834", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HERNIA REPAIR PREEMIE", "code_information": [{"code": "836", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP ARTHROPLASTY", "code_information": [{"code": "1214", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP DISARTICULATION", "code_information": [{"code": "1212", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP JOINT PROCEDURE", "code_information": [{"code": "1200", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP JOINT SURGERY", "code_information": [{"code": "1210", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HRT SURG W/PMP AGE 1+", "code_information": [{"code": "562", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERAL LESION SURG", "code_information": [{"code": "1758", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERUS REPAIR", "code_information": [{"code": "1744", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERUS SURGERY", "code_information": [{"code": "1742", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HYSTERECTOMY", "code_information": [{"code": "846", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HYSTEROSCOPE/GRAPH", "code_information": [{"code": "952", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH INSERT PENIS DEVICE", "code_information": [{"code": "938", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH INTRCRN NERVE", "code_information": [{"code": "220", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH IRIDECTOMY", "code_information": [{"code": "147", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY STONE DESTRUCT", "code_information": [{"code": "872", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY STONE DESTRUCT", "code_information": [{"code": "873", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY TRANSPLANT", "code_information": [{"code": "868", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY/URETER SURG", "code_information": [{"code": "862", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA PROCEDURE", "code_information": [{"code": "1340", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA PROCEDURE", "code_information": [{"code": "1390", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1320", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1360", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1392", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERIES SURG", "code_information": [{"code": "1440", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY REPAIR", "code_information": [{"code": "1444", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY SURG", "code_information": [{"code": "1442", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTHROPLASTY", "code_information": [{"code": "1402", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT CASTING", "code_information": [{"code": "1420", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT PROCEDURE", "code_information": [{"code": "1380", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT SURGERY", "code_information": [{"code": "1400", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE VEINS SURGERY", "code_information": [{"code": "1430", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE VESSEL SURG", "code_information": [{"code": "1432", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LARYNX/TRACH < 1 YR", "code_information": [{"code": "326", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LEG ARTERIES SURG", "code_information": [{"code": "1500", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LENS SURGERY", "code_information": [{"code": "142", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM CASTING", "code_information": [{"code": "1860", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM PROCEDURE", "code_information": [{"code": "1820", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM SURGERY", "code_information": [{"code": "1810", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM SURGERY", "code_information": [{"code": "1830", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM VEIN SURG", "code_information": [{"code": "1850", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG BONE SURG", "code_information": [{"code": "1480", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG CASTING", "code_information": [{"code": "1490", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG PROCEDURE", "code_information": [{"code": "1462", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG REVISION", "code_information": [{"code": "1484", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG SURGERY", "code_information": [{"code": "1470", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG SURGERY", "code_information": [{"code": "1474", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG VEIN SURG", "code_information": [{"code": "1520", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG VEIN SURG", "code_information": [{"code": "1522", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LUMBAR PUNCTURE", "code_information": [{"code": "635", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LUNG CHEST WALL SURG", "code_information": [{"code": "546", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM ARTERY SURG", "code_information": [{"code": "1840", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM EMBOLECTOMY", "code_information": [{"code": "1842", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM VEIN REPAIR", "code_information": [{"code": "1852", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR LEG EMBOLECTOMY", "code_information": [{"code": "1502", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH MAJOR VEIN LIGATION", "code_information": [{"code": "882", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH N BLOCK/INJ PRONE", "code_information": [{"code": "1992", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK ORGAN 1YR/>", "code_information": [{"code": "320", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK VESSEL SURGERY", "code_information": [{"code": "350", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK VESSEL SURGERY", "code_information": [{"code": "352", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH NERVE BLOCK/INJ", "code_information": [{"code": "1991", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH NOSE/SINUS SURGERY", "code_information": [{"code": "160", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH NOSE/SINUS SURGERY", "code_information": [{"code": "162", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ONE LUNG VENTILATION", "code_information": [{"code": "541", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PACEMAKER INSERTION", "code_information": [{"code": "530", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC ORGAN SURG", "code_information": [{"code": "848", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC TUMOR SURGERY", "code_information": [{"code": "1150", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS PROCEDURE", "code_information": [{"code": "1160", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "1120", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "1170", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "844", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "934", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "936", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PERINEAL SURGERY", "code_information": [{"code": "904", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "174", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "176", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURE ON FEMUR", "code_information": [{"code": "1220", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURE ON MOUTH", "code_information": [{"code": "170", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURES ON EYE", "code_information": [{"code": "140", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL FEMUR SURG", "code_information": [{"code": "1234", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL HUMERUS SURG", "code_information": [{"code": "1756", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL LEG SURGERY", "code_information": [{"code": "1482", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF ADRENAL", "code_information": [{"code": "866", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF BLADDER", "code_information": [{"code": "864", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF NERVES", "code_information": [{"code": "632", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "865", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "908", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "914", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF RIB", "code_information": [{"code": "470", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF TESTIS", "code_information": [{"code": "926", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF TESTIS", "code_information": [{"code": "928", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF VULVA", "code_information": [{"code": "906", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF CERVIX", "code_information": [{"code": "948", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF CLEFT LIP", "code_information": [{"code": "102", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF HERNIA", "code_information": [{"code": "830", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF HERNIA", "code_information": [{"code": "832", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REVISE HIP REPAIR", "code_information": [{"code": "1215", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SALIVARY GLAND", "code_information": [{"code": "100", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER ARTERY SURG", "code_information": [{"code": "1650", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER CASTING", "code_information": [{"code": "1680", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER JOINT AMPUT", "code_information": [{"code": "1634", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER PROCEDURE", "code_information": [{"code": "1620", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER REPLACEMENT", "code_information": [{"code": "1638", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VEIN SURG", "code_information": [{"code": "1670", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1652", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1654", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SITTING PROCEDURE", "code_information": [{"code": "604", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKIN EXT/PER/ATRUNK", "code_information": [{"code": "400", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL DRAINAGE", "code_information": [{"code": "212", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL DRAINAGE", "code_information": [{"code": "214", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL REPAIR/FRACT", "code_information": [{"code": "215", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPECIAL HEAD SURGERY", "code_information": [{"code": "218", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SPERM DUCT SURGERY", "code_information": [{"code": "922", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "600", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "620", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "630", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "670", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE MANIPULATION", "code_information": [{"code": "640", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH STERNAL DEBRIDEMENT", "code_information": [{"code": "550", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH STONE REMOVAL", "code_information": [{"code": "918", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURG LOWER ABDOMEN", "code_information": [{"code": "840", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURG ON VAG/URETHRAL", "code_information": [{"code": "942", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF ABDOMEN", "code_information": [{"code": "860", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "402", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "404", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "406", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF FEMUR", "code_information": [{"code": "1230", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF RIB", "code_information": [{"code": "474", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "1610", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "1630", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "450", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH TESTIS EXPLORATION", "code_information": [{"code": "924", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH TESTIS SUSPENSION", "code_information": [{"code": "930", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH THIGH ARTERIES SURG", "code_information": [{"code": "1270", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH TRACH-BRONCH RECONST", "code_information": [{"code": "539", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH TRACHEA BRONCHI SURG", "code_information": [{"code": "548", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH TUBAL LIGATION", "code_information": [{"code": "851", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH TYMPANOTOMY", "code_information": [{"code": "126", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER ARM SURGERY", "code_information": [{"code": "1740", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER ARM VEIN SURG", "code_information": [{"code": "1780", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER LEG SURGERY", "code_information": [{"code": "1250", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER LEG VEINS SURG", "code_information": [{"code": "1260", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM ARTERY SURG", "code_information": [{"code": "1770", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM EMBOLECTOMY", "code_information": [{"code": "1772", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM PROCEDURE", "code_information": [{"code": "1730", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM TENDON SURG", "code_information": [{"code": "1712", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM TENDON SURG", "code_information": [{"code": "1714", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM VEIN REPAIR", "code_information": [{"code": "1782", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL ENDOSCOPY", "code_information": [{"code": "950", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL HYSTERECTOMY", "code_information": [{"code": "944", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL PROCEDURES", "code_information": [{"code": "940", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VASCULAR ACCESS", "code_information": [{"code": "532", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VASCULAR SHUNT SURG", "code_information": [{"code": "1844", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VASECTOMY", "code_information": [{"code": "921", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VITREORETINAL SURG", "code_information": [{"code": "145", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH WRIST REPLACEMENT", "code_information": [{"code": "1832", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTHESIA EXTENSION 90IN MEDLINE", "code_information": [{"code": "DYNJAA10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ANESTHESIA REMOVAL PLEURA", "code_information": [{"code": "542", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHESIOLOGY SS", "code_information": [{"code": "G0061", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGINA PECTORIS", "code_information": [{"code": "311", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4248.98, "maximum": 7294.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4248.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6076.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6684.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7294.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANGIO FEM/POP W/ US", "code_information": [{"code": "C7531", "type": "HCPCS"}], "standard_charges": [{"minimum": 2743.0, "maximum": 6125.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO W/ US NON-CORONARY", "code_information": [{"code": "C7532", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIOCATH SPECIAL ORANGE 14GX5.25 10/BX 382269", "code_information": [{"code": "382269", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIOSCOPY", "code_information": [{"code": "35400", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIOTENSIN I ENZYME TEST", "code_information": [{"code": "82164", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANJESO 30 MG/ML IV DSPR 1 ML", "code_information": [{"code": "MED0842", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 336.0, "discounted_cash": 117.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29899", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE SCREW 3.5 MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-35-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ANKLE SCREW 3.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-35-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ANNUAL GYNECOLOGICAL EXAMINA", "code_information": [{"code": "S0610", "type": "HCPCS"}], "standard_charges": [{"minimum": 192.32, "maximum": 302.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 192.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 302.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 302.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 302.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANNUAL GYNECOLOGICAL EXAMINA", "code_information": [{"code": "S0612", "type": "HCPCS"}], "standard_charges": [{"minimum": 144.65, "maximum": 227.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 144.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANNULAR CLOSURE DEVICE (ACD) BARRICAID DISC PROLAPSE REPAIR IMPLANT 8MM WIDTH BAR-A8-8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BAR-A8-8MM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 3850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANOGENITAL EXAM CHILD W IMAG", "code_information": [{"code": "99170", "type": "CPT"}], "standard_charges": [{"minimum": 392.58, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 392.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 616.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 616.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 616.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOPLASTY FOR STRICTURE-ADULT 46700", "code_information": [{"code": "46700", "type": "CPT"}, {"code": "1479922", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANORECTAL MYOMECTOMY 45108", "code_information": [{"code": "45108", "type": "CPT"}, {"code": "1479924", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPE ANOSPEC BEVELED 103MM X 18MM SINGLE-USE C060120", "code_information": [{"code": "C060120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.04, "discounted_cash": 11.91, "setting": "both", "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46611", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY CONTROL BLEEDING", "code_information": [{"code": "46614", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE FOR BODY", "code_information": [{"code": "46608", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESION", "code_information": [{"code": "46610", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESIONS", "code_information": [{"code": "46612", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY W/BIOPSY ANUS 46606", "code_information": [{"code": "46606", "type": "CPT"}, {"code": "1479926", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 869.0, "maximum": 8450.0, "gross_charge": 3069.0, "discounted_cash": 1074.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1485.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY WITH DILATION BALLOON/WIRE/BOUGIE 46604", "code_information": [{"code": "46604", "type": "CPT"}, {"code": "9975582", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 625.32, "maximum": 8450.0, "gross_charge": 1292.0, "discounted_cash": 452.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 625.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY; W/ABLATION OF TUMORS/POLYPS OR LESIONS; BIPOLAR OR SNARE TECHNIQUE 46615", "code_information": [{"code": "46615", "type": "CPT"}, {"code": "44798763", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANS PARASYMP & SYMP W/TILT", "code_information": [{"code": "95924", "type": "CPT"}], "standard_charges": [{"minimum": 271.79, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 271.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 427.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 427.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 427.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG I&R SPECLR MIC", "code_information": [{"code": "92286", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG IR FLRSCN ANGRPH", "code_information": [{"code": "92287", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG 8+", "code_information": [{"code": "22837", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG <7", "code_information": [{"code": "22836", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTB TP TOTAL&RPR IA QUAL", "code_information": [{"code": "64U", "type": "CPT"}], "standard_charges": [{"minimum": 45.12, "maximum": 125.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 79.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 125.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 125.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 125.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 45.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 45.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTENNA PRGRMMR PT EXTERNAL TO BE USED W/ 37742 OR 7439 PATIENT PROGRAMMER", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "37092", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59425", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59426", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM MANIPULATION", "code_information": [{"code": "59412", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTERIOR COLPORRHAPHY REPAIR OF CYSTOCELE 57240", "code_information": [{"code": "57240", "type": "CPT"}, {"code": "1479927", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTERIOR INSTRUMENTATION 2-3 VERTERBRAL SEGMENTS 22845", "code_information": [{"code": "22845", "type": "CPT"}, {"code": "1479928", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 9735.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTERIOR INSTRUMENTATION 4 TO 7 VERTEBRAL SEG 22846", "code_information": [{"code": "22846", "type": "CPT"}, {"code": "1700062", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.67, "maximum": 9735.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTERIOR TIBIAL TUBERCLEPLASTY 27418", "code_information": [{"code": "27418", "type": "CPT"}, {"code": "1479929", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEROPOSTERIOR COLPORRHAPHY 57260", "code_information": [{"code": "57260", "type": "CPT"}, {"code": "1479930", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEROPOSTERIOR COLPORRHAPHY WITH ENTEROCELE REPAIR 57265", "code_information": [{"code": "57265", "type": "CPT"}, {"code": "1479931", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTHOLOGY SO POROUS SZ 11 71356011", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71356011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10160.0, "discounted_cash": 3556.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANTHRAX VACCINE SC OR IM", "code_information": [{"code": "90581", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTHROTOMY POST CAPSULAR RELEASE ANKLE W ORW/O ACHILLES LENGTHENING 27612", "code_information": [{"code": "27612", "type": "CPT"}, {"code": "1682320", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-EGFR MON ANTI THER", "code_information": [{"code": "G9839", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-PHOSPHOLIPID ANTIBODY", "code_information": [{"code": "86148", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIBIO RX W IN 10D OF SYMPT", "code_information": [{"code": "G9286", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIBIOTIC NOT PRES", "code_information": [{"code": "G8708", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIBODY DETECTION NOS IF", "code_information": [{"code": "87299", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIBODY SARS-COV-2 TITER(S)", "code_information": [{"code": "224U", "type": "CPT"}], "standard_charges": [{"minimum": 74.06, "maximum": 168.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 107.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTICOAG MGMT PT WARFARIN", "code_information": [{"code": "93793", "type": "CPT"}], "standard_charges": [{"minimum": 54.02, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 84.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 84.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 84.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANT NOT SPECIFIED", "code_information": [{"code": "80338", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANT TRICYCLIC 1/2", "code_information": [{"code": "80335", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANT TRICYCLIC 3-5", "code_information": [{"code": "80336", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS CLASS 1 OR 2", "code_information": [{"code": "80332", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS CLASS 3-5", "code_information": [{"code": "80333", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS CLASS 6/MORE", "code_information": [{"code": "80334", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTICS NOS 1-3", "code_information": [{"code": "80339", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTICS NOS 4-6", "code_information": [{"code": "80340", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTICS NOS 7/MORE", "code_information": [{"code": "80341", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95144", "type": "CPT"}], "standard_charges": [{"minimum": 168.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95145", "type": "CPT"}], "standard_charges": [{"minimum": 168.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95146", "type": "CPT"}], "standard_charges": [{"minimum": 168.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95147", "type": "CPT"}], "standard_charges": [{"minimum": 266.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95148", "type": "CPT"}], "standard_charges": [{"minimum": 266.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95149", "type": "CPT"}], "standard_charges": [{"minimum": 266.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95165", "type": "CPT"}], "standard_charges": [{"minimum": 168.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95170", "type": "CPT"}], "standard_charges": [{"minimum": 168.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTINOMYCES ANTIBODY", "code_information": [{"code": "86602", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTINUCLEAR ANTIBODIES (ANA)", "code_information": [{"code": "86039", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 44.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 44.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 44.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS NOS 1-3", "code_information": [{"code": "80342", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS NOS 4-6", "code_information": [{"code": "80343", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS NOS 7/MORE", "code_information": [{"code": "80344", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTISPERM ANTIBODIES TEST", "code_information": [{"code": "S3655", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTISTREPTOLYSIN O SCREEN", "code_information": [{"code": "86063", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTISTREPTOLYSIN O TITER", "code_information": [{"code": "86060", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III ACTIVITY", "code_information": [{"code": "85300", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 47.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III ANTIGEN", "code_information": [{"code": "85301", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC GUIDE 3D PRINT 1ST GD", "code_information": [{"code": "561T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 381.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC GUIDE 3D PRINT EA ADDL", "code_information": [{"code": "562T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 164.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 104.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 164.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 164.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 164.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC MDL 3D PRINT 1ST CMPNT", "code_information": [{"code": "559T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 381.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC MDL 3D PRINT EA ADDL", "code_information": [{"code": "560T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 164.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 104.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 164.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 164.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 164.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AOR ANE 5.5-5.9 CM MAX DIAM", "code_information": [{"code": "G9598", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AOR ANE >=6.0 CM MAX DIAM", "code_information": [{"code": "G9599", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "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": 42357.75, "maximum": 72717.74, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42357.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60580.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 66638.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72717.74, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [{"code": "269", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26248.75, "maximum": 45062.59, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26248.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37541.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 41295.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 45062.59, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33970", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33971", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81410", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2021.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2021.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2021.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 725.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 725.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81411", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1687.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3442.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5414.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5414.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5414.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1944.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1944.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC HEMIARCH GRAFT", "code_information": [{"code": "33866", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC SUSPENSION", "code_information": [{"code": "33800", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE DUP/DELET VARIANTS", "code_information": [{"code": "81203", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 250.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 802.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 802.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 802.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE FULL SEQUENCE", "code_information": [{"code": "81201", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 975.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3127.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3127.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3127.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1123.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1123.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81202", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1122.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1122.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1122.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC MRNA SEQ ALYS", "code_information": [{"code": "157U", "type": "CPT"}], "standard_charges": [{"minimum": 407.35, "maximum": 3127.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3127.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3127.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3127.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHAKIA PROSTH SERVICE TEMP", "code_information": [{"code": "92358", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS IMMUNOADS SLCTV", "code_information": [{"code": "36516", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLASMA", "code_information": [{"code": "36514", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLATELETS", "code_information": [{"code": "36513", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS RBC", "code_information": [{"code": "36512", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS WBC", "code_information": [{"code": "36511", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHLX TO VAX BEF ENC", "code_information": [{"code": "M1311", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOL1 RISK VARIANTS", "code_information": [{"code": "355U", "type": "CPT"}], "standard_charges": [{"minimum": 197.28, "maximum": 3809.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2422.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOLLORF HOOK NON-ASPIRATING 90 DEGREE", "code_information": [{"code": "AR-9825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP MDLTY 1+CNTRST BTH EA 15", "code_information": [{"code": "97034", "type": "CPT"}], "standard_charges": [{"minimum": 68.36, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 107.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 107.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 107.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+HUBBRD TNK EA 15", "code_information": [{"code": "97036", "type": "CPT"}], "standard_charges": [{"minimum": 157.35, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 157.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+IONTPHRSIS EA 15", "code_information": [{"code": "97033", "type": "CPT"}], "standard_charges": [{"minimum": 93.76, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+ULTRASOUND EA 15", "code_information": [{"code": "97035", "type": "CPT"}], "standard_charges": [{"minimum": 62.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 62.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 97.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 97.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 97.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX 1ST", "code_information": [{"code": "20696", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX XCH", "code_information": [{"code": "20697", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP OF HYDROXYAPATITE", "code_information": [{"code": "D2991", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "99188", "type": "CPT"}], "standard_charges": [{"minimum": 46.08, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP. SKIN SUB. GRAFT HEAD/GENITALIA/HND/FT/DIG. UP TO 100SQ CM EA ADD 25SQ CM 15276", "code_information": [{"code": "15276", "type": "CPT"}, {"code": "23179559", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44960", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY ADD-ON", "code_information": [{"code": "44955", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY INCIDENTAL DURING INTRA-ABDOMINAL SURGERY 44950", "code_information": [{"code": "44950", "type": "CPT"}, {"code": "1479933", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY LAPAROSCOPIC 44970", "code_information": [{"code": "44970", "type": "CPT"}, {"code": "1479935", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDICO-VESICOSTOMY", "code_information": [{"code": "50845", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL HALO CRANIAL 6+PINS", "code_information": [{"code": "20664", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL MODALITY 1+ESTIM EA 15", "code_information": [{"code": "97032", "type": "CPT"}], "standard_charges": [{"minimum": 66.77, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL MODALITY 1+LLLT PO PAIN", "code_information": [{"code": "97037", "type": "CPT"}], "standard_charges": [{"minimum": 168.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL MULTLAY COMPRS ARM/HAND", "code_information": [{"code": "29584", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL SLVR DIAMN FLUORIDE 38%", "code_information": [{"code": "792T", "type": "CPT"}], "standard_charges": [{"minimum": 46.08, "maximum": 72.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION ARCH BARS 21110", "code_information": [{"code": "21110", "type": "CPT"}, {"code": "1479936", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST ELBOW TO FINGERS 29075", "code_information": [{"code": "29075", "type": "CPT"}, {"code": "1479940", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST FIGURE OF EIGHT 29049", "code_information": [{"code": "29049", "type": "CPT"}, {"code": "1479941", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST FINGER-CONTRACTURE 29086", "code_information": [{"code": "29086", "type": "CPT"}, {"code": "1479942", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST FULL BODY 29046", "code_information": [{"code": "29046", "type": "CPT"}, {"code": "1479943", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST HAND AND LOWER FOREARM 29085", "code_information": [{"code": "29085", "type": "CPT"}, {"code": "1479944", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST HIP SPICA-1 LEG 29305", "code_information": [{"code": "29305", "type": "CPT"}, {"code": "1479945", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST HIP SPICA-BOTH LEGS 29325", "code_information": [{"code": "29325", "type": "CPT"}, {"code": "1479946", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST PLASTER VELPEAU 29058", "code_information": [{"code": "29058", "type": "CPT"}, {"code": "1479947", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST SHOULDER SPICA 29055", "code_information": [{"code": "29055", "type": "CPT"}, {"code": "1479948", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST SHOULDER TO HAND 29065", "code_information": [{"code": "29065", "type": "CPT"}, {"code": "1479949", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST THIGH TO TOES 29345", "code_information": [{"code": "29345", "type": "CPT"}, {"code": "1479950", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CAST-WALKER OR AMBULATORY TYPE 29355", "code_information": [{"code": "29355", "type": "CPT"}, {"code": "1479951", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION CRANIAL TONGS 20660", "code_information": [{"code": "20660", "type": "CPT"}, {"code": "1479952", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION EXTERNAL FIXATION MAXILLA", "code_information": [{"code": "21100", "type": "CPT"}, {"code": "1479954", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 5228.0, "discounted_cash": 1829.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO CRANIAL", "code_information": [{"code": "20661", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO FEMORAL", "code_information": [{"code": "20663", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO PELVIC", "code_information": [{"code": "20662", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION INTERVERTERAL DEVICE 22851", "code_information": [{"code": "22851", "type": "CPT"}, {"code": "1479958", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29000", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29010", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29015", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29035", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29040", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29044", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FINGER SPLINT", "code_information": [{"code": "29131", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LEG CAST", "code_information": [{"code": "29450", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29365", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST BRACE 29358", "code_information": [{"code": "29358", "type": "CPT"}, {"code": "1479960", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 213.92, "maximum": 8450.0, "gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 213.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG SPLINT-THIGH TO ANKLE/TOES 29505", "code_information": [{"code": "29505", "type": "CPT"}, {"code": "1479961", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 213.92, "maximum": 8450.0, "gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 213.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF MULTIPLANE UNILATERAL EXT. FIX. SYSTEM 20692", "code_information": [{"code": "20692", "type": "CPT"}, {"code": "1479955", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF PASTE BOOT", "code_information": [{"code": "29580", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SKIN SUBSTITUTE; EACH ADDITIONAL 100 SQ CM 15278", "code_information": [{"code": "15278", "type": "CPT"}, {"code": "28481847", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1154.0, "discounted_cash": 403.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 558.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SKIN SUBSTITUTE; TOTAL WOUND SURFACE AREA GREATER OR EQUAL TO 100 SQ CM 15277", "code_information": [{"code": "15277", "type": "CPT"}, {"code": "28481794", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 558.53, "maximum": 8450.0, "gross_charge": 1154.0, "discounted_cash": 403.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 558.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF UNIPLANE UNILATERAL EXT. FIX. SYSTEM 20690", "code_information": [{"code": "20690", "type": "CPT"}, {"code": "1479956", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION SHORT LEG SPLINT-CALF TO FOOT 29515", "code_information": [{"code": "29515", "type": "CPT"}, {"code": "1479968", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 128.74, "maximum": 8450.0, "gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION SKIN SUB. GRAFT TO TRK/ARM/LEG TOTAL WOUND AREA UP TO 100SQ CM/1ST 25SQ CM OR LESS 15271", "code_information": [{"code": "15271", "type": "CPT"}, {"code": "2025475", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 763.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION SKIN SUB. GRAFT-FACE-SCALP-EYELIDS-MOUTH-NECK-EARS-ORBITS-GENITALIA-HANDS-FEET-DIG 15275", "code_information": [{"code": "15275", "type": "CPT"}, {"code": "1582401", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION SPLINT FINGER-STATIC 29130", "code_information": [{"code": "29130", "type": "CPT"}, {"code": "1479971", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 20.32, "maximum": 8450.0, "gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION SPLINT FOREARM TO HAND-STATIC 29125", "code_information": [{"code": "29125", "type": "CPT"}, {"code": "1479973", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 65.34, "maximum": 8450.0, "gross_charge": 135.0, "discounted_cash": 47.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION SPLINT SHOULDER TO HAND 29105", "code_information": [{"code": "29105", "type": "CPT"}, {"code": "1479974", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 65.34, "maximum": 8450.0, "gross_charge": 135.0, "discounted_cash": 47.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATON ON-BODY INJECTOR", "code_information": [{"code": "96377", "type": "CPT"}], "standard_charges": [{"minimum": 168.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATOR BELLOW 5GM SPRY HEMOSTATIC FOR DEL OF ARISTA AH ABSORBL HEMOSTATIC PO", "code_information": [{"code": "SM0007-USA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.11, "discounted_cash": 58.14, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORAPREP 10.5ML 930700", "code_information": [{"code": "930700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.03, "discounted_cash": 5.61, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORAPREP 3ML CLEAR 930400", "code_information": [{"code": "930400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 10.5 ML ORANGE SKIN PREP CHLORAPREP LF", "code_information": [{"code": "260715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 26 ML ORANGE SKIN PREP CHLORAPREP LF", "code_information": [{"code": "260815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 3 ML ORANGE TINT SKIN PREP CHLORAPREP LF", "code_information": [{"code": "260415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLRPRP ORNG TNTD 10.5ML 930715", "code_information": [{"code": "930715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.46, "discounted_cash": 6.11, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR COTTON TIP WOOD 3 STERILE 31-848", "code_information": [{"code": "31-848", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR COTTON-TIP WOOD 6 STERIL MDS202000", "code_information": [{"code": "MDS202000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.06, "discounted_cash": 3.17, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR EXTENDED VITAGEL MALLEABLE", "code_information": [{"code": "2113-0002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR EXTENDID TIP 5.1MM X 8MM", "code_information": [{"code": "205108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 677.13, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR PROCTO RAYON TIP 16 NS 50 BX 816", "code_information": [{"code": "816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR SPNG 3 ML CLR SPONGE TIP 1-STEP PLASTIC SHAFT CHLORAPREP STRL", "code_information": [{"code": "260400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR SURG 38CM XL ABSORBL HEMOSTATIC PARTICLES ARISTA FLEXITIP", "code_information": [{"code": "AM0005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.7, "discounted_cash": 25.8, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR SURGICEL ENDOSCOPIC 3123SPEA", "code_information": [{"code": "3123SPEA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.7, "discounted_cash": 27.2, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR TIP DUAL SPRAY FOR GPS II SYS", "code_information": [{"code": "800-0201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIED 12X150 NON BLADE", "code_information": [{"code": "CFF71", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 11.5IN MED PREMIUM SURGICLIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "134053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 11.5IN SM PREMIUM SURGICLIP DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "134031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 145.0, "discounted_cash": 50.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 5MM X 34CM UNIVERSAL W/ 10 CLIP EPIX", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "CA500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 9.75IN MD PREMIUM SURGICLIP II SUPER INTERLOCK BLUE", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "134051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 9IN SM PREMIUM SURGICLIP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "134046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 43.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP ENDO 5MM EL5ML", "code_information": [{"code": "EL5ML", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP ENDO CLIP II 10MM TITANIUM 176657", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "176657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 603.0, "discounted_cash": 211.05, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP 20SMALL 9 3/8 MCS20", "code_information": [{"code": "MCS20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MD/LG STERILE ER320", "code_information": [{"code": "ER320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.86, "discounted_cash": 186.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MULTI 20LARGE 13 MCL20", "code_information": [{"code": "MCL20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MULTI 20MD 11 MCM20", "code_information": [{"code": "MCM20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MULTI 20MD 9 3/8 MSM20", "code_information": [{"code": "MSM20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP MED LNG 30 CLIP LIGACLIP MCA LIGACLIP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "MCM30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP SM 9.375IN MULTIPLE W/ TWENTY CLIP LIGACLIP", "code_information": [{"code": "MSC20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP SURGICLIP L-13.0 AUTO G 134048", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "134048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER MENISCAL CLIP REPAIR KNEE RAPIDLOC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 381.0, "discounted_cash": 133.35, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY FOREARM SPLINT", "code_information": [{"code": "29126", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTERSTIT RADIAT COMPL", "code_information": [{"code": "77778", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1249.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1732.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2723.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2723.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2723.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1134.19, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1209.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT COMPL", "code_information": [{"code": "77763", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1249.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1322.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2079.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2079.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2079.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 814.25, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 868.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT INTERM", "code_information": [{"code": "77762", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 914.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1006.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1582.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1582.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1582.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 618.16, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 658.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT SIMPLE", "code_information": [{"code": "77761", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 914.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 878.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1381.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1381.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1381.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 536.97, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 572.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY MULTLAY COMPRS LWR LEG", "code_information": [{"code": "29581", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY R&L PULM ART BANDS", "code_information": [{"code": "33620", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY RIGID LEG CAST", "code_information": [{"code": "29445", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29405", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29425", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29435", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SRS HEADFRAME ADD-ON", "code_information": [{"code": "61800", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 33274.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SURF LDR RADIONUCLIDE", "code_information": [{"code": "77789", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 280.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 440.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 440.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 440.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 176.84, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 188.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQAPRN-4 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86053", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQMBF PET REST & RX STRESS", "code_information": [{"code": "78434", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQMBF SPECT XERS/STRS & REST", "code_information": [{"code": "742T", "type": "CPT"}], "standard_charges": [{"minimum": 138.57, "maximum": 217.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 ANTB CBA EACH", "code_information": [{"code": "86052", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 ANTB ELISA", "code_information": [{"code": "86051", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY/EXERCISES", "code_information": [{"code": "97113", "type": "CPT"}], "standard_charges": [{"minimum": 174.81, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 274.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 274.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 274.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/O GRAFT", "code_information": [{"code": "66179", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR EXTERNAL APPROACH; WITH GRAFT 66180", "code_information": [{"code": "66180", "type": "CPT"}, {"code": "1479975", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR FULL SEQUENCE ANALYSIS", "code_information": [{"code": "230U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 549.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR GENE CHARAC ALLELES", "code_information": [{"code": "81204", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR GENE FULL GENE SEQUENCE", "code_information": [{"code": "81173", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 768.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR GENE KNOWN FAMIL VARIANT", "code_information": [{"code": "81174", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 472.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARCUS GUIDED ACCESS SYSTEM - BEVEL TIP STERILE 16122-02-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "16122-02-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1623.0, "discounted_cash": 568.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIA 8DEGX18X45X12 48751112", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48751112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIA 8DEGX18X45X14 48751114", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48751114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIA 8DEGX22X50X10 48753210", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48753210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIA 8DEGX22X50X12 48753212", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48753212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIA 8DEGX22X55X12 48753312", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48753312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIA 8DEGX22X60X12 48753412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48753412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIA ANCHORING PIN 100MM 48755900", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48755900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIA ANCHORING PIN 110MM 48755910", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48755910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIA ANCHORING PIN 140MM 48755940", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48755940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIA ANCHORING PIN 90MM 48755890", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48755890", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ARROW-LOK DEVICE 2.5-3.5MM X 30MM 27-253530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "27-253530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1390.0, "discounted_cash": 486.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARROW-LOK DEVICE HYBRID 2.5-3.5/22MM ANGLED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "27-253522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1550.0, "discounted_cash": 542.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARROW-LOK DEVICE HYBRID 2.5-3.5/25MM ANGLED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "27-253525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1390.0, "discounted_cash": 486.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARSENAL CALC PERIMETER PLATE LEFT 300-86-003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-86-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ART BYP AOR-CELIAC-MSN-RENAL", "code_information": [{"code": "35631", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AORSUBCL/CAROT/INNOM", "code_information": [{"code": "35626", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBI-ILIAC", "code_information": [{"code": "35638", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBIFEMORAL", "code_information": [{"code": "35646", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOFEMORAL", "code_information": [{"code": "35647", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOILIAC", "code_information": [{"code": "35637", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILL-FEM-FEMORAL", "code_information": [{"code": "35654", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-AXILLARY", "code_information": [{"code": "35650", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-FEMORAL", "code_information": [{"code": "35621", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-POP-TIBIAL", "code_information": [{"code": "35623", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-SUBCLAVIAN", "code_information": [{"code": "35606", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-VERTEBRAL", "code_information": [{"code": "35642", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP COMMON IPSI CAROTID", "code_information": [{"code": "35601", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35566", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35666", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-FEMORAL", "code_information": [{"code": "35661", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-POPLITEAL", "code_information": [{"code": "35656", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AOR/CAROT/INNOM", "code_information": [{"code": "35526", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORCEL/AORMESEN", "code_information": [{"code": "35531", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTBIFEMORAL", "code_information": [{"code": "35540", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOBI-ILIAC", "code_information": [{"code": "35538", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOFEMORAL", "code_information": [{"code": "35539", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOILIAC", "code_information": [{"code": "35537", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTORENAL", "code_information": [{"code": "35560", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-BRACHIAL", "code_information": [{"code": "35522", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-FEMORAL", "code_information": [{"code": "35521", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL/FEM/FEM", "code_information": [{"code": "35533", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILLARY-AXILRY", "code_information": [{"code": "35518", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRACHIAL-BRCHL", "code_information": [{"code": "35525", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRCHL-ULNR-RDL", "code_information": [{"code": "35523", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-BRCHIAL", "code_information": [{"code": "35510", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-VERTBRL", "code_information": [{"code": "35508", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CONTRAL CAROTID", "code_information": [{"code": "35509", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-FEMORAL", "code_information": [{"code": "35558", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35556", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT HEPATORENAL", "code_information": [{"code": "35535", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOFEMORAL", "code_information": [{"code": "35565", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOILIAC", "code_information": [{"code": "35563", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT IPSILAT CAROTID", "code_information": [{"code": "35501", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SPLENORENAL", "code_information": [{"code": "35536", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-AXILARY", "code_information": [{"code": "35516", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-BRCHIAL", "code_information": [{"code": "35512", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-CAROTID", "code_information": [{"code": "35506", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-SUBCLAV", "code_information": [{"code": "35511", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-VERTBRL", "code_information": [{"code": "35515", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-CELIAC", "code_information": [{"code": "35632", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-MESENTERIC", "code_information": [{"code": "35633", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOFEMORAL", "code_information": [{"code": "35665", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOILIAC", "code_information": [{"code": "35663", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIORENAL", "code_information": [{"code": "35634", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35571", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35671", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SPENORENAL", "code_information": [{"code": "35636", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-AXILLARY", "code_information": [{"code": "35616", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-SUBCLAVIAN", "code_information": [{"code": "35612", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-VERTEBRL", "code_information": [{"code": "35645", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP TIBIAL-TIB/PERONEAL", "code_information": [{"code": "35570", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART PRESSURE WAVEFORM ANALYS", "code_information": [{"code": "93050", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ CAROTID SUBCLAV", "code_information": [{"code": "35695", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAV CAROTID", "code_information": [{"code": "35694", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAVIAN", "code_information": [{"code": "35693", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ VERTBRL CAROTID", "code_information": [{"code": "35691", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY EXPOS/GRAFT ARTERY", "code_information": [{"code": "33987", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY TO VEIN SHUNT", "code_information": [{"code": "36835", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY TRANSPOSE/ENDOVAS TAA", "code_information": [{"code": "33889", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAY EACH VESSEL", "code_information": [{"code": "75774", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 289.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 455.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 455.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 455.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 121.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 129.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ABDOMEN", "code_information": [{"code": "75726", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 31575.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7463.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20085.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 186.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 198.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENAL GLAND", "code_information": [{"code": "75731", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1072.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 488.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 767.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 767.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 767.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 242.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 258.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENALS", "code_information": [{"code": "75733", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 271.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 289.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARM/LEG", "code_information": [{"code": "75710", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 162.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 173.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARMS/LEGS", "code_information": [{"code": "75716", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 172.03, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 183.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS CHEST", "code_information": [{"code": "75756", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 260.45, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 277.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75741", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 168.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 179.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75746", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1720.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 406.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 638.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 638.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 638.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 200.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 214.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNGS", "code_information": [{"code": "75743", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 172.03, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 183.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS PELVIS", "code_information": [{"code": "75736", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 31575.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7463.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20085.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 225.08, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 239.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS SPINE", "code_information": [{"code": "75705", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 31575.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7463.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20085.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 336.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 358.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN AUTOGRAFT", "code_information": [{"code": "36825", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN NONAUTOGRAFT", "code_information": [{"code": "36830", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHODESIS SACROILIAC JOINT INC. GRAFT/ INST. 27280", "code_information": [{"code": "27280", "type": "CPT"}, {"code": "2034629", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1437.15, "maximum": 14796.0, "gross_charge": 4355.0, "discounted_cash": 1524.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2107.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1437.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 2-3 VRT SGM", "code_information": [{"code": "22808", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 4-7 VRT SGM", "code_information": [{"code": "22810", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 8+ VRT SGM", "code_information": [{"code": "22812", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC THC", "code_information": [{"code": "22556", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT TORAL/XORAL C1-C2", "code_information": [{"code": "22548", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD HIP JT SBTRCHC OSTEOT", "code_information": [{"code": "27286", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ EA AD", "code_information": [{"code": "22534", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ LMBR", "code_information": [{"code": "22533", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ THRC", "code_information": [{"code": "22532", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PRE-SAC NTRBDY L5-S1", "code_information": [{"code": "22586", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 13+ VRT SGM", "code_information": [{"code": "22804", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 7-12 VRT SGM", "code_information": [{"code": "22802", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM<6 VRT SGM", "code_information": [{"code": "22800", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC CRV", "code_information": [{"code": "22600", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC THRC", "code_information": [{"code": "22610", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ ATLAS-AXIS", "code_information": [{"code": "22595", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ CRANIOCERVICAL", "code_information": [{"code": "22590", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD SI JT PRQ WO TFXJ DEV", "code_information": [{"code": "27278", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRO/SHOUL SURG; W/SPACER", "code_information": [{"code": "C9781", "type": "HCPCS"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROCENTESIS ASPIRATION AND/OR INJECTION INTERMEDIATE JT OR BURSA W/ULTRASOUND 20606", "code_information": [{"code": "20606", "type": "CPT"}, {"code": "38612798", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROCENTESIS SMALL JOINT OR BURSA; W/O ULTRASOUND GUIDANCE 20600", "code_information": [{"code": "20600", "type": "CPT"}, {"code": "1479979", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANKLE OPEN 27870", "code_information": [{"code": "27870", "type": "CPT"}, {"code": "1479980", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANT. INTER W/DISC PREP/DISCECTOMY/OSTEO W/DEC CERVICAL BEL C2 EA ADD SP 22552", "code_information": [{"code": "22552", "type": "CPT"}, {"code": "1643968", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 9357.0, "gross_charge": 6507.0, "discounted_cash": 2277.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3149.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANTERIOR INTERBODY CERVICAL BELOW C2 22551", "code_information": [{"code": "22551", "type": "CPT"}, {"code": "1479982", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2375.47, "maximum": 9735.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANTERIOR INTERBODY/INCL MIN. DISCECTOMY ; EA ADDTL INTERSPACE 22585", "code_information": [{"code": "22585", "type": "CPT"}, {"code": "1653278", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 9735.0, "gross_charge": 6022.0, "discounted_cash": 2107.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2914.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANTERIOR INTERBODY/INCL MIN. DISCECTOMY ; LUMBAR 22558", "code_information": [{"code": "22558", "type": "CPT"}, {"code": "1480967", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 14796.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANTERIOR INTERBODYBODY 22554", "code_information": [{"code": "22554", "type": "CPT"}, {"code": "1479981", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS CARPOMETACARPAL JOINT DIGIT OTHER THAN THUMB 26843", "code_information": [{"code": "26843", "type": "CPT"}, {"code": "1479984", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS CARPOMETACARPAL JOINT DIGIT W/AUTOGRAFT 26842", "code_information": [{"code": "26842", "type": "CPT"}, {"code": "1479985", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS CARPOMETACARPAL JOINT OTHER THAN THUMB W/AUTOGRAFT 26844", "code_information": [{"code": "26844", "type": "CPT"}, {"code": "1479986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS CARPOMETACARPAL JOINT THUMB 26841", "code_information": [{"code": "26841", "type": "CPT"}, {"code": "1479983", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS COMB. POSTERIOR INTERBODY TECH . W/LAMI OR DISC SIN. LUM. 22633", "code_information": [{"code": "22633", "type": "CPT"}, {"code": "1792992", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2347.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS DISTAL RADIOULNAR JT W/SEGMENTAL RESEC. ULNA 25830", "code_information": [{"code": "25830", "type": "CPT"}, {"code": "1700112", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2631.5, "maximum": 9357.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS FUSION IN OPPOSITION-THUMB W/ AUTOGENOUS GRAFT 26820", "code_information": [{"code": "26820", "type": "CPT"}, {"code": "1480000", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS GLENOHUMERAL JOINT 23800", "code_information": [{"code": "23800", "type": "CPT"}, {"code": "1479997", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS GLENOHUMERAL JOINT W/ AUTOGENOUS GRAFT 23802", "code_information": [{"code": "23802", "type": "CPT"}, {"code": "1479998", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS GREAT TOE/INTERPHALANGEAL JOINT 28755", "code_information": [{"code": "28755", "type": "CPT"}, {"code": "1479987", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS GREAT TOE/METATARSALPHALANGEAL JOINT 28750", "code_information": [{"code": "28750", "type": "CPT"}, {"code": "1479988", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS HIP JOINT", "code_information": [{"code": "27284", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS INTERPHALANGEAL JOINIT W/ OR W/O INTERNAL FIXATION EA ADD JT 26861", "code_information": [{"code": "26861", "type": "CPT"}, {"code": "1764934", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS INTERPHALANGEAL JOINT 26860", "code_information": [{"code": "26860", "type": "CPT"}, {"code": "1479989", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS INTERPHALANGEAL JOINT W/AUTOGRAFT 26862", "code_information": [{"code": "26862", "type": "CPT"}, {"code": "1479990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS METACARPOPHALANGELA JOINT 26850", "code_information": [{"code": "26850", "type": "CPT"}, {"code": "1479992", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS METACARPOPHALANGELA JOINT W/AUTOGRAFT 26852", "code_information": [{"code": "26852", "type": "CPT"}, {"code": "1479993", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS MIDTARSAL OR TARSOMETATARSAL-MULTIPLE OR TRANSVERSE 28730", "code_information": [{"code": "28730", "type": "CPT"}, {"code": "1479994", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS MIDTARSAL OR TARSOMETATARSAL-SINGLE JOINT 28740", "code_information": [{"code": "28740", "type": "CPT"}, {"code": "1479995", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS MIDTARSAL/TARSOMETATARSAL MULTI OR TRANSVERSE W/OSTEOTOMY 28735", "code_information": [{"code": "28735", "type": "CPT"}, {"code": "9761830", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2375.47, "maximum": 9735.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS PANTALAR 28705", "code_information": [{"code": "28705", "type": "CPT"}, {"code": "4734920", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2375.47, "maximum": 9735.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS PANTALAR SUBTALAR 28725", "code_information": [{"code": "28725", "type": "CPT"}, {"code": "1479999", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS PANTALAR TRIPLE 28715", "code_information": [{"code": "28715", "type": "CPT"}, {"code": "1479996", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS POST INTERBODY TECH W/LAMI OR DISCECTOMY PREP INTERSP 22632", "code_information": [{"code": "22632", "type": "CPT"}, {"code": "1653281", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 6143.0, "discounted_cash": 2150.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2973.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS POST/POSTEROLATERAL TECH. W/POST. INT. TECH INC. LAMI/DISCECTOMY EA. ADD. SPACE 22634", "code_information": [{"code": "22634", "type": "CPT"}, {"code": "2401823", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS POSTERIOR POSTEROLATERAL TECH EA ADD VERT 22614", "code_information": [{"code": "22614", "type": "CPT"}, {"code": "1653277", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS SACROILIAC JT. PERCUT. OR MIN. INV. W/IMAGE INC. TRANSFIX DEVICE 27279", "code_information": [{"code": "27279", "type": "CPT"}, {"code": "41282644", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1037.21, "maximum": 14796.0, "gross_charge": 2143.0, "discounted_cash": 750.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1037.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS SYMPHYSIS PUBIS", "code_information": [{"code": "27282", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS TIBIOFIBULAR JOINT 27871", "code_information": [{"code": "27871", "type": "CPT"}, {"code": "1480001", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS W/EXT. HALLUCIS LONGUS TRANSFER TO 1ST METATARSASL GREAT TOE INTERPHALANGEAL JOINT 28760", "code_information": [{"code": "28760", "type": "CPT"}, {"code": "2156865", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2375.47, "maximum": 9735.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS W/TENDON LENGTHENING AND ADVANCEMENT MIDTARSAL 28737", "code_information": [{"code": "28737", "type": "CPT"}, {"code": "1480002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS WRIST COMPLETE 25800", "code_information": [{"code": "25800", "type": "CPT"}, {"code": "1480003", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS WRIST LIMITED 25820", "code_information": [{"code": "25820", "type": "CPT"}, {"code": "1480004", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 9357.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS WRIST LIMITED W/AUTOGRAFT 25825", "code_information": [{"code": "25825", "type": "CPT"}, {"code": "1480005", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9735.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS WRIST W/ILIAC GRAFT 25810", "code_information": [{"code": "25810", "type": "CPT"}, {"code": "1480006", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS WRIST W/SLIDING GRAFT 25805", "code_information": [{"code": "25805", "type": "CPT"}, {"code": "1480007", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROEREISIS SUBTALAR S2117", "code_information": [{"code": "S2117", "type": "HCPCS"}, {"code": "4734915", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13222.0, "discounted_cash": 4627.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTHROFLEX 20X25X1.0MM AFLEX402", "code_information": [{"code": "Q4125", "type": "HCPCS"}, {"code": "AFLEX402", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTHROPLASTY ACETABULAR & PROXIMAL FEMORAL PROSTHETIC REPLACEMENT 27130", "code_information": [{"code": "27130", "type": "CPT"}, {"code": "1480008", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2375.47, "maximum": 16063.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10038.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14437.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15789.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15789.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 16063.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 16063.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY ANKLE 27700", "code_information": [{"code": "27700", "type": "CPT"}, {"code": "1480009", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY ANKLE TOTAL REPLACEMENT 27702", "code_information": [{"code": "27702", "type": "CPT"}, {"code": "1480010", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2375.47, "maximum": 16063.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14250.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10038.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14437.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15789.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15789.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 16063.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 16063.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY ANKLE TOTAL REPLACEMENT-REVISION 27703", "code_information": [{"code": "27703", "type": "CPT"}, {"code": "1480011", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.67, "maximum": 9735.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY ELBOW 24360", "code_information": [{"code": "24360", "type": "CPT"}, {"code": "1480012", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY ELBOW TOTAL REPLACEMENT 24363", "code_information": [{"code": "24363", "type": "CPT"}, {"code": "1480013", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY FEMORAL CONDYLES OR TIBIAL PLATEAU KNEE 27442", "code_information": [{"code": "27442", "type": "CPT"}, {"code": "1480014", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY FEMORAL CONDYLES OR TIBIAL PLATEAU W/DEBRIDEMENT AND PARTIAL SYNOVECTOMY 27443", "code_information": [{"code": "27443", "type": "CPT"}, {"code": "8822132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2115.56, "maximum": 9357.0, "gross_charge": 4371.0, "discounted_cash": 1529.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2115.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY GLENOHUMERAL JOINT SHOULDER 23470", "code_information": [{"code": "23470", "type": "CPT"}, {"code": "1480015", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY INTERPHALANGEAL JOINT 26535", "code_information": [{"code": "26535", "type": "CPT"}, {"code": "1480017", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY INTERPHALANGEAL JOINT W/IMPLANT 26536", "code_information": [{"code": "26536", "type": "CPT"}, {"code": "1480018", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY INTERPOSITION INTERCARPAL/CARPOMETACARPAL JOINTS 25447", "code_information": [{"code": "25447", "type": "CPT"}, {"code": "1480019", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY KNEE CONDYLE & PLATEAU MEDIAL AND LATERAL 27447", "code_information": [{"code": "27447", "type": "CPT"}, {"code": "1480020", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3471.0, "maximum": 16063.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14250.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10038.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14437.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15789.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15789.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 16063.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 16063.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY KNEE CONDYLE AND PLATEA MEDIAL OR LATERAL COMPARTMENT 27446", "code_information": [{"code": "27446", "type": "CPT"}, {"code": "1480023", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 16063.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 16063.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 16063.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY METACARPOPHALANGEAL JOINT 26530", "code_information": [{"code": "26530", "type": "CPT"}, {"code": "1480024", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY METACARPOPHALANGEAL JOINT W/IMPLANT 26531", "code_information": [{"code": "26531", "type": "CPT"}, {"code": "1480025", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY PATELLA W/O PROSTHESIS 27437", "code_information": [{"code": "27437", "type": "CPT"}, {"code": "1480026", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY PATELLA W/PROSTHESIS 27438", "code_information": [{"code": "27438", "type": "CPT"}, {"code": "1480027", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY RADIAL HEAD 24365", "code_information": [{"code": "24365", "type": "CPT"}, {"code": "2401682", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY RADIUS W/ IMPLANT 24366", "code_information": [{"code": "24366", "type": "CPT"}, {"code": "1480028", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY TEMPORAL MANDIBULAR JOINT W/JOINT REPLACEMENT 21243", "code_information": [{"code": "21243", "type": "CPT"}, {"code": "1480029", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY TEMPORAL MANDIBULAR JOINT W/OR W/O AUTOGRAFT 21240", "code_information": [{"code": "21240", "type": "CPT"}, {"code": "1480030", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY W/PROSTHETIC REPLACEMENT OF DISTAL RADIUS 25441", "code_information": [{"code": "25441", "type": "CPT"}, {"code": "1480035", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY W/PROSTHETIC REPLACEMENT OF LUNATE BONE 25444", "code_information": [{"code": "25444", "type": "CPT"}, {"code": "1480036", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY W/PROSTHETIC REPLACEMENT OF NAVICULAR BONE 25443", "code_information": [{"code": "25443", "type": "CPT"}, {"code": "1480037", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY W/PROSTHETIC REPLACEMENT OF TRAPEZIUM BONE 25445", "code_information": [{"code": "25445", "type": "CPT"}, {"code": "1480038", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY WRIST DISTAL ULNA 25442", "code_information": [{"code": "25442", "type": "CPT"}, {"code": "1480039", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY WRIST INTERPOSITION 25332", "code_information": [{"code": "25332", "type": "CPT"}, {"code": "1480040", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY WRIST REVISION 25449", "code_information": [{"code": "25449", "type": "CPT"}, {"code": "1480041", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY WRIST TOTAL REPLACEMENT 25446", "code_information": [{"code": "25446", "type": "CPT"}, {"code": "1480042", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY; INTERCARPAL/CARPOMETACARPAL JOINTS 25448", "code_information": [{"code": "25448", "type": "CPT"}, {"code": "46436888", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "gross_charge": 3197.57, "discounted_cash": 1119.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPIC DEBRIDEMENT SHOULDER-EXTENSIVE 29823", "code_information": [{"code": "29823", "type": "CPT"}, {"code": "1480043", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPIC DEBRIDEMENT SHOULDER-LIMITED 29822", "code_information": [{"code": "29822", "type": "CPT"}, {"code": "1480044", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPIC REPAIR OSTEOCHON.DISSICAN LESION/TIBIAL PLAFOND FX/TALAR FX 29892", "code_information": [{"code": "29892", "type": "CPT"}, {"code": "1480045", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 8135.0, "discounted_cash": 2847.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3937.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPICALLY AIDED INTERNAL FIXATION OF PROXIMAL TIBIAL FRACTURE 29855", "code_information": [{"code": "29855", "type": "CPT"}, {"code": "2401713", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6507.0, "discounted_cash": 2277.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3149.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPICALLY AIDED KNEE ANTERIOR CRUCIATE LIGAMENT REPAIR/RECONSTRUCTION 29888", "code_information": [{"code": "29888", "type": "CPT"}, {"code": "1480046", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPICALLY AIDED KNEE POSTERIOR CRUCIATE LIGAMENT REPAIR/RECONSTRUCTION 29889", "code_information": [{"code": "29889", "type": "CPT"}, {"code": "1480047", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPICALLY AIDED TREAT. INTERCONDYLAR SPINE AND/OR TUBEROSITY FX KNEE W/O INT/EXT. FIX 29850", "code_information": [{"code": "29850", "type": "CPT"}, {"code": "9555601", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2375.47, "maximum": 8450.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FX PROX. BICONDYLAR W/INT. FIX. 29856", "code_information": [{"code": "29856", "type": "CPT"}, {"code": "1909740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPICALLY TREAT INTERCONYLAR SPINE AND/OR TUBER. FX KNEE W/ INT/EXT FIX AND/OR MANIP 29851", "code_information": [{"code": "29851", "type": "CPT"}, {"code": "9975573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 6501.0, "discounted_cash": 2275.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3146.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY", "code_information": [{"code": "509", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10258.98, "maximum": 17612.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10258.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14672.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16139.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17612.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ANKLE W/EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR TIBIA 29891", "code_information": [{"code": "29891", "type": "CPT"}, {"code": "1480050", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ANKLE W/EXTENSIVE DEBRIBEMENT 29898", "code_information": [{"code": "29898", "type": "CPT"}, {"code": "1480051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ANKLE W/LIMITED DEBRIDEMENT 29897", "code_information": [{"code": "29897", "type": "CPT"}, {"code": "1480052", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ANKLE W/PARTIAL SYNOVECTOMY 29895", "code_information": [{"code": "29895", "type": "CPT"}, {"code": "1480053", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY 29894", "code_information": [{"code": "29894", "type": "CPT"}, {"code": "1480054", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ELBOW W/COMPLETE SYNOVECTOMY 29836", "code_information": [{"code": "29836", "type": "CPT"}, {"code": "1480055", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ELBOW W/EXTENSIVE DEBRIDEMENT 29838", "code_information": [{"code": "29838", "type": "CPT"}, {"code": "1480056", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ELBOW W/LIMITED DEBRIDEMENT 29837", "code_information": [{"code": "29837", "type": "CPT"}, {"code": "1480057", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ELBOW W/PARTIAL SYNOVECTOMY 29835", "code_information": [{"code": "29835", "type": "CPT"}, {"code": "1480058", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ELBOW W/REMOVAL LOOSE BODY 29834", "code_information": [{"code": "29834", "type": "CPT"}, {"code": "1480059", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ELBOW-DIAGNOSTIC 29830", "code_information": [{"code": "29830", "type": "CPT"}, {"code": "1480060", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY HIP DIAGNOSTIC W OR W/O SYNOVIAL BIOPSY 29860", "code_information": [{"code": "29860", "type": "CPT"}, {"code": "3927235", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 10152.0, "discounted_cash": 3553.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4913.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY HIP SURGICAL W/REMOVAL OF LOOSE BODY W/LABRAL REPAIR 29916", "code_information": [{"code": "29916", "type": "CPT"}, {"code": "1764921", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1465.55, "maximum": 9735.0, "gross_charge": 3028.0, "discounted_cash": 1059.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1465.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE CHONDROPLASTY 29877", "code_information": [{"code": "29877", "type": "CPT"}, {"code": "1480064", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE DIAGNOSTIC 29870", "code_information": [{"code": "29870", "type": "CPT"}, {"code": "1480063", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE FOR INFECTION LAVAGE AND DRAINAGE 29871", "code_information": [{"code": "29871", "type": "CPT"}, {"code": "1480065", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE LATERAL RELEASE 29873", "code_information": [{"code": "29873", "type": "CPT"}, {"code": "1480066", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT 29867", "code_information": [{"code": "29867", "type": "CPT"}, {"code": "1480068", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6507.0, "discounted_cash": 2277.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3149.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/ABRASION ARTHROPLASTY/MICROFRACTURE 29879", "code_information": [{"code": "29879", "type": "CPT"}, {"code": "1480070", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS 29886", "code_information": [{"code": "29886", "type": "CPT"}, {"code": "1480071", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/DRILLING FOR OSTEOCHONDRITIS DISSECANS 29885", "code_information": [{"code": "29885", "type": "CPT"}, {"code": "1480072", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/DRILLING FOR OSTEOCHONDRITIS DISSECANS W/INTERNAL FIXATION 29887", "code_information": [{"code": "29887", "type": "CPT"}, {"code": "1480073", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/LYSIS OF ADHESIONS 29884", "code_information": [{"code": "29884", "type": "CPT"}, {"code": "1480074", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/MEDIAL AND LATERAL MENISCAL REPAIR 29883", "code_information": [{"code": "29883", "type": "CPT"}, {"code": "1480075", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/MEDIAL AND LATERAL MENISCECTOMY 29880", "code_information": [{"code": "29880", "type": "CPT"}, {"code": "1480076", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/MEDIAL OR LATERAL MENISCAL REPAIR 29882", "code_information": [{"code": "29882", "type": "CPT"}, {"code": "1480077", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/MEDIAL OR LATERAL MENISCECTOMY 29881", "code_information": [{"code": "29881", "type": "CPT"}, {"code": "1427822", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/REM OF FOREIGN BODY DEBRID/SHAVE ART. CART DIFF COMP. G0289", "code_information": [{"code": "G0289", "type": "HCPCS"}, {"code": "1807645", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 3147.45, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/REMOVAL LOOSE BODY 29874", "code_information": [{"code": "29874", "type": "CPT"}, {"code": "1480078", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/SYNOVECTOMY-1 COMPARTMENT 29875", "code_information": [{"code": "29875", "type": "CPT"}, {"code": "1480079", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE W/SYNOVECTOMY-2 OR MORE COMPARTMENTS 29876", "code_information": [{"code": "29876", "type": "CPT"}, {"code": "1480080", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SHOULDER FOR EXCISION OF DISTAL CLAVICLE 29824", "code_information": [{"code": "29824", "type": "CPT"}, {"code": "1480081", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SHOULDER FOR REMOVAL LOOSE/FOREIGN BODY 29819", "code_information": [{"code": "29819", "type": "CPT"}, {"code": "1480082", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SHOULDER REPAIR OF SUPERIOR LABRUM ANTERIOR TO POSTERIOR TEAR 29807", "code_information": [{"code": "29807", "type": "CPT"}, {"code": "1480083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR 29827", "code_information": [{"code": "29827", "type": "CPT"}, {"code": "1480084", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY 29806", "code_information": [{"code": "29806", "type": "CPT"}, {"code": "1697275", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SHOULDER W/BICEPS TENDONESIS 29828", "code_information": [{"code": "29828", "type": "CPT"}, {"code": "1480085", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SHOULDER W/COMPLETE SYNOVECTOMY 29821", "code_information": [{"code": "29821", "type": "CPT"}, {"code": "1480086", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SHOULDER W/LYSIS OF ADHESIONS 29825", "code_information": [{"code": "29825", "type": "CPT"}, {"code": "1480087", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SHOULDER W/PARTIAL SYNOVECTOMY 29820", "code_information": [{"code": "29820", "type": "CPT"}, {"code": "1480088", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SHOULDER W/SUBACROMIAL DECOMPRESSION/ACROMIOPLASTY 29826", "code_information": [{"code": "29826", "type": "CPT"}, {"code": "1480089", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SHOULDER-DIAGNOSTIC 29805", "code_information": [{"code": "29805", "type": "CPT"}, {"code": "1480090", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY SUBTALAR JOINT SURGICAL W/SNYOVECTOMY 29905", "code_information": [{"code": "29905", "type": "CPT"}, {"code": "7633151", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY TEMPORAL MANDIBULAR JOINT-SURGICAL 29804", "code_information": [{"code": "29804", "type": "CPT"}, {"code": "1480093", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY W/ARTHRODESIS SUBTALAR JOINT 29907", "code_information": [{"code": "29907", "type": "CPT"}, {"code": "1480094", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 13648.8, "gross_charge": 28200.0, "discounted_cash": 9870.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 13648.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY WRIST FOR COMPLETE SYNOVECTOMY 29845", "code_information": [{"code": "29845", "type": "CPT"}, {"code": "1480095", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY WRIST FOR DEBRIDEMENT 29846", "code_information": [{"code": "29846", "type": "CPT"}, {"code": "1479978", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY WRIST FOR INTERNAL FIXATION 29847", "code_information": [{"code": "29847", "type": "CPT"}, {"code": "1480096", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY WRIST FOR PARTIAL SYNOVECTOMY 29844", "code_information": [{"code": "29844", "type": "CPT"}, {"code": "1480097", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY WRIST-DIAGNOSTIC 29840", "code_information": [{"code": "29840", "type": "CPT"}, {"code": "1480098", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY WRIST-FOR INFECTION LAVAGE AND DRAINAGE 29843", "code_information": [{"code": "29843", "type": "CPT"}, {"code": "1480099", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY ANKLE INCLUDING EXPLORATION DRAINAGE REMOVAL FB 27610", "code_information": [{"code": "27610", "type": "CPT"}, {"code": "1480100", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY ANKLE W/TENOSYNOVECTOMY 27626", "code_information": [{"code": "27626", "type": "CPT"}, {"code": "1480101", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY ANKLE WITH OR WITHOUT BIOPSY/FOREIGN BODY REMOVAL 27620", "code_information": [{"code": "27620", "type": "CPT"}, {"code": "2401687", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY ELBOW W/ CAPSULAR RELEASE 24006", "code_information": [{"code": "24006", "type": "CPT"}, {"code": "1480103", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY ELBOW W/ SYNOVIAL BIOPSY 24100", "code_information": [{"code": "24100", "type": "CPT"}, {"code": "1480102", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY ELBOW W/EXPLORATION/DRAINAGE/REMOVAL OF FB 24000", "code_information": [{"code": "24000", "type": "CPT"}, {"code": "1480104", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY ELBOW W/JOINT EXPLORATION 24101", "code_information": [{"code": "24101", "type": "CPT"}, {"code": "1480105", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY FOOT INTERTARSAL/TARSOMETATARSAL JOINT 28020", "code_information": [{"code": "28020", "type": "CPT"}, {"code": "1480106", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY FOOT METOTARSAOPHALANGEAL JOINT 28022", "code_information": [{"code": "28022", "type": "CPT"}, {"code": "1480107", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY GLENOHUMERAL JOINT INC. BIOPSY 23100", "code_information": [{"code": "23100", "type": "CPT"}, {"code": "44626046", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY HIP W/ EXPLORATION/REMOVAL OF FB 27033", "code_information": [{"code": "27033", "type": "CPT"}, {"code": "1480108", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY INTERPHANALNGEAL JOINT 26080", "code_information": [{"code": "26080", "type": "CPT"}, {"code": "1480109", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY KNEE INC. JT. EXPLORATION BIOPSY OR REMOVAL OF LOOSE OR FOREIGN BODIES 27331", "code_information": [{"code": "27331", "type": "CPT"}, {"code": "1945953", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY KNEE W/MENISCAL REPAIR 27403", "code_information": [{"code": "27403", "type": "CPT"}, {"code": "1480112", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY KNEE W/SYNOVECTOMY 27334", "code_information": [{"code": "27334", "type": "CPT"}, {"code": "1480114", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY KNEE W/SYNOVIAL BIOPSY 27330", "code_information": [{"code": "27330", "type": "CPT"}, {"code": "1480113", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY METACARPPHALANGEAL JOINT 26075", "code_information": [{"code": "26075", "type": "CPT"}, {"code": "1480115", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY SHOULDER", "code_information": [{"code": "23044", "type": "CPT"}, {"code": "1480116", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY TOE INTERPHALANGEAL JOINT 28024", "code_information": [{"code": "28024", "type": "CPT"}, {"code": "1480117", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY W/ SYNOVECTOMY ELBOW 24102", "code_information": [{"code": "24102", "type": "CPT"}, {"code": "1482182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY W/BIOPSY METACARPOPHALANGEAL JOINT 26015", "code_information": [{"code": "26105", "type": "CPT"}, {"code": "5324746", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY W/SYNOVECTOMY ANKLE 27625", "code_information": [{"code": "27625", "type": "CPT"}, {"code": "1994342", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY WITH BIOPSY CARPOMETARCARPAL JOINT 26100", "code_information": [{"code": "26100", "type": "CPT"}, {"code": "1480118", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY WITH BIOPSY INTERPHALANGEAL JOINT 26110", "code_information": [{"code": "26110", "type": "CPT"}, {"code": "1480119", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY WITH EXPLORATION CARPOMETACARPAL JOINT 26070", "code_information": [{"code": "26070", "type": "CPT"}, {"code": "1480120", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY WRIST DISTAL RADIAOULNAR JOINT 25107", "code_information": [{"code": "25107", "type": "CPT"}, {"code": "1480121", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY WRIST W/BIOPSY 25100", "code_information": [{"code": "25100", "type": "CPT"}, {"code": "1480122", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY WRIST W/CARPAL JOINT W/ DRAINAGE/REMOVAL FB 25040", "code_information": [{"code": "25040", "type": "CPT"}, {"code": "1480123", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY WRIST W/JOINT EXPLORATION 25101", "code_information": [{"code": "25101", "type": "CPT"}, {"code": "1480124", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY WRIST W/SYNOVECTOMY 25105", "code_information": [{"code": "25105", "type": "CPT"}, {"code": "1480125", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58321", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58322", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AS-AORT GRF F/AORTIC DSJ", "code_information": [{"code": "33858", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AS-AORT GRF F/DS OTH/THN DSJ", "code_information": [{"code": "33859", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASA/ANTIPLAT THER USED", "code_information": [{"code": "G8598", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASAY OF INTERLEUKIN-6 (IL-6)", "code_information": [{"code": "83529", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33863", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33864", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASCENT PRI LIP BRG 10X63/67", "code_information": [{"code": "179310", "type": "CDM"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCENT PRI LIP BRG 12X59", "code_information": [{"code": "179301", "type": "CDM"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCENT PRI LIP BRG 16X59", "code_information": [{"code": "179303", "type": "CDM"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 33.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCENT PRI LIP BRG 20X59", "code_information": [{"code": "179305", "type": "CDM"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCENT REV FMRL STEM 18X150", "code_information": [{"code": "179074", "type": "CDM"}], "standard_charges": [{"gross_charge": 2517.0, "discounted_cash": 880.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCOPE 4 RHINOLARYNGO SLIM 510001000", "code_information": [{"code": "510001000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 421.0, "discounted_cash": 147.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCVD RISK >=20PCT", "code_information": [{"code": "M1364", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASHKENAZI JEWISH ASSOC DIS", "code_information": [{"code": "81412", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 9818.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3060.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6243.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3525.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3525.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPA GENE", "code_information": [{"code": "81200", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 59.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 68.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 68.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS AG IA", "code_information": [{"code": "87305", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS ANTIBODY", "code_information": [{"code": "86606", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIR/INJ THYROID CYST", "code_information": [{"code": "60300", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W/ IMAGING", "code_information": [{"code": "32555", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1334.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W/O IMAGING", "code_information": [{"code": "32554", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1334.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION & INJECTION BONE CYST 20615", "code_information": [{"code": "20615", "type": "CPT"}, {"code": "1480126", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION AND/OR INJECTION OF GANGLION CYST 20612", "code_information": [{"code": "20612", "type": "CPT"}, {"code": "10236967", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1127.0, "discounted_cash": 394.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 545.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION BLADDER W/INSERTION OF SUPRAPUBIC CATHETER 51102", "code_information": [{"code": "51102", "type": "CPT"}, {"code": "1480129", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION BREAST CYST 19000", "code_information": [{"code": "19000", "type": "CPT"}, {"code": "1480130", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION INTERMEDIATE JOINT/BURSA W/O ULTRASOUND GUIDANCE 20605", "code_information": [{"code": "20605", "type": "CPT"}, {"code": "1480131", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION OF TUNICA VAGINALIS HYDROCELE 55000", "code_information": [{"code": "55000", "type": "CPT"}, {"code": "1480133", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION OR RELEASE OF VITREOUS SUBRETINAL OR CHOROIDAL FLUID PARS PLANA 67015", "code_information": [{"code": "67015", "type": "CPT"}, {"code": "1480134", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION ORBITAL CONTENTS", "code_information": [{"code": "67415", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION/INJECTION MAJOR JOINT/BURSA W/O ULTRASOUND GUIDANCE 20610", "code_information": [{"code": "20610", "type": "CPT"}, {"code": "1480132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATOR FLOOR PUDDLEVAC SUCTION DE 9321", "code_information": [{"code": "9321", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIRIN NOT USED, NO RSN", "code_information": [{"code": "M1057", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRIN USED", "code_information": [{"code": "M1055", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY 17- KETOSTEROIDS", "code_information": [{"code": "83586", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ACID PHOSPHATASE", "code_information": [{"code": "84060", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ACTIVATED PROTEIN C", "code_information": [{"code": "85307", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ALKALINE PHOSPHATASE", "code_information": [{"code": "84078", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 33.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 33.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ALKALINE PHOSPHATASES", "code_information": [{"code": "84080", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY AMINOLEVULINIC ACID", "code_information": [{"code": "82135", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 65.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 65.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 65.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ANTI-MULLERIAN HORM", "code_information": [{"code": "82166", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 154.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 154.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 154.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY BLOOD CARBON DIOXIDE", "code_information": [{"code": "82374", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY BLOOD CATECHOLAMINES", "code_information": [{"code": "82383", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 38.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 116.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 116.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 116.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 41.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 41.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY C-D TRANSFER MEASURE", "code_information": [{"code": "82373", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY CARBAMAZEPINE FREE", "code_information": [{"code": "80157", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY CARBOXYHB QUAL", "code_information": [{"code": "82376", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY CARBOXYHB QUANT", "code_information": [{"code": "82375", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY CHONDROITIN SULFATE", "code_information": [{"code": "82485", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 82.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 82.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 82.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY DIR MEAS FR ESTRADIOL", "code_information": [{"code": "82681", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 112.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 112.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 112.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY DUODENAL FLUID TRYPSIN", "code_information": [{"code": "84485", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY FOR CALPROTECTIN FECAL", "code_information": [{"code": "83993", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 78.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 78.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 78.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY FOR PHENCYCLIDINE", "code_information": [{"code": "83992", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 51.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 51.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY FREE HYDROXYPROLINE", "code_information": [{"code": "83500", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 90.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 90.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 90.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY GALACTOSE TRANSFERASE", "code_information": [{"code": "82775", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 84.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 84.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 84.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY GROWTH HORMONE (HGH)", "code_information": [{"code": "83003", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 66.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 66.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 66.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY IGA/IGD/IGG/IGM EACH", "code_information": [{"code": "82784", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY LIPOPROTEIN PLA2", "code_information": [{"code": "83698", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 57.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 118.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 185.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 185.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 185.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 66.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 66.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY MALATE DEHYDROGENASE", "code_information": [{"code": "83775", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY MYELOPEROXIDASE", "code_information": [{"code": "83876", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 63.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 203.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 203.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 203.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 73.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 73.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY NEPHELOMETRY NOT SPEC", "code_information": [{"code": "83883", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY NONENDOCRINE RECEPTOR", "code_information": [{"code": "84238", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 56.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 146.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 146.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 146.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 52.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 52.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF 17-HYDROXYPREGNENO", "code_information": [{"code": "84143", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 91.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 91.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 91.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF 5-HIAA", "code_information": [{"code": "83497", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ACTH", "code_information": [{"code": "82024", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 59.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 154.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 154.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 154.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ADP & AMP", "code_information": [{"code": "82030", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 103.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 103.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 103.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ALDOLASE", "code_information": [{"code": "82085", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ALDOSTERONE", "code_information": [{"code": "82088", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 103.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 163.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 163.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 163.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ALUMINUM", "code_information": [{"code": "82108", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF AMIKACIN", "code_information": [{"code": "80150", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF AMMONIA", "code_information": [{"code": "82140", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ANDROSTENEDIONE", "code_information": [{"code": "82157", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ANDROSTERONE", "code_information": [{"code": "82160", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 38.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ANGIOTENSIN II", "code_information": [{"code": "82163", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 82.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 82.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 82.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF APOLIPOPROTEIN", "code_information": [{"code": "82172", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 84.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 84.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 84.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ARSENIC", "code_information": [{"code": "82175", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 76.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 76.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 76.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ASCORBIC ACID", "code_information": [{"code": "82180", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF B HEXOSAMINIDASE EA", "code_information": [{"code": "83080", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BETA-2 PROTEIN", "code_information": [{"code": "82232", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BIOTINIDASE", "code_information": [{"code": "82261", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD CHLORIDE", "code_information": [{"code": "82435", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD FATTY ACIDS", "code_information": [{"code": "82725", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD LIPOPROTEIN", "code_information": [{"code": "83719", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD OSMOLALITY", "code_information": [{"code": "83930", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD PKU", "code_information": [{"code": "84030", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BRADYKININ", "code_information": [{"code": "82286", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BREATH ETHANOL", "code_information": [{"code": "82075", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 120.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 120.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 120.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 43.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 43.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF C-PEPTIDE", "code_information": [{"code": "84681", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CADMIUM", "code_information": [{"code": "82300", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 35.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 60.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 94.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 94.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 94.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 34.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CALCIUM IN URINE", "code_information": [{"code": "82340", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CARNITINE", "code_information": [{"code": "82379", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CAROTENE", "code_information": [{"code": "82380", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 36.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 36.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CATHEPSIN-D", "code_information": [{"code": "82387", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CERULOPLASMIN", "code_information": [{"code": "82390", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CHLORAMPHENICOL", "code_information": [{"code": "82415", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CHROMIUM", "code_information": [{"code": "82495", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 81.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 81.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 81.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CITRATE", "code_information": [{"code": "82507", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 42.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 70.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 111.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 111.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 111.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF COPPER", "code_information": [{"code": "82525", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CORTICOSTERONE", "code_information": [{"code": "82528", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 90.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 90.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 90.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 32.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CREATINE", "code_information": [{"code": "82540", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CRYOFIBRINOGEN", "code_information": [{"code": "82585", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CRYOGLOBULIN", "code_information": [{"code": "82595", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CSF PROTEIN", "code_information": [{"code": "83873", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CYANIDE", "code_information": [{"code": "82600", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 77.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 77.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 77.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF DIBUCAINE NUMBER", "code_information": [{"code": "82638", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF DIGOXIN FREE", "code_information": [{"code": "80163", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ENDOCRINE HORMONE", "code_information": [{"code": "84235", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 89.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 285.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 285.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 285.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 102.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 102.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ERYTHROPOIETIN", "code_information": [{"code": "82668", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTRIOL", "code_information": [{"code": "82677", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 34.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTROGEN", "code_information": [{"code": "82672", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 87.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 87.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 87.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTROGEN", "code_information": [{"code": "84233", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 109.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 224.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 352.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 352.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 352.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 126.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 126.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTROGENS", "code_information": [{"code": "82671", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 49.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 82.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 129.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 129.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 129.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 46.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 46.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTRONE", "code_information": [{"code": "82679", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 38.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 100.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 100.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 100.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 35.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 35.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ETHOSUXIMIDE", "code_information": [{"code": "80168", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ETHYLENE GLYCOL", "code_information": [{"code": "82693", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ETIOCHOLANOLONE", "code_information": [{"code": "82696", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 105.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 105.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 105.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 37.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 37.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECAL FAT", "code_information": [{"code": "82715", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECES FOR TRYPSIN", "code_information": [{"code": "84490", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECES PORPHYRINS", "code_information": [{"code": "84126", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 48.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 99.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 156.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 156.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 156.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 56.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECES/UROBILINOGEN", "code_information": [{"code": "84577", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FETAL FIBRONECTIN", "code_information": [{"code": "82731", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FLUORIDE", "code_information": [{"code": "82735", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FOLIC ACID RBC", "code_information": [{"code": "82747", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 70.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 70.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 70.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FOLIC ACID SERUM", "code_information": [{"code": "82746", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF G6PD ENZYME", "code_information": [{"code": "82955", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GALACTOSE", "code_information": [{"code": "82760", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 44.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 44.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 44.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GASTRIN", "code_information": [{"code": "82941", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 70.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 70.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 70.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GDH ENZYME", "code_information": [{"code": "82965", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GENTAMICIN", "code_information": [{"code": "80170", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 65.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 65.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 65.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GGT", "code_information": [{"code": "82977", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GLUCAGON", "code_information": [{"code": "82943", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GLUCOSIDASE", "code_information": [{"code": "82963", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 86.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 86.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 86.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GLUTATHIONE", "code_information": [{"code": "82978", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 61.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 61.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 61.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GLYCATED PROTEIN", "code_information": [{"code": "82985", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HALOPERIDOL", "code_information": [{"code": "80173", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 63.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 63.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HAPTOGLOBIN QUANT", "code_information": [{"code": "83010", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HAPTOGLOBINS", "code_information": [{"code": "83012", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 107.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 107.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 107.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HEMOSIDERIN QUAL", "code_information": [{"code": "83070", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HISTAMINE", "code_information": [{"code": "83088", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 75.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 118.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 118.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 118.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HOMOVANILLIC ACID", "code_information": [{"code": "83150", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 32.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF IDH ENZYME", "code_information": [{"code": "83570", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 35.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF IGE", "code_information": [{"code": "82785", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF INSULIN", "code_information": [{"code": "83525", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 45.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 45.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 45.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF INSULIN", "code_information": [{"code": "83527", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF INTRINSIC FACTOR", "code_information": [{"code": "83528", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 79.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 79.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 79.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF IRON", "code_information": [{"code": "83540", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF KETOGENIC STEROIDS", "code_information": [{"code": "83582", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LACTIC ACID", "code_information": [{"code": "83605", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LAP ENZYME", "code_information": [{"code": "83670", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LDH ENZYMES", "code_information": [{"code": "83625", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LEAD", "code_information": [{"code": "83655", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LIDOCAINE", "code_information": [{"code": "80176", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LIPOPROTEIN", "code_information": [{"code": "83718", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LIPOPROTEIN(A)", "code_information": [{"code": "83695", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LRH HORMONE", "code_information": [{"code": "83727", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF MANGANESE", "code_information": [{"code": "83785", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 67.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 106.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 106.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 106.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF MERCURY", "code_information": [{"code": "83825", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 65.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 65.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 65.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF METANEPHRINES", "code_information": [{"code": "83835", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF METHEMALBUMIN", "code_information": [{"code": "83857", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF MYOGLOBIN", "code_information": [{"code": "83874", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NATRIURETIC PEPTIDE", "code_information": [{"code": "83880", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 157.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 157.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 56.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NEONATAL THYROXINE", "code_information": [{"code": "84437", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NICKEL", "code_information": [{"code": "83885", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 62.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 98.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 98.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 98.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 35.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 35.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NOS VITAMIN", "code_information": [{"code": "84591", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NUCLEOTIDASE", "code_information": [{"code": "83915", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 44.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 44.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 44.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF OSTEOCALCIN", "code_information": [{"code": "83937", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 46.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF OXALATE", "code_information": [{"code": "83945", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PHENOBARBITAL", "code_information": [{"code": "80184", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 61.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 61.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 61.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PHENYLKETONES", "code_information": [{"code": "84035", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PHENYTOIN FREE", "code_information": [{"code": "80186", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PORPHOBILINOGEN", "code_information": [{"code": "84110", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PREGNANEDIOL", "code_information": [{"code": "84135", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 85.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 85.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 85.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PREGNANETRIOL", "code_information": [{"code": "84138", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 84.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 84.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 84.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PREGNENOLONE", "code_information": [{"code": "84140", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 82.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 82.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 82.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PRIMIDONE", "code_information": [{"code": "80188", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 66.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 66.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 66.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROCAINAMIDE", "code_information": [{"code": "80190", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 240.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 240.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 240.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROCAINAMIDE", "code_information": [{"code": "80192", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROGESTERONE", "code_information": [{"code": "84144", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROGESTERONE", "code_information": [{"code": "84234", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 100.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 165.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 260.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 260.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 260.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 93.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 93.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROINSULIN", "code_information": [{"code": "84206", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 107.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 107.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 107.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROLACTIN", "code_information": [{"code": "84146", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 77.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 77.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 77.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROSTAGLANDIN", "code_information": [{"code": "84150", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 167.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 167.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 167.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 60.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 60.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROTEIN ANY SOURCE", "code_information": [{"code": "84160", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROTEIN OTHER", "code_information": [{"code": "84157", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROTEIN SERUM", "code_information": [{"code": "84155", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROTEIN URINE", "code_information": [{"code": "84156", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PSA COMPLEXED", "code_information": [{"code": "84152", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PSA FREE", "code_information": [{"code": "84154", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PYRUVATE", "code_information": [{"code": "84210", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PYRUVATE KINASE", "code_information": [{"code": "84220", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF QUINIDINE", "code_information": [{"code": "80194", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF QUININE", "code_information": [{"code": "84228", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF RBC GALACTOKINASE", "code_information": [{"code": "82759", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 86.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 86.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 86.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF RBC PG6D ENZYME", "code_information": [{"code": "84085", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF RENIN", "code_information": [{"code": "84244", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 88.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 88.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 88.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SELENIUM", "code_information": [{"code": "84255", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SEMEN FRUCTOSE", "code_information": [{"code": "82757", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SEROTONIN", "code_information": [{"code": "84260", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 79.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 124.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 124.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 124.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SERUM SODIUM", "code_information": [{"code": "84295", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SIALIC ACID", "code_information": [{"code": "84275", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SILICA", "code_information": [{"code": "84285", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 36.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 101.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 101.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 101.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SIROLIMUS", "code_information": [{"code": "80195", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SOMATOMEDIN", "code_information": [{"code": "84305", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SOMATOSTATIN", "code_information": [{"code": "84307", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SWEAT SODIUM", "code_information": [{"code": "84302", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TACROLIMUS", "code_information": [{"code": "80197", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF THIOCYANATE", "code_information": [{"code": "84430", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF THYROGLOBULIN", "code_information": [{"code": "84432", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF THYROID ACTIVITY", "code_information": [{"code": "84442", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TOBRAMYCIN", "code_information": [{"code": "80200", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TOPIRAMATE", "code_information": [{"code": "80201", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 47.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TRANSCORTIN", "code_information": [{"code": "84449", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TRANSFERRIN", "code_information": [{"code": "84466", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TRIGLYCERIDES", "code_information": [{"code": "84478", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TROPONIN QUAL", "code_information": [{"code": "84512", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TSI GLOBULIN", "code_information": [{"code": "84445", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 78.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 203.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 203.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 203.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 73.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 73.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TYROSINE", "code_information": [{"code": "84510", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 42.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 42.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 42.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE CHLORIDE", "code_information": [{"code": "82436", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE CREATININE", "code_information": [{"code": "82570", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE OSMOLALITY", "code_information": [{"code": "83935", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE PHOSPHORUS", "code_information": [{"code": "84105", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE PORPHYRINS", "code_information": [{"code": "84120", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE POTASSIUM", "code_information": [{"code": "84133", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE SODIUM", "code_information": [{"code": "84300", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE SULFATE", "code_information": [{"code": "84392", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE UROBILINOGEN", "code_information": [{"code": "84580", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE UROBILINOGEN", "code_information": [{"code": "84583", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE VMA", "code_information": [{"code": "84585", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE/UREA-N", "code_information": [{"code": "84540", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE/URIC ACID", "code_information": [{"code": "84560", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VANCOMYCIN", "code_information": [{"code": "80202", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VASOPRESSIN", "code_information": [{"code": "84588", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 136.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 136.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 136.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 48.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 48.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VIP", "code_information": [{"code": "84586", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 90.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 141.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 141.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 141.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VITAMIN A", "code_information": [{"code": "84590", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VITAMIN B-1", "code_information": [{"code": "84425", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VITAMIN B-2", "code_information": [{"code": "84252", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 81.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 81.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 81.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VITAMIN B-6", "code_information": [{"code": "84207", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 43.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 112.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 112.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 112.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VITAMIN E", "code_information": [{"code": "84446", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VITAMIN K", "code_information": [{"code": "84597", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VOLATILES", "code_information": [{"code": "84600", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ZINC", "code_information": [{"code": "84630", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 45.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 45.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 45.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OTHER FLUID CHLORIDES", "code_information": [{"code": "82438", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY PH BODY FLUID NOS", "code_information": [{"code": "83986", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY PHOSPHATIDYLGLYCEROL", "code_information": [{"code": "84081", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 66.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 66.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 66.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY PHOSPHOHEXOSE ENZYMES", "code_information": [{"code": "84087", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY PROSTATE PHOSPHATASE", "code_information": [{"code": "84066", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY RBC CHOLINESTERASE", "code_information": [{"code": "82482", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY RBC GLUTATHIONE", "code_information": [{"code": "82979", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY RBC PROTOPORPHYRIN", "code_information": [{"code": "84202", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY SERUM CHOLINESTERASE", "code_information": [{"code": "82480", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY SPEC XCP UR&BREATH IA", "code_information": [{"code": "82077", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY SYNOVIAL FLUID MUCIN", "code_information": [{"code": "83872", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY TEST FOR BLOOD FECAL", "code_information": [{"code": "82274", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 63.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 63.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY THREE CATECHOLAMINES", "code_information": [{"code": "82384", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY TOTAL HYDROXYPROLINE", "code_information": [{"code": "83505", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 97.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 97.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 97.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 34.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY TOXIN OR ANTITOXIN", "code_information": [{"code": "87230", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 79.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 79.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 79.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY TRIIODOTHYRONINE (T3)", "code_information": [{"code": "84480", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY URINE CATECHOLAMINES", "code_information": [{"code": "82382", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 109.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 109.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 109.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSEMBLY BLADE FOR CARPAL TUNNEL RELEASE SYS DISP", "code_information": [{"code": "81010-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 655.0, "discounted_cash": 229.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY BLADE REPROCESS SMARTRELEASE ECTRINSTR DISP", "code_information": [{"code": "81010R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1167.0, "discounted_cash": 408.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY BLADE SNGL FOR CARPAL TUNNEL RELEASE SYS DISP", "code_information": [{"code": "81010-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 655.0, "discounted_cash": 229.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY FIXED TAPER GLOBAL 135 DEG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1130-02-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY IMPLANT FIXED 135DEG TAPER NECK IMPLANT COMPONENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "113002000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY PIN 2.5MM CLAVICLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1129-10-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1998.0, "discounted_cash": 699.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY SCREW VAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7901-1512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSEMBLY SYRNG 60 ML GA", "code_information": [{"code": "M00550601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.53, "discounted_cash": 32.04, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSESS CYST CONTRAST INJECT", "code_information": [{"code": "49424", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSESS VOL MGMT NOT DOC", "code_information": [{"code": "G8958", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSESSMENT OF APHASIA", "code_information": [{"code": "96105", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSIST OOCYTE FERTILIZATION", "code_information": [{"code": "89280", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSIST OOCYTE FERTILIZATION", "code_information": [{"code": "89281", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSISTIVE TECHNOLOGY ASSESS", "code_information": [{"code": "97755", "type": "CPT"}], "standard_charges": [{"minimum": 171.64, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSMT & CARE PLN PT COG IMP", "code_information": [{"code": "99483", "type": "CPT"}], "standard_charges": [{"minimum": 808.97, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 808.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1271.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1271.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1271.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSTV ALG ECG RSK ASMT CNCRT", "code_information": [{"code": "764T", "type": "CPT"}], "standard_charges": [{"minimum": 22.06, "maximum": 34.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSTV ALG ECG RSK ASMT PREV", "code_information": [{"code": "765T", "type": "CPT"}], "standard_charges": [{"minimum": 22.06, "maximum": 34.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AST", "code_information": [{"code": "84450", "type": "CPT"}, {"code": "633633", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASTH CONTROLLED", "code_information": [{"code": "G9432", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASTH NOT CONTROLLED", "code_information": [{"code": "G9434", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASXL1 FULL GENE SEQUENCE", "code_information": [{"code": "81175", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 883.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1725.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2712.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2712.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2712.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 974.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 974.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASXL1 GENE TARGET SEQ ALYS", "code_information": [{"code": "81176", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 373.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 616.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 970.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 970.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 970.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 348.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 348.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASY CARBAMAZEPIN 10,11-EPXID", "code_information": [{"code": "80161", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASY HYDROXYCORTICOSTEROIDS17", "code_information": [{"code": "83491", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASY HYDROXYPROGESTERONE 17-D", "code_information": [{"code": "83498", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 108.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 108.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 108.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASY THIOPURIN S-MTHYLTRNSFRS", "code_information": [{"code": "84433", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATHEROSCLEROSIS WITH MCC", "code_information": [{"code": "302", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6659.67, "maximum": 11433.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6659.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9524.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10477.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11433.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [{"code": "303", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4121.84, "maximum": 7076.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4121.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5895.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6484.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7076.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATHLETIC SUPPORTER SIZE L STSSA1503WHLG", "code_information": [{"code": "STSSA1503WHLG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.94, "discounted_cash": 20.28, "setting": "both", "billing_class": "facility"}]}, {"description": "ATHLETIC TRN EVAL HIGH CMPLX", "code_information": [{"code": "97171", "type": "CPT"}], "standard_charges": [{"minimum": 692.94, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 692.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1088.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1088.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1088.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATHLETIC TRN EVAL LOW CMPLX", "code_information": [{"code": "97169", "type": "CPT"}], "standard_charges": [{"minimum": 227.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 227.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATHLETIC TRN EVAL MOD CMPLX", "code_information": [{"code": "97170", "type": "CPT"}], "standard_charges": [{"minimum": 354.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 354.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 556.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 556.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 556.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATHLETIC TRN RE-EVAL PLAN CR", "code_information": [{"code": "97172", "type": "CPT"}], "standard_charges": [{"minimum": 227.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 227.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATM MRNA SEQ ALYS", "code_information": [{"code": "136U", "type": "CPT"}], "standard_charges": [{"minimum": 586.7, "maximum": 8020.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8020.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8020.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8020.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 586.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 586.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATN1 GENE DETC ABNOR ALLELES", "code_information": [{"code": "81177", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATOMIC ABSORPTION", "code_information": [{"code": "82190", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 63.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 63.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE 1% 3.5 GM OPTH OINTMENT", "code_information": [{"code": "MED0011", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51840", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51841", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTACH OCULAR IMPLANT", "code_information": [{"code": "65140", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTACHMENT SCREW DRIVER AO TT-10", "code_information": [{"code": "P99-191-TT10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1205.0, "discounted_cash": 421.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC AFTER CARE", "code_information": [{"code": "59622", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY", "code_information": [{"code": "59618", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY ONLY", "code_information": [{"code": "59620", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTENDANCE AT DELIVERY", "code_information": [{"code": "99464", "type": "CPT"}], "standard_charges": [{"minimum": 336.92, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 336.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 529.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 529.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 529.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTUNE CR FEM RT SZ 5 ATTUNE FEMORAL CRUCIATE NAR RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "150400225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8405.0, "discounted_cash": 2941.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ATUNE CR LT MS INS SZ 5 5 1518-20-505", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1518-20-505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1400.0, "discounted_cash": 490.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ATXN1 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81178", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN10 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81183", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN2 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81179", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN3 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81180", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN7 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81181", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN8OS GEN DETC ABNOR ALLEL", "code_information": [{"code": "81182", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUD BRAINSTEM IMPLT PROGRAMG", "code_information": [{"code": "92640", "type": "CPT"}], "standard_charges": [{"minimum": 433.9, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 433.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 681.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 681.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 681.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUD REHAB POSTLING HEAR LOSS", "code_information": [{"code": "92633", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUD REHAB PRE-LING HEAR LOSS", "code_information": [{"code": "92630", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIO-ONLY HHS", "code_information": [{"code": "G0321", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.32, "maximum": 64.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIOLOGY SS", "code_information": [{"code": "G0062", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR & BONE", "code_information": [{"code": "209T", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 231.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR & BONE", "code_information": [{"code": "92553", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR ONLY", "code_information": [{"code": "208T", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 231.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIT/DAST 15-30 MIN", "code_information": [{"code": "99408", "type": "CPT"}], "standard_charges": [{"minimum": 149.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIT/DAST OVER 30 MIN", "code_information": [{"code": "99409", "type": "CPT"}], "standard_charges": [{"minimum": 298.78, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 298.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 469.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 469.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 469.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION + 15 MIN", "code_information": [{"code": "92621", "type": "CPT"}], "standard_charges": [{"minimum": 85.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION 60 MIN", "code_information": [{"code": "92620", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENT 3.0CC INJECTABLE", "code_information": [{"code": "C1734", "type": "HCPCS"}, {"code": "K300-030-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6839.0, "discounted_cash": 2393.65, "setting": "both", "billing_class": "facility"}]}, {"description": "AUGMENT BONE 10CC MATERIAL", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2101-0010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "AUGMENT FEMORAL DISTAL 5MM 42-5566-058-05", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5566-058-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2039.0, "discounted_cash": 713.65, "setting": "both", "billing_class": "facility"}]}, {"description": "AUGMENT FEMORAL DISTAL SZ5 5MM 42-5568-058-05", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5568-058-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2039.0, "discounted_cash": 713.65, "setting": "both", "billing_class": "facility"}]}, {"description": "AUGMENTATION CHEEK BONE", "code_information": [{"code": "21270", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION GENIOPLASTY MULTIPLE CHIN 21122", "code_information": [{"code": "21122", "type": "CPT"}, {"code": "1480137", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION GENIOPLASTY SINGLE CHIN 21121", "code_information": [{"code": "21121", "type": "CPT"}, {"code": "1480138", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21125", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21127", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION OF FACIAL BONES", "code_information": [{"code": "21208", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTSIZE CD TIBIAL HALF BLOCK 5MM THICKNESS RIGHT LATERAL 42-5558-032-05", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5558-032-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2039.0, "discounted_cash": 713.65, "setting": "both", "billing_class": "facility"}]}, {"description": "AUGMNT AI-BASED FCL PHNT A/R", "code_information": [{"code": "731T", "type": "CPT"}], "standard_charges": [{"minimum": 250.71, "maximum": 393.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 250.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 393.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 393.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 393.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29866", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO ALYS XST CT STD VRT FX", "code_information": [{"code": "691T", "type": "CPT"}], "standard_charges": [{"minimum": 72.45, "maximum": 113.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 72.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 113.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 113.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 113.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ CPTR ALYS", "code_information": [{"code": "625T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 6529.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4153.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6529.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6529.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6529.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ DATA PREP", "code_information": [{"code": "624T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 950.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 604.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ I&R", "code_information": [{"code": "626T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 950.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 604.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUANTIFICATION C PLAQUE", "code_information": [{"code": "623T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 950.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 604.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO TRANSFUSION SUPPLIES", "code_information": [{"code": "SMI-AUTO", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 859.0, "discounted_cash": 300.65, "setting": "both", "billing_class": "facility"}]}, {"description": "AUTOCHONDROCYTE IMPLANT KNEE", "code_information": [{"code": "27412", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOGRAFT FOR SPINAL SURGERY ONLY W/HARVEST OF GRAFT LOCAL MORSELIZED 20937", "code_information": [{"code": "20937", "type": "CPT"}, {"code": "1956285", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL BICORTICAL OR TIRCORTICAL 20938", "code_information": [{"code": "20938", "type": "CPT"}, {"code": "2334787", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3665.0, "discounted_cash": 1282.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1773.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOIMMUNE RA ALYS 12 BMRK", "code_information": [{"code": "81490", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1050.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2143.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3371.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3371.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3371.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1210.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1210.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS HRVG", "code_information": [{"code": "565T", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 4382.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS NJX", "code_information": [{"code": "566T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BLOOD PROCESS", "code_information": [{"code": "86890", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOMATED DIFF WBC COUNT", "code_information": [{"code": "85004", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOMATED LEUKOCYTE COUNT", "code_information": [{"code": "85048", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOMATED PLATELET COUNT", "code_information": [{"code": "85049", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOMATED RBC COUNT", "code_information": [{"code": "85041", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOMATED RETICULOCYTE COUNT", "code_information": [{"code": "85045", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV ADRENRG INERVJ", "code_information": [{"code": "95922", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV PARASYM INERVJ", "code_information": [{"code": "95921", "type": "CPT"}], "standard_charges": [{"minimum": 170.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 170.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV SYST FUNJ TEST", "code_information": [{"code": "95923", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPLEX W/VEA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "605-687-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1429.0, "discounted_cash": 500.15, "setting": "both", "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88020", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1377.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2166.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2166.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2166.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 514.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 514.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88025", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1514.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2381.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2381.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2381.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 497.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 497.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88027", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1653.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2599.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2599.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2599.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 530.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 530.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88028", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1431.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2251.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2251.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2251.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88029", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1431.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2251.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2251.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2251.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88000", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1101.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1732.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1732.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1732.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88005", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1239.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1949.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1949.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1949.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 348.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 348.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88007", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1377.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2166.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2166.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2166.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 364.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 364.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88012", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1156.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1818.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1818.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1818.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88014", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1156.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1818.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1818.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1818.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 273.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 273.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88016", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1101.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1732.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1732.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1732.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 381.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 381.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOSUTRE VERSAPORT PLUS SLEEVE 5.0MM", "code_information": [{"code": "177092 (ETHICON)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 32.9, "setting": "both", "billing_class": "facility"}]}, {"description": "AUTOTRANSPLANT PARATHYROID", "code_information": [{"code": "60512", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION", "code_information": [{"code": "36833", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION OPEN", "code_information": [{"code": "36832", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM BASILIC", "code_information": [{"code": "36819", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM CEPHALIC", "code_information": [{"code": "36818", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FUSION DIRECT ANY SITE", "code_information": [{"code": "36821", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FUSION/FOREARM VEIN", "code_information": [{"code": "36820", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AVAFLEX CURVED NEEDLE 1025-011-500", "code_information": [{"code": "1025-011-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 967.0, "discounted_cash": 338.45, "setting": "both", "billing_class": "facility"}]}, {"description": "AVAFLEX VERTEBRAL AUGMENTATION NEEDLE 11GA", "code_information": [{"code": "1025-011-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1080.38, "discounted_cash": 378.13, "setting": "both", "billing_class": "facility"}]}, {"description": "AVITENE 1 GM MICROFIBRILLAR COLLAGEN HEMOSTAT", "code_information": [{"code": "MED0013", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AVITENE MICROFIBRILLAR COLLAGEN HEMOSTAT 0.5GM POWDER", "code_information": [{"code": "MED0012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 224.0, "discounted_cash": 78.4, "setting": "both", "billing_class": "facility"}]}, {"description": "AVULSION NAIL PLATE PARTIAL OR COMPLETE SIMPLE SINGLE 11730", "code_information": [{"code": "11730", "type": "CPT"}, {"code": "1679589", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AVULSION OF NAIL PLATE PARTIAL OR COMP. SIMPLE EA. ADD NAIL PLATE 11732", "code_information": [{"code": "11732", "type": "CPT"}, {"code": "1923075", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AWL BONE 4.75MM ALPHAVENT AND OMEGA 3910-947-201", "code_information": [{"code": "3910-947-201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1022.2, "discounted_cash": 357.77, "setting": "both", "billing_class": "facility"}]}, {"description": "AWL MCP STARTER METACARPOPHALANGEALINSTR", "code_information": [{"code": "17-0835", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.0, "discounted_cash": 148.75, "setting": "both", "billing_class": "facility"}]}, {"description": "Ablation of 1 or more thyroid nodule(s), additional lobe, percutaneous, including imaging guidance, radiofrequency (List separately in addition to code for primary procedure)", "code_information": [{"code": "60661", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ablation of 1 or more thyroid nodule(s), one lobe or the isthmus, percutaneous, including imaging guidance, radiofrequency", "code_information": [{"code": "60660", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ablation of benign prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance", "code_information": [{"code": "950T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation", "code_information": [{"code": "55881", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducer for delivery of thermal ultrasound, includin", "code_information": [{"code": "55882", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ablation, benign breast tumor (eg, fibroadenoma), percutaneous, laser, including imaging guidance when performed, each tumor", "code_information": [{"code": "970T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ablation, malignant breast tumor(s), percutaneous, laser, including imaging guidance when performed, unilateral", "code_information": [{"code": "971T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, including neuronavigation, delivery and management, subsequent motor threshold redetermination with delivery and management, per treatment day", "code_information": [{"code": "892T", "type": "CPT"}], "standard_charges": [{"minimum": 9924.71, "maximum": 15595.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9924.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15595.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15595.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15595.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, including neuronavigation, delivery and management, subsequent treatment day", "code_information": [{"code": "891T", "type": "CPT"}], "standard_charges": [{"minimum": 9924.71, "maximum": 15595.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9924.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15595.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15595.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15595.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, including target assessment, initial motor threshold determination, neuronavigation, delivery and management, initial treatment day", "code_information": [{"code": "890T", "type": "CPT"}], "standard_charges": [{"minimum": 9924.71, "maximum": 15595.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9924.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15595.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15595.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15595.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Acetylcholine receptor (AChR), antibody identification by immunofluorescence, using live cells, reported as positive or negative", "code_information": [{"code": "545U", "type": "CPT"}], "standard_charges": [{"minimum": 46.92, "maximum": 73.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Activated Clotting Time", "code_information": [{"code": "85347", "type": "CPT"}, {"code": "633631", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 111.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Acute PVD", "code_information": [{"code": "M1383", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ASCVD) risk assessment, 5-15 minutes, not more often than every 12 months", "code_information": [{"code": "G0537", "type": "HCPCS"}], "standard_charges": [{"minimum": 131.37, "maximum": 206.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 131.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 206.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 206.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 206.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Adult day center, 8-hour unit, for use in CMMI model", "code_information": [{"code": "G0530", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Advanced primary care management services for a patient that is a qualified Medicare beneficiary with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant ", "code_information": [{"code": "G0558", "type": "HCPCS"}], "standard_charges": [{"minimum": 407.93, "maximum": 641.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 407.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 641.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 641.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 641.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Advanced primary care management services for a patient with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompe", "code_information": [{"code": "G0557", "type": "HCPCS"}], "standard_charges": [{"minimum": 131.37, "maximum": 206.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 131.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 206.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 206.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 206.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Advanced primary care management services for a patient with one chronic condition [expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functio", "code_information": [{"code": "G0556", "type": "HCPCS"}], "standard_charges": [{"minimum": 131.37, "maximum": 206.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 131.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 206.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 206.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 206.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Aerobic Culture", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "1097822", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 167.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Aerobic Culture.", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "45340855", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 167.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Alanine Aminotransferase", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "633632", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 110.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Albumin Level", "code_information": [{"code": "82040", "type": "CPT"}, {"code": "633634", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 32.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Alkaline Phosphatase", "code_information": [{"code": "84075", "type": "CPT"}, {"code": "633642", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 27.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "All patients who were diagnosed with recurrent melanoma during the current performance period", "code_information": [{"code": "M1391", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Allergen specific IgE; quantitative or semiquantitative, eac", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "24709840", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 103.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ambulance Air Ambulance", "code_information": [{"code": "545", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ambulance, Electrocardiogram (Ekg) Transmission", "code_information": [{"code": "548", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ambulance, General", "code_information": [{"code": "540", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ambulance, Heart Mobile", "code_information": [{"code": "543", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ambulance, Medical Transport", "code_information": [{"code": "542", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ambulance, Neonatal Services", "code_information": [{"code": "546", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ambulance, Other", "code_information": [{"code": "549", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ambulance, Pharmacy", "code_information": [{"code": "547", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ambulatory Surgical Care General", "code_information": [{"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 3700.0, "maximum": 3700.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3700.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ambulatory Surgical Care Other", "code_information": [{"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 3700.0, "maximum": 3700.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3700.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "An additional encounter with an RA diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an RA diagnosis during the performance period", "code_information": [{"code": "M1374", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "An additional encounter with an RA diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an RA diagnosis during the performance period", "code_information": [{"code": "M1375", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "An additional encounter with an RA diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an RA diagnosis during the performance period", "code_information": [{"code": "M1376", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Anaerobic Culture, addl method, each isolate 87076", "code_information": [{"code": "87076", "type": "CPT"}, {"code": "633881", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 421.0, "discounted_cash": 147.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 156.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Anesthesia For Diagnostic X-Ray Procedure (Accessed Through The Skin) On Spine And Spinal Cord", "code_information": [{"code": "1935", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Anesthesia For X-Ray Procedure (Accessed Through The Skin) On Spine And Spinal Cord", "code_information": [{"code": "1936", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Anoscopy with directed submucosal injection of bulking agent into anal canal", "code_information": [{"code": "963T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Antibody Screen", "code_information": [{"code": "86850", "type": "CPT"}, {"code": "634329", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 366.0, "discounted_cash": 128.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 135.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Antinuclear Antibody Screen", "code_information": [{"code": "86038", "type": "CPT"}, {"code": "633655", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 267.0, "discounted_cash": 93.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 99.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Appendectomy With Complicated Principal Diagnosis With CC", "code_information": [{"code": "339", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10325.28, "maximum": 17725.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10325.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14767.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16244.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17725.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy With Complicated Principal Diagnosis With MCC", "code_information": [{"code": "338", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17015.98, "maximum": 29212.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17015.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24336.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26770.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29212.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy With Complicated Principal Diagnosis Without CC/MCC", "code_information": [{"code": "340", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7471.75, "maximum": 12827.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7471.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10686.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11754.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12827.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy Without Complicated Principal Diagnosis With CC", "code_information": [{"code": "342", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8716.33, "maximum": 14963.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8716.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12466.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13712.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14963.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy Without Complicated Principal Diagnosis With MCC", "code_information": [{"code": "341", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14127.16, "maximum": 24252.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14127.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20204.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22225.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24252.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy Without Complicated Principal Diagnosis Without CC/MCC", "code_information": [{"code": "343", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6743.61, "maximum": 11577.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6743.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9644.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10609.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11577.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 480 sq cm or part thereof (", "code_information": [{"code": "15018", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 480 sq cm or less", "code_information": [{"code": "15017", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, trunk, arms, legs; each additional 480 sq cm or part thereof (List separately in addition to code for primary procedure)", "code_information": [{"code": "15016", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, trunk, arms, legs; first 480 sq cm or less", "code_information": [{"code": "15015", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Assessment Of Hearing Loss Performed On A Group Of Patients", "code_information": [{"code": "92559", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Assistive algorithmic analysis of acoustic and electrocardiogram recording for detection of cardiac dysfunction (eg, reduced ejection fraction, cardiac murmurs, atrial fibrillation), with review and interpretation by a physician or other qualified health ", "code_information": [{"code": "962T", "type": "CPT"}], "standard_charges": [{"minimum": 328.7, "maximum": 516.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 328.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 516.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 516.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 516.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Assistive algorithmic classification of burn healing (ie, healing or nonhealing) by noninvasive multispectral imaging, including system set-up and acquisition, selection, and transmission of images, with automated generation of report", "code_information": [{"code": "972T", "type": "CPT"}], "standard_charges": [{"minimum": 22.06, "maximum": 34.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Atherosclerotic cardiovascular disease (ASCVD) risk management services; clinical staff time; per calendar month", "code_information": [{"code": "G0538", "type": "HCPCS"}], "standard_charges": [{"minimum": 407.93, "maximum": 641.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 407.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 641.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 641.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 641.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Attention Discharge Status G-9167 -> CH 0% impaired", "code_information": [{"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "Attention Goal Status G-9166 -> CI At least 1% but less than 20% impaired", "code_information": [{"code": "G9166", "type": "HCPCS"}, {"code": "16164849", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "Attention Goal Status G-9166 -> CJ At least 20% but less than 40% impaired", "code_information": [{"code": "G9166", "type": "HCPCS"}, {"code": "16164848", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "Autoimmune diseases (systemic lupus erythematosus [SLE]), analysis of 10 cytokine soluble mediator biomarkers by immunoassay, plasma, individual components reported with an algorithmic risk score for current disease activity", "code_information": [{"code": "446U", "type": "CPT"}], "standard_charges": [{"minimum": 23.72, "maximum": 37.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Autoimmune diseases (systemic lupus erythematosus [SLE]), analysis of 11 cytokine soluble mediator biomarkers by immunoassay, plasma, individual components reported with an algorithmic prognostic risk score for developing a clinical flare", "code_information": [{"code": "447U", "type": "CPT"}], "standard_charges": [{"minimum": 23.72, "maximum": 37.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Autoinflammatory disease (VEXAS syndrome), DNA, UBA1 gene mutations, targeted variant analysis (M41T, M41V, M41L, c.118-2A>C, c.118-1G>C, c.118-9_118-2del, S56F, S621C)", "code_information": [{"code": "500U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Autologous blood or component, collection processing and storage 86891", "code_information": [{"code": "86891", "type": "CPT"}, {"code": "4684282", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 2452.0, "discounted_cash": 858.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 910.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B BRGDRFERI ANTB 12 PRTN IGG", "code_information": [{"code": "42U", "type": "CPT"}], "standard_charges": [{"minimum": 24.78, "maximum": 69.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B BRGDRFERI ANTB 5 PRTN IGM", "code_information": [{"code": "41U", "type": "CPT"}], "standard_charges": [{"minimum": 24.78, "maximum": 69.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B BRGDRFERI LYME DS OSPA EVL", "code_information": [{"code": "316U", "type": "CPT"}], "standard_charges": [{"minimum": 26.87, "maximum": 69.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B CELLS TOTAL COUNT", "code_information": [{"code": "86355", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 58.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 96.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B-12 BINDING CAPACITY", "code_information": [{"code": "82608", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B1 MATRL QUAL TST MCRIND TIB", "code_information": [{"code": "547T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 285.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 449.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 449.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 449.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK ANALYSIS", "code_information": [{"code": "554T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 411.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 261.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK ASSESSMENT", "code_information": [{"code": "556T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 1600.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK I&R", "code_information": [{"code": "557T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 769.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK VRT FX ASSMT", "code_information": [{"code": "743T", "type": "CPT"}], "standard_charges": [{"minimum": 261.89, "maximum": 411.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 261.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B1 STR&FX RSK ASMT DXRBMD1VW", "code_information": [{"code": "750T", "type": "CPT"}], "standard_charges": [{"minimum": 261.89, "maximum": 411.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 261.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B1 STR&FX RSK ASSMT DXR-BMD", "code_information": [{"code": "749T", "type": "CPT"}], "standard_charges": [{"minimum": 261.89, "maximum": 411.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 261.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B1 STR&FX RSK TRANSMIS DATA", "code_information": [{"code": "555T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 157.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 157.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 157.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BABCOCK ENDOPATH HANDLE 10MM -ORDR QTY 6 10BB", "code_information": [{"code": "10BB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 72.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BABESIA MICROTI AMP PRB", "code_information": [{"code": "87469", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACI/NEO/POLY(NEOSPORIN OPHTH) 3.5GM", "code_information": [{"code": "MED0017", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BACI/NEO/POLY(NEOSPORIN) OINTMENT FOIL PACK UD", "code_information": [{"code": "MED0018", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN 500 UNITS/G OINTMENT 15GM", "code_information": [{"code": "MED0015", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN OPHTHALMIC OINTMENT 500U/GM 3.5 GM", "code_information": [{"code": "MED0016", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN STERILE 50,000 UNIT VIAL", "code_information": [{"code": "MED0019", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN TOP 500 UNITS/G OINT 30 GM (BACIGUENT)", "code_information": [{"code": "MED0797", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN TOP 500 UNITS/G OINT UD 0.9 GM", "code_information": [{"code": "MED0014", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN ZINC OINTMENT PACKET 500U 0.9GM", "code_information": [{"code": "MED0021", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN ZINC/POLYMYXIN B OINTMENT 0.9 GM FOIL PACKET", "code_information": [{"code": "MED0022", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN-POLYMYXIN B TOP OINTMENT 15 GM", "code_information": [{"code": "MED0020", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN/POLYMYXIN (POLYSPORIN) 3.5GM OPHTHALMIC OINTMENT", "code_information": [{"code": "MED0023", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [{"code": "519", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11922.68, "maximum": 20468.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11922.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17052.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18757.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20468.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [{"code": "518", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21819.11, "maximum": 37458.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21819.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31206.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34326.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37458.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "520", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8627.52, "maximum": 14811.31, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8627.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12339.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13573.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14811.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BACKBENCH PREP OF CORNEAL ENDOTHELIAL ALLOGRAFT PRIOR TO TRANSPLANTATION 65757", "code_information": [{"code": "65757", "type": "CPT"}, {"code": "22687712", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 5229.0, "discounted_cash": 1830.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACKFLUSH SHIRAGE 25GA 0.5MM BRUSH TIP ACTIVE ASPIRATION", "code_information": [{"code": "1281.SD05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 155.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BACLOFEN 0.05 MG/ML INTRATHECAL SOL 1 ML KIT", "code_information": [{"code": "MED0024", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 233.0, "discounted_cash": 81.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [{"code": "95", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15251.91, "maximum": 26183.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15251.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21813.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23994.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26183.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [{"code": "94", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22129.35, "maximum": 37990.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22129.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31649.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34814.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37990.59, "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": 14189.81, "maximum": 24360.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14189.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20294.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22323.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24360.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BACTERICIDAL LEVEL SERUM", "code_information": [{"code": "87197", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACTERIUM ANTIBODY", "code_information": [{"code": "86609", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAG BANDED C-ARM COVER BOUFFANT DYNJE60050S", "code_information": [{"code": "DYNJE60050S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG BREATHING 1 L RAINBOW VARIOUS COLORS", "code_information": [{"code": "V10901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG BREATHING 1L UNIVERSAL GRN ANESTHESIA CIRCUIT LF DISP", "code_information": [{"code": "20901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG BREATHING 2 L GRN LF", "code_information": [{"code": "20902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.53, "discounted_cash": 2.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG DRAIN 2000 ML UROLOGY ANTI REFLUX LF", "code_information": [{"code": "154002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG DRAIN 2LT CENTER ENTRY ANTI REFLUX DEV LF", "code_information": [{"code": "153504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG DRAIN 32OZ LG LEG TWIST VALVE STRAPS", "code_information": [{"code": "DYND12578", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG DRAIN UROLOGIC WITH UNDER BUTTOCKS FLAP 08-CC164", "code_information": [{"code": "8-CC164", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.29, "discounted_cash": 9.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG DRAINAGE 2 LITERINFECTION CONTROL CHMB", "code_information": [{"code": "154004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG DRAINAGE 4000 ML UROLOGY ANTI REFLUX", "code_information": [{"code": "153509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG ICE 12IN X 5IN SM VELCRO STRAPS", "code_information": [{"code": "6001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG ICE EYE 4.5 X 10IN VELCRO 3 LAYER REUSABLE", "code_information": [{"code": "11900-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG RETRIEVAL 224 ML 6IN X 4IN 10MM SPECIMEN ENDOPOUCH STRL DISP", "code_information": [{"code": "ETHPOUCH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG SPECIMEN RETRIEVAL 224 ML DISP STRL POUCH", "code_information": [{"code": "POUCH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 417.08, "discounted_cash": 145.98, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG SPONGE COUNTER BLUE 50/BX 5BX/CS", "code_information": [{"code": "DYNJE1001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG URINE METER", "code_information": [{"code": "153207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL COTTON 1IN X 3IN LG HIGH ABSORBENCY PEEL OPEN PACKAGE STRL DISP", "code_information": [{"code": "C15000-300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL COTTON MED 1IN NON STRL", "code_information": [{"code": "MDS21461", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL LLETZ 5MM ES07", "code_information": [{"code": "ES07", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL PIN .028IN RED FOR KIRSCHNER WIRE W SERIES", "code_information": [{"code": "W028-RD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.92, "discounted_cash": 15.37, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL PIN .035IN .9MM DARK BLUE FOR KIRSCHNER WIRE W SERIES", "code_information": [{"code": "W035-DB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.92, "discounted_cash": 15.37, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL PIN .045IN 1.1MM YELLOW FOR KIRSCHNER WIRE W SERIES", "code_information": [{"code": "W045-YL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.92, "discounted_cash": 15.37, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL PIN .062IN 1.6MM GRN FOR KIRSCHNER WIRE W SERIES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "W062-GN", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL PIN 3/32IN CREAM FOR KIRSCHNER WIRE W SERIES", "code_information": [{"code": "W332-CR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL TIP BONE RESECTOR JSBBR274543", "code_information": [{"code": "JSBBR274543", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1241.0, "discounted_cash": 434.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL TIP DIAMOND ABRASOR COARSE JSBDA274544C", "code_information": [{"code": "JSBDA274544C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1342.0, "discounted_cash": 469.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL TIP VAPORFLEX PROBE 275 BIPOLAR JVP28024", "code_information": [{"code": "JVP28024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1218.0, "discounted_cash": 426.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLON NASAL NUVENT 70D FRONTAL 6 X 17MM", "code_information": [{"code": "1830617FRT70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1584.0, "discounted_cash": 554.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON AVAFLEX 11G 20MM CURVED", "code_information": [{"code": "1031-120-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5245.0, "discounted_cash": 1835.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CATHETER RELIEVA TRACT BALLOON DILATION SYSTEM", "code_information": [{"code": "RT1640A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.0, "discounted_cash": 159.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON DILATE URTRL STRIX", "code_information": [{"code": "50706", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLOON DILATION 6MM X 18MM LOW PROFILE W/ LIGHT FIBER", "code_information": [{"code": "LPLF-106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON KIT OMNICURVE 11G X 15 MM 1032-115-000", "code_information": [{"code": "1032-115-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5639.0, "discounted_cash": 1973.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON NAVIGATION SINUSPLASTY 6MM MA FRNTAL SPHENDIO", "code_information": [{"code": "RSP0616MFSN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON PDB STERILE KIDNEY-SHAPE OMS-PDBS2", "code_information": [{"code": "OMS-PDBS2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 535.31, "discounted_cash": 187.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON PDB STERILE KIDNEY-SHAPE OMSPDBS2", "code_information": [{"code": "OMSPDBS2", "type": "CDM"}], "standard_charges": [{"gross_charge": 1064.0, "discounted_cash": 372.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON PREPERITONEAL DIST OMSPDB1000", "code_information": [{"code": "OMSPDB1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1043.0, "discounted_cash": 365.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON REGULATING 61CM TO 70CM PRESSURE URINARY", "code_information": [{"code": "C1815", "type": "HCPCS"}, {"code": "72400024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5764.0, "discounted_cash": 2017.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON SEEKER 5 X 17MM NUVENT EM SINUS DILATION FRTNT", "code_information": [{"code": "1830517FRT", "type": "CDM"}], "standard_charges": [{"gross_charge": 1979.0, "discounted_cash": 692.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON SINUPLASTY SYSTEM", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "RS0516M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3858.0, "discounted_cash": 1350.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON SINUS 6 X 17MM DILATION NUVENT EM", "code_information": [{"code": "1830617SPH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 726.3, "discounted_cash": 254.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON SINUSPLASTY 5MM MAXILLARY FRONTAL PHENOID", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "RSP0516MFS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4399.0, "discounted_cash": 1539.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON SINUSPLASTY 6MM MAXILLARY FRONTAL SPHENOID", "code_information": [{"code": "RSP0616MFS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2792.25, "discounted_cash": 977.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON STRUCTURAL TROCAR 10MM OMS-T10SB", "code_information": [{"code": "OMS-T10SB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 414.7, "discounted_cash": 145.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON TRAY AVAFLEX VERTEBRAL 10G X 20MM", "code_information": [{"code": "AFB1020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5644.0, "discounted_cash": 1975.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON VERTEBRAL 11G X 15MM AVAFLEX", "code_information": [{"code": "AFB1115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5645.0, "discounted_cash": 1975.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON VERTEBRAL 11G X 30MM AVAFLEX", "code_information": [{"code": "AFB1130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5645.0, "discounted_cash": 1975.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON VERTEBRAL AVAFLEX 11G 15MM", "code_information": [{"code": "1031-115-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5245.0, "discounted_cash": 1835.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BALO ANGIOP CTR DIALYSIS SEG", "code_information": [{"code": "36907", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAMLAN AND ETESEV INFUS HOME", "code_information": [{"code": "M0246", "type": "HCPCS"}], "standard_charges": [{"minimum": 3307.5, "maximum": 5197.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3307.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5197.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5197.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5197.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAMLAN AND ETESEV INFUSION", "code_information": [{"code": "M0245", "type": "HCPCS"}], "standard_charges": [{"minimum": 1984.5, "maximum": 3118.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1984.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAND BAG SEWN 44 DAIM VBB0044", "code_information": [{"code": "VBB0044", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.04, "discounted_cash": 2.11, "setting": "both", "billing_class": "facility"}]}, {"description": "BAND BAG W/RUBBER BAND 30 X36 VBB3036R", "code_information": [{"code": "VBB3036R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BAND CIRCLING STYLE 240 2.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "92-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BAND STABILIZATION PER TOOTH", "code_information": [{"code": "D2976", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAND TOURNIQUET 1IN X 18IN BLUE ROLLED BANDED LF", "code_information": [{"code": "DYND75020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ADHSV 1IN X 3IN LITE WOVEN COMFORT CLOTH LF", "code_information": [{"code": "NON25660", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE CASTING 4IN X 5YD WHT EXTRA FAST ROLL PLASTER SPECIALIST", "code_information": [{"code": "7367", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE COMPRESS 6INX210IN ELAS HONEYCMB 23593-06LF", "code_information": [{"code": "23593-06LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE COMPRESSION ELITE LATEX FREE COTTON POLYESTER KNIT ELASTIC 3 X 210IN", "code_information": [{"code": "23593-13LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE COMPRESSION ELITE LATEX FREE COTTON POLYESTER KNIT ELASTIC 4 X 210IN", "code_information": [{"code": "23593-14LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE CONFORM 2\" NON25496H", "code_information": [{"code": "NON25496H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE CONFORM 3\" NON25497H", "code_information": [{"code": "NON25497H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE CONFORM STERILE 1 IN DERMACEA 441506", "code_information": [{"code": "441506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE CONFORM STERILE 3IN DERMACEA 0715441505", "code_information": [{"code": "715441505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE CONFORM STRETCH 3X75 STRL", "code_information": [{"code": "2232", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE CONFORMING 1IN X 75IN RAYON POLYESTER SOF FORM STRL", "code_information": [{"code": "NON254955", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE CONFORMING 3IN X 4 1/10YD ELASTIC SOF FORM", "code_information": [{"code": "NON25497A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE CONFORMS STERILE 2IN DERMACEA 0715441504", "code_information": [{"code": "715441504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELASTIC 6IN ESMARK LF", "code_information": [{"code": "99304", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELASTIC 6IN X 5.8YD HONEYCOMB VELCRO CLOSURE BEIGE LF", "code_information": [{"code": "23593-16LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELASTIC 6IN X 9FT ESMARK LF", "code_information": [{"code": "99303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELSTC 2IN X 5YD WHT BEIGE WND MED COMPRESSION COLOR CODED POLYESTER COTT", "code_information": [{"code": "DYNJ05152LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELSTC 3IN X 5YD WND MED COMPRESSION COLOR CODED POLYESTER COTTON BLEND M", "code_information": [{"code": "DYNJ05153LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.73, "discounted_cash": 1.31, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELSTC 4IN X 5YD WHT BEIGE WND MED COMPRESSION COLOR CODED POLYESTER COTT", "code_information": [{"code": "DYNJ05154LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELSTC 6IN X 5YD WHT BEIGE WND MED COMPRESSION COLOR CODED POLYESTER COTT", "code_information": [{"code": "DYNJ05156LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE GAUZE 1IN X 41YD WHT RAYON POLYESTER ELASTOMULL STRL", "code_information": [{"code": "2075001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE GAUZE 2IN X 41YD WHT RAYON POLYESTER ELASTOMULL STRL", "code_information": [{"code": "2076001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE GAUZE 3IN X 4 1/10YD STRETCHED BULKEE LITE LF STRL", "code_information": [{"code": "NON27497", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE GAUZE 3IN X 41YD CONFORMING WOUND ELASTOMULL STRL", "code_information": [{"code": "23631-603X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE GAUZE 3IN X 4IN ELASTOMULL STRL", "code_information": [{"code": "2070001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE GAUZE 4 1/2IN X 4 1/10YD FLUFF BULKEE II STRL", "code_information": [{"code": "NON25865", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE GAUZE 4IN X 4 1/10YD STRETCHED BULKEE LITE STRL", "code_information": [{"code": "NON27498", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE GAUZE BULKEE LITE 4 X 4", "code_information": [{"code": "NON274498", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE GAUZE SOF-FORM 2X75 STRL L NON25496", "code_information": [{"code": "NON25496", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE HONEYCOMB ELAS 2IN LF STR 23593-12LF", "code_information": [{"code": "23593-12LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE PLASTER 3IN X 3YD X-FAST SET SPECIALIST", "code_information": [{"code": "7363", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.94, "discounted_cash": 1.73, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE PLASTER X-FAST SET 2 X 3YDS 7362", "code_information": [{"code": "7362", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.95, "discounted_cash": 1.38, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE SELF ADHERENT 1X5YD LF NON-S CAH15LF", "code_information": [{"code": "CAH15LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE SELF ADHERENT 2X5YD LF NS 36EA/B", "code_information": [{"code": "CAH25LF", "type": "CDM"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE SLF ADHERENT 4IN X 5YD TAN NON WOVEN MATERIALS AND ELASTIC FIBERS COBAN", "code_information": [{"code": "1584S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE SLF ADHERENT 6IN X 5YD TAN WRAP COBAN LF STRL", "code_information": [{"code": "2086S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.04, "discounted_cash": 5.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE SLF ADHERENT TAN WRAP SPRM088006", "code_information": [{"code": "SPRM088006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.28, "discounted_cash": 6.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WND 1 7/8IN X 1/2IN TRANSPARENT SKIN CLOSURE ADHSV ELSTC STERI-STRIP", "code_information": [{"code": "W8516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WND 3IN X 5YD WHT BEIGE VELCRO CLOSURE MED COMPRESSION ELSTC POLYESTER C", "code_information": [{"code": "MDS087003LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WND 4IN X 5YD TAN SLF ADHSV THIN LIGHTWEIGHT BREATHABLE NON WOVEN MATERI", "code_information": [{"code": "2084S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.43, "discounted_cash": 3.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WND 6IN X 5YD TAN SLF ADHERENT HND TEAR COMPRESSION POWERFLEX STRL", "code_information": [{"code": "DYNJ086006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.99, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WOUND 1IN X 5YD ADHSV ELASTIC LATEX ELASTOPLAST", "code_information": [{"code": "2593002", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WOUND 6IN X 550IN BEIGE ELITE COTTON POLYESTER", "code_information": [{"code": "23593-960", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE.ESMARK LATEX FREE 4X9 CTM UMMS 99301", "code_information": [{"code": "99301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDE 3.5 X 0.75 TYPE 41 S5.1010", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "S5.1010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43.34, "discounted_cash": 15.17, "setting": "both", "billing_class": "facility"}]}, {"description": "BANKART PROCEDURE 23455", "code_information": [{"code": "23455", "type": "CPT"}, {"code": "1480139", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2440.32, "maximum": 9735.0, "gross_charge": 5042.0, "discounted_cash": 1764.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2440.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAR CONNECTING 11MM X 350MM ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4922-8-350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 962.0, "discounted_cash": 336.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BAR FXTN 10.5MM X 40MM JET X", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71062400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1205.0, "discounted_cash": 421.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BAR JET-X 10.5MM X 100MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7106-2100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BAR LOCKING TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "141205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 241.0, "discounted_cash": 84.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BARREL CUTTER BARREL TIP WITH DISTAL PROTECTION JSBBC3235", "code_information": [{"code": "JSBBC3235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1372.0, "discounted_cash": 480.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BARRIER ADHESION 3IN X 4IN ABSORBLINTERCEED HEMOSTATIC STRL", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "4350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARRIER ADHESION 45 AMNIOGEN WOUND COVERING", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "HT4544", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARRIER WOUND 5GM CELLERATERX ACTIVE COLLAGEN", "code_information": [{"code": "A6010", "type": "HCPCS"}, {"code": "WCI-05-SACRXP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3100.0, "discounted_cash": 1085.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BARTONELLA ANTIBODY", "code_information": [{"code": "86611", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA DNA AMP PROBE", "code_information": [{"code": "87471", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA DNA QUANT", "code_information": [{"code": "87472", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASE FEMORAL SIZE 6 JOURNEY POLY UNICOMPARTMENTAL RHT MED LFT LAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71422436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2378.0, "discounted_cash": 832.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BASE FEMORAL SIZE 7 JOURNEY POLY UNICOMPARTMENTAL RHT MED LFT LAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71422357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5908.0, "discounted_cash": 2067.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BASE PLATE REVISION AND TAPER KIT 8.0MM 508-80-000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "508-80-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11972.0, "discounted_cash": 4190.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BASE TIBIA SZ 6 NON POROUS RIGHT JOURNEY IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2184.0, "discounted_cash": 764.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BASE TIBIAL ATTUNE FB SZ 4 CEMENTED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1506-70-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BASE TIBIAL SZ 2 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5178.0, "discounted_cash": 1812.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BASELINE MRS > 2", "code_information": [{"code": "M1236", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE FULL-WEDGE AUGMENT 25MM 15 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE GLENOID 29MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWD003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4429.0, "discounted_cash": 1550.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE GLENOID UNIVERSAL LARGE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9120-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5047.0, "discounted_cash": 1766.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE LATERALIZED 25MM, 36MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3929.0, "discounted_cash": 1375.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE LEFT SIZE 3 POROUS TIBIA W/JOURNEY LOCK 71425323", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71425323", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 0.02, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE LEFT SIZE 5 POROUS TIBIA W/ JRNY LOCK A/P 52MM M/L 74MM 71425325", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71425325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE RSP 30 MM GLENOID P2 POROUS COAT///LOL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "508-32-204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2596.0, "discounted_cash": 908.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE STANDARD 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2884.0, "discounted_cash": 1009.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE THREADED POST 29 X 30MM PTC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWE830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4351.0, "discounted_cash": 1522.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE THREADED POST 29MM 35MM PTC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4483.0, "discounted_cash": 1569.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE THREADED POST PTC 25MM X 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWE735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIA POROUS W/JOURNEY LOCK SZ 3 RIGHT 71425303", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71425303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL CEMENTED SIZE 5 UNIVERSAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5521-B-500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL LEGION SZ3 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15295.5, "discounted_cash": 5353.43, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL LEGION SZ6 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8448.0, "discounted_cash": 2956.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBL SZ 2 RIGHT NONPOROUS JOURNEY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1047.0, "discounted_cash": 366.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBL SZ 3 UNIVERSAL TRIATHLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5521-B-300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2300.0, "discounted_cash": 805.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBL SZ 4 UNIVERSAL CEMENTED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5521-B-400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBL SZ 5 LFT NONPOROUS JOURNEY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2821.0, "discounted_cash": 987.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBL SZ 5 PRIMARY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5520-B-500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3801.0, "discounted_cash": 1330.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBL SZ 6 PRIMARY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5520-B-600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3215.0, "discounted_cash": 1125.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBL SZ 7 LFT NONPOROUS JOURNEY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2184.0, "discounted_cash": 764.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBL SZ 7 RIGHT NONPOROUS JOURNEY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2184.0, "discounted_cash": 764.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBL SZ 8 LFT NONPOROUS JOURNEY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2184.0, "discounted_cash": 764.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBL SZ 8 RIGHT NONPOROUS JOURNEY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2184.0, "discounted_cash": 764.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BASIC LIFE DISABILITY EXAM", "code_information": [{"code": "99450", "type": "CPT"}], "standard_charges": [{"minimum": 789.88, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 789.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1241.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1241.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1241.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASIC SUPPORT ROUTINE SUPPLS", "code_information": [{"code": "A0382", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BASIC VESTIBULAR EVALUATION", "code_information": [{"code": "92540", "type": "CPT"}], "standard_charges": [{"minimum": 111.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASKET NGAGE 1.7FR X 115CM G48294", "code_information": [{"code": "G48294", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1092.41, "discounted_cash": 382.34, "setting": "both", "billing_class": "facility"}]}, {"description": "BASKET SPECIMEN 120 CM 1.9FR 12MM 4 WR SHTH URETERAL", "code_information": [{"code": "M0063901050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BASKET SPECIMEN 120 CM 2.4FR 16MM STONE 4 WR PLMD", "code_information": [{"code": "M0063801070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 651.0, "discounted_cash": 227.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BASKET WIRE STONE RETRIEVAL ATLUS 4 WIRE 2.8FR 115CM", "code_information": [{"code": "G32788", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 743.0, "discounted_cash": 260.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BATTERY INSTRUMENT FOR NAVIGATION SPINE SYSTEM 6000-006-000", "code_information": [{"code": "6000-006-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.53, "discounted_cash": 47.44, "setting": "both", "billing_class": "facility"}]}, {"description": "BATTERY NUEROSTIM DBS ACTIVA SC", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "37602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18530.0, "discounted_cash": 6485.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BATTERY TRACKING INSTRUMENT 700001577578", "code_information": [{"code": "7.00002E+11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.41, "discounted_cash": 56.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BCAT1&IKZF1 PRMTR MTHYLN ALY", "code_information": [{"code": "229U", "type": "CPT"}], "standard_charges": [{"minimum": 317.83, "maximum": 552.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 317.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 499.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 499.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 499.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 552.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 552.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Arthrography Injection 25246", "code_information": [{"code": "25246", "type": "CPT"}, {"code": "36202798", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Arthrography Injection Hip 27093", "code_information": [{"code": "27093", "type": "CPT"}, {"code": "36450188", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE CT Pelvis w/o Contrast 72192", "code_information": [{"code": "72192", "type": "CPT"}, {"code": "42630774", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 3818.0, "discounted_cash": 1336.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1567.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1567.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1933.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1418.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 202.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 215.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE CT Spine Cervical w/o Contrast 72125", "code_information": [{"code": "72125", "type": "CPT"}, {"code": "35562054", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5348.0, "discounted_cash": 1871.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2195.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2195.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2707.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1986.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 218.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE CT Spine Lumbar w/Contrast 72132", "code_information": [{"code": "72132", "type": "CPT"}, {"code": "36202780", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 382.0, "discounted_cash": 133.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 156.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 156.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 193.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 141.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 276.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 294.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE CT Thorax w/ + w/o Contrast 71270", "code_information": [{"code": "71270", "type": "CPT"}, {"code": "42619201", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4330.0, "discounted_cash": 1515.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1777.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1777.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2192.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1608.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 338.43, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 359.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE CT head or brain w/contrast 70460", "code_information": [{"code": "70460", "type": "CPT"}, {"code": "42921146", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2860.0, "discounted_cash": 1001.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1174.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1174.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1448.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1062.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 250.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE CT, Head or brain; w/o contrast 70450", "code_information": [{"code": "70450", "type": "CPT"}, {"code": "34077307", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 3142.0, "discounted_cash": 1099.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1289.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1289.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1590.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1166.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 164.8, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 175.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Discography Lumbar 72295", "code_information": [{"code": "72295", "type": "CPT"}, {"code": "34389144", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 11811.93, "gross_charge": 3478.0, "discounted_cash": 1217.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1427.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1427.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1760.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2818.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1291.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7513.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1791.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2159.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 172.03, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 182.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Discography, cervical or thoracic 72285", "code_information": [{"code": "72285", "type": "CPT"}, {"code": "42639246", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 11811.93, "gross_charge": 3479.0, "discounted_cash": 1217.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1428.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1428.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1761.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2818.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1292.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7513.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1791.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2160.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 184.1, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 195.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE EKG, at least 12 leads, tracing only 93005", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "34093804", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Fine needle aspiration, w/imaging 10022", "code_information": [{"code": "34077308", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BCE Fluroscopic guidance for needle placement 77002", "code_information": [{"code": "77002", "type": "CPT"}, {"code": "34389163", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2055.0, "discounted_cash": 719.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1040.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 763.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 326.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1058.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1276.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 210.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 223.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE IR Arthrography Injection 23350", "code_information": [{"code": "23350", "type": "CPT"}, {"code": "34060925", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE IR Asp &/or Inj Major Jt or Bursa 20610", "code_information": [{"code": "20610", "type": "CPT"}, {"code": "40162621", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE IR Hip Arthrography 73525", "code_information": [{"code": "73525", "type": "CPT"}, {"code": "35312680", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1022.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 749.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1039.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1253.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 233.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 248.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE IR Shoulder Arthroscopy 73040", "code_information": [{"code": "73040", "type": "CPT"}, {"code": "34077298", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 276.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 276.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 341.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 250.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 347.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 418.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 247.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 263.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE IR Wrist Arthrography 73115", "code_information": [{"code": "73115", "type": "CPT"}, {"code": "40146244", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 221.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 162.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 271.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 250.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 266.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Injection procedure for elbow arthrography 24220", "code_information": [{"code": "24220", "type": "CPT"}, {"code": "34077306", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3598.0, "discounted_cash": 1259.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1741.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Joint Rad w/manual app of stress 77071", "code_information": [{"code": "77071", "type": "CPT"}, {"code": "42710648", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 92.0, "discounted_cash": 32.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 37.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 37.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 46.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 34.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 47.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 57.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRA Head w/ + w/o Contrast 70546", "code_information": [{"code": "70546", "type": "CPT"}, {"code": "42931573", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5079.0, "discounted_cash": 1777.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2084.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2084.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2571.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1886.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 639.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 680.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRA Neck W/O Contrast 70547", "code_information": [{"code": "70547", "type": "CPT"}, {"code": "42923487", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1032.0, "discounted_cash": 361.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 383.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 393.08, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 418.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRA Neck w/wo contrast & further sequences 70549", "code_information": [{"code": "70549", "type": "CPT"}, {"code": "44731006", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5079.0, "discounted_cash": 1777.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2084.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2084.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2571.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1886.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 642.3, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 683.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRA/MRV Head w/o Contrast 70544", "code_information": [{"code": "70544", "type": "CPT"}, {"code": "42589521", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1032.0, "discounted_cash": 361.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 383.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 392.29, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 417.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Brain w/o Contrast 70551", "code_information": [{"code": "70551", "type": "CPT"}, {"code": "41581927", "type": "CDM"}, {"code": "611", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2379.0, "discounted_cash": 832.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 976.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 976.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1204.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 883.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 313.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 333.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Brain, w/o & w/contrast 70553", "code_information": [{"code": "70553", "type": "CPT"}, {"code": "34060923", "type": "CDM"}, {"code": "611", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 520.11, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 553.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Chest w/o Contrast 71550", "code_information": [{"code": "71550", "type": "CPT"}, {"code": "42649815", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 653.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 694.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Face Neck Orbit w/ + w/o Cont 70543", "code_information": [{"code": "70543", "type": "CPT"}, {"code": "35312667", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 584.41, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 621.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI LE Joint w/o contrast 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "39629434", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 391.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 416.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Orbit,face,neck w/o contrast 70540", "code_information": [{"code": "70540", "type": "CPT"}, {"code": "42890210", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2571.0, "discounted_cash": 899.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1055.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1055.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1301.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 954.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 400.34, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 425.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Pelvis s/contrast 72196", "code_information": [{"code": "72196", "type": "CPT"}, {"code": "42887856", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2271.0, "discounted_cash": 794.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 932.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 932.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1149.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 843.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 461.43, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 490.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Pelvis w/o Contrast + w Contrast 72197", "code_information": [{"code": "72197", "type": "CPT"}, {"code": "42908475", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 573.18, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 609.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Pelvis w/o Contrast 72195", "code_information": [{"code": "72195", "type": "CPT"}, {"code": "42619190", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 392.29, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 417.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Spinal canal w/o & w/contrast, cervical 72156", "code_information": [{"code": "72156", "type": "CPT"}, {"code": "34091771", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 521.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 554.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Spine Cervical 72141", "code_information": [{"code": "72141", "type": "CPT"}, {"code": "34060821", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 298.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Spine Lumbar w/ & w/o contrast 72158", "code_information": [{"code": "72158", "type": "CPT"}, {"code": "39263659", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 520.11, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 553.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Spine Lumbar w/contrast 72149", "code_information": [{"code": "72149", "type": "CPT"}, {"code": "42757616", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 673.0, "discounted_cash": 235.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 276.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 276.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 340.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 249.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 458.2, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 487.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Spine Lumbar w/o contrast 72148", "code_information": [{"code": "72148", "type": "CPT"}, {"code": "34044473", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 299.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 318.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Spine Thoracic w/ + w/o Cont 72157", "code_information": [{"code": "72157", "type": "CPT"}, {"code": "39612043", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 523.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 556.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Spine Thoracic w/o Contrast 72146", "code_information": [{"code": "72146", "type": "CPT"}, {"code": "39678693", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5685.0, "discounted_cash": 1989.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2333.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2333.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2878.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2111.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 299.03, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 318.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI UE Joint 73221", "code_information": [{"code": "73221", "type": "CPT"}, {"code": "34044475", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 367.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI UE Joint, w/contrast 73222", "code_information": [{"code": "73222", "type": "CPT"}, {"code": "34060829", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6639.0, "discounted_cash": 2323.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3361.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2465.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 575.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI UE Non Joint w/ + w/o Contrast 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "36927932", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI Upper Extremity, other than joint w/contrast 73219", "code_information": [{"code": "73219", "type": "CPT"}, {"code": "42871484", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 417.0, "discounted_cash": 145.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 171.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 171.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 211.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 154.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 623.02, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 662.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI W/ + W/O Contrast 73720", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "42918278", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 615.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI any joint of lower extremity w/ + w/o Contrast 73723", "code_information": [{"code": "73723", "type": "CPT"}, {"code": "42615776", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 692.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 736.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI any joint of lower extremity w/Contrast 73722", "code_information": [{"code": "73722", "type": "CPT"}, {"code": "35562048", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 3463.0, "discounted_cash": 1212.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1421.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1421.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1753.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 579.6, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 616.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI spinal canal and contents, cervical; with contrast material(s) 72142", "code_information": [{"code": "72142", "type": "CPT"}, {"code": "42594841", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1951.0, "discounted_cash": 682.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 987.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 724.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 469.46, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 499.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI w/o contrast lower extremity 73721", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "34044474", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI, UE Joint; w/o & w/contrast 73223", "code_information": [{"code": "73223", "type": "CPT"}, {"code": "34093797", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 695.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 739.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI, UE Other than joint; w/o contrast 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "34093739", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI, abdomen; w/o contrast & w/contrast 74183", "code_information": [{"code": "74183", "type": "CPT"}, {"code": "34093800", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 576.39, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 612.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE MRI, abdomen; without contrast material(s) 74181", "code_information": [{"code": "74181", "type": "CPT"}, {"code": "44735473", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 313.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 333.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE OT Eval, high complexity 97167", "code_information": [{"code": "97167", "type": "CPT"}, {"code": "44671476", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 154.13, "maximum": 8450.0, "gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 210.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 410.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE OT Eval, low complexity 97165", "code_information": [{"code": "97165", "type": "CPT"}, {"code": "44671474", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 154.13, "maximum": 8450.0, "gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 210.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 410.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE OT Eval, moderate complexity, 97166", "code_information": [{"code": "97166", "type": "CPT"}, {"code": "44671475", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 154.13, "maximum": 8450.0, "gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 210.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 410.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE OT Re-Eval 97168", "code_information": [{"code": "97168", "type": "CPT"}, {"code": "44671545", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 76.5, "maximum": 8450.0, "gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 84.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 84.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 104.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 281.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 442.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 442.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 442.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE PT Eval, high complexity 97163", "code_information": [{"code": "97163", "type": "CPT"}, {"code": "44671388", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 154.13, "maximum": 8450.0, "gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 210.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 381.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE PT Eval, low complexity 97161", "code_information": [{"code": "97161", "type": "CPT"}, {"code": "44671386", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 154.13, "maximum": 8450.0, "gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 210.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 381.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE PT Eval, moderate complexity 97162", "code_information": [{"code": "97162", "type": "CPT"}, {"code": "44671387", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 154.13, "maximum": 8450.0, "gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 210.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 381.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE PT Re-Eval 97164", "code_information": [{"code": "97164", "type": "CPT"}, {"code": "44671389", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 76.5, "maximum": 8450.0, "gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 84.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 84.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 104.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 259.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 407.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 407.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 407.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE PT Wound Care 50 sq cm or less 97605", "code_information": [{"code": "97605", "type": "CPT"}, {"code": "45415568", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 770.56, "maximum": 8450.0, "gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Radiologic examination, abdomen; 1 view 74018", "code_information": [{"code": "74018", "type": "CPT"}, {"code": "44896635", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 148.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 247.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 51.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 54.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Radiologic examination, abdomen; 2 views 74019", "code_information": [{"code": "74019", "type": "CPT"}, {"code": "44894790", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 148.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 247.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Radiologic examination, abdomen; 3 or more views 74021", "code_information": [{"code": "74021", "type": "CPT"}, {"code": "44897267", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 148.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 247.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Radiologic examination, chest; 2 views 71046", "code_information": [{"code": "71046", "type": "CPT"}, {"code": "44894687", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 492.0, "discounted_cash": 172.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 249.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 182.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 253.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 305.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Radiologic examination, chest; 4 or more views 71048", "code_information": [{"code": "71048", "type": "CPT"}, {"code": "44899807", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 56.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 56.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 69.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 50.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 70.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 85.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 74.74, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 79.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Radiologic examination, chest; single view 71045", "code_information": [{"code": "71045", "type": "CPT"}, {"code": "44894688", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 279.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 205.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 41.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 44.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Radiologic examination, femur; 1 view 73551", "code_information": [{"code": "73551", "type": "CPT"}, {"code": "44619651", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 92.0, "discounted_cash": 32.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 37.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 37.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 46.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 34.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 47.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 57.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 55.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Short-latency EP trunk/head 95927", "code_information": [{"code": "95927", "type": "CPT"}, {"code": "34389182", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"minimum": 470.46, "maximum": 8450.0, "gross_charge": 1145.0, "discounted_cash": 400.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 470.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 739.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 739.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 739.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE US Guidance for Vascular Access 76937", "code_information": [{"code": "76937", "type": "CPT"}, {"code": "41579600", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2155.0, "discounted_cash": 754.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 884.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 884.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1109.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 60.28, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 64.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE Urethrocystrography Retro 74450", "code_information": [{"code": "74450", "type": "CPT"}, {"code": "42873545", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 238.24, "discounted_cash": 83.38, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 97.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 97.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 120.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 88.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 122.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 147.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Abdomen Series w/ Chest 1 View 74022", "code_information": [{"code": "74022", "type": "CPT"}, {"code": "40773518", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 148.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 247.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 83.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 89.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Ankle 2 Views 73600", "code_information": [{"code": "73600", "type": "CPT"}, {"code": "39828483", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 518.0, "discounted_cash": 181.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 262.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 192.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 266.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 321.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Ankle, complete min 3 views 73610", "code_information": [{"code": "73610", "type": "CPT"}, {"code": "34077286", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 518.0, "discounted_cash": 181.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 262.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 192.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 266.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 321.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 67.51, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 72.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Arthrogram Hip 73525", "code_information": [{"code": "73525", "type": "CPT"}, {"code": "35312681", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1022.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 749.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1039.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1253.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 233.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 248.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Bilateral Hip 73520", "code_information": [{"code": "36202805", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BCE XR Calcaneus, min 2 views 73650", "code_information": [{"code": "73650", "type": "CPT"}, {"code": "42710827", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 37.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 37.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 33.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 46.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 56.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 49.84, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 53.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Cholangiography and/or pancreatography in OR 74300", "code_information": [{"code": "74300", "type": "CPT"}, {"code": "41562452", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 933.0, "discounted_cash": 326.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 382.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 382.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 472.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 346.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 480.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 579.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Elbow Complete, min 3 views 73080", "code_information": [{"code": "73080", "type": "CPT"}, {"code": "35247047", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Femur, minimum 2 Views 73552", "code_information": [{"code": "73552", "type": "CPT"}, {"code": "42949282", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 130.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 130.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 161.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 118.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 164.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 198.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 65.12, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 69.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Flouro Guid CVA Device Replace 77001", "code_information": [{"code": "77001", "type": "CPT"}, {"code": "35562072", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1001.0, "discounted_cash": 350.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 410.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 410.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 506.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 371.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 318.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 500.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 500.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 500.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 515.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 621.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 190.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 202.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Fluoro Guide & Loc Spine Inj 77003", "code_information": [{"code": "77003", "type": "CPT"}, {"code": "35562060", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2055.0, "discounted_cash": 719.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1040.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 763.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 300.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 472.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1058.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1276.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 180.08, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 191.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Fluoroscopy, up to 1 hour 76000", "code_information": [{"code": "76000", "type": "CPT"}, {"code": "38198418", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 507.0, "discounted_cash": 177.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 208.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 208.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 256.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 188.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 140.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 220.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 220.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 220.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 261.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 314.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 67.51, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 72.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Foot Complete 73620", "code_information": [{"code": "73620", "type": "CPT"}, {"code": "34060820", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 271.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 276.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 333.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 50.63, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 54.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Foot, complete, min 3 views 73630", "code_information": [{"code": "73630", "type": "CPT"}, {"code": "34060871", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 271.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 276.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 333.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Forearm, 2 views 73090", "code_information": [{"code": "73090", "type": "CPT"}, {"code": "41134240", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 481.0, "discounted_cash": 168.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 197.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 197.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 243.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 178.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 247.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 298.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 55.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Hand, min 3 views 73130", "code_information": [{"code": "73130", "type": "CPT"}, {"code": "34060830", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Hip, Bilateral w/Pelvis Min 5V 73523", "code_information": [{"code": "73523", "type": "CPT"}, {"code": "43008929", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 187.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 113.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 120.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Hip, Unilateral, w Pelvis 2-3 Views 73502", "code_information": [{"code": "73502", "type": "CPT"}, {"code": "42933811", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 89.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 95.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Hip, Unilateral, with pelvis when performed;1 view 73501", "code_information": [{"code": "73501", "type": "CPT"}, {"code": "42936399", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Hip, unilateral; 1 view 73500", "code_information": [{"code": "39017794", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BCE XR Hips, Bilateral, W/Pelvis 2 View 73521", "code_information": [{"code": "73521", "type": "CPT"}, {"code": "42941717", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 73.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 78.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Humerus, min of 2 views 73060", "code_information": [{"code": "73060", "type": "CPT"}, {"code": "34093632", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 553.0, "discounted_cash": 193.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 227.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 227.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 279.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 205.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 284.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 343.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Inj SI Joint w/ or w/o Arth G0260", "code_information": [{"code": "G0260", "type": "HCPCS"}, {"code": "39612038", "type": "CDM"}, {"code": "409", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 2881.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Jt Survey 1 View 2/more Joints 77077", "code_information": [{"code": "77077", "type": "CPT"}, {"code": "39303765", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 507.0, "discounted_cash": 177.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 208.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 208.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 256.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 188.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 261.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 314.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Knee 3 Views 73562", "code_information": [{"code": "73562", "type": "CPT"}, {"code": "34060822", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Knee, 1 or 2 views 73560", "code_information": [{"code": "73560", "type": "CPT"}, {"code": "35214032", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 525.0, "discounted_cash": 183.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 215.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 215.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 265.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 194.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 270.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 326.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Knee, complete, 4 or more views 73564", "code_information": [{"code": "73564", "type": "CPT"}, {"code": "34093798", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1708.0, "discounted_cash": 597.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 701.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 701.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 864.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 634.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 879.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1060.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 87.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 93.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Mandible; Complete, Minimum of 4 V 70110", "code_information": [{"code": "70110", "type": "CPT"}, {"code": "42965153", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 510.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 258.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 189.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 262.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 316.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Neck Soft Tissue 70360", "code_information": [{"code": "70360", "type": "CPT"}, {"code": "36153301", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 510.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 258.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 189.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 262.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 316.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Pelvis Complete 3 View Min 72190", "code_information": [{"code": "72190", "type": "CPT"}, {"code": "41217199", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 696.0, "discounted_cash": 243.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 285.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 285.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 352.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 258.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 358.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 432.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Pelvis, 1 or 2 views 72170", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "35214001", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 151.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 151.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 186.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 137.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 190.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 229.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 47.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 50.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Ribs, bilateral; 3 views 71110", "code_information": [{"code": "71110", "type": "CPT"}, {"code": "42639237", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 551.0, "discounted_cash": 192.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 226.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 226.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 278.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 204.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 283.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 342.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Ribs, unilateral, min 3 views 71101", "code_information": [{"code": "71101", "type": "CPT"}, {"code": "34077300", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 44.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 44.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 55.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 40.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 56.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 67.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 75.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Ribs, unilateral; 2 views 71100", "code_information": [{"code": "71100", "type": "CPT"}, {"code": "35213986", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 279.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 205.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Shoulder Complete 73030", "code_information": [{"code": "73030", "type": "CPT"}, {"code": "34077299", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 336.0, "discounted_cash": 117.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 137.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 137.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 170.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 124.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 173.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 208.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 61.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Skull Complete Minimum 4 Views 70260", "code_information": [{"code": "70260", "type": "CPT"}, {"code": "45571530", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 136.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 136.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 168.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 170.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 206.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 75.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 80.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Skull Less Than 4 Views 70250", "code_information": [{"code": "70250", "type": "CPT"}, {"code": "42615770", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 65.91, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 70.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Spine Cervical 72052", "code_information": [{"code": "72052", "type": "CPT"}, {"code": "36202821", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 780.0, "discounted_cash": 273.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 394.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 289.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 401.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 484.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 114.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 122.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Spine Lumbosacral Min 4 views 72110", "code_information": [{"code": "72110", "type": "CPT"}, {"code": "34044476", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 926.0, "discounted_cash": 324.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 380.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 380.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 468.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 343.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 476.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 575.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 94.86, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 101.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Spine Thoracic 2 Views 72070", "code_information": [{"code": "72070", "type": "CPT"}, {"code": "36153307", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 741.0, "discounted_cash": 259.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 304.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 304.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 375.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 275.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 381.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 460.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Spine Thoracic 3 Views 72072", "code_information": [{"code": "72072", "type": "CPT"}, {"code": "38957069", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 803.0, "discounted_cash": 281.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 329.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 329.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 406.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 298.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 413.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 498.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.12, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Spine Thoracic Min 4 views 72074", "code_information": [{"code": "72074", "type": "CPT"}, {"code": "42882978", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 741.0, "discounted_cash": 259.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 304.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 304.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 375.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 275.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 381.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 460.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 79.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 84.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Spine, cervical 4 or 5 views 72050", "code_information": [{"code": "72050", "type": "CPT"}, {"code": "34084166", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 975.0, "discounted_cash": 341.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 400.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 400.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 493.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 362.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 502.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 605.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 98.86, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 105.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Spine, cervical; 2 or 3 views 72040", "code_information": [{"code": "72040", "type": "CPT"}, {"code": "34081995", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Spine, lumbosacral, 2 or 3 views 72100", "code_information": [{"code": "72100", "type": "CPT"}, {"code": "34088591", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Spine, lumbosacral, bending 72114", "code_information": [{"code": "72114", "type": "CPT"}, {"code": "42886752", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 673.0, "discounted_cash": 235.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 276.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 276.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 340.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 249.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 346.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 417.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 112.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 119.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Spine,1 View 72020", "code_information": [{"code": "72020", "type": "CPT"}, {"code": "35213997", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 271.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 276.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 333.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 40.19, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 43.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Tibia/Fibula 2 Views 73590", "code_information": [{"code": "73590", "type": "CPT"}, {"code": "34077285", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 234.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 234.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 289.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 212.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 294.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 354.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 61.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Urography, retrograde, w/ + w/o KUB 74420", "code_information": [{"code": "74420", "type": "CPT"}, {"code": "39612049", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2092.0, "discounted_cash": 732.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 858.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 858.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1059.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 776.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 203.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 319.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 319.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 319.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1077.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1299.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 129.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 137.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Wrist Arthrography 73115", "code_information": [{"code": "73115", "type": "CPT"}, {"code": "40146245", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 221.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 162.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 271.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 250.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 266.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR Wrist, complete min of 3 views 73110", "code_information": [{"code": "73110", "type": "CPT"}, {"code": "34093641", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 79.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 84.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR facial bones; complete, minimum of 3 views 70150", "code_information": [{"code": "70150", "type": "CPT"}, {"code": "42991832", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 82.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 88.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR femur, 2 views 73550", "code_information": [{"code": "39017784", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BCE XR hips, bilateral, with pelvis when performed; 3-4 views 73522", "code_information": [{"code": "73522", "type": "CPT"}, {"code": "42989658", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 96.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 102.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR knee; both knees, standing, anteroposterior 73565", "code_information": [{"code": "73565", "type": "CPT"}, {"code": "42630043", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 524.0, "discounted_cash": 183.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 215.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 215.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 265.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 194.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 269.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 325.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR nasal bones, complete, minimum of 3 views 70160", "code_information": [{"code": "70160", "type": "CPT"}, {"code": "44734721", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 492.0, "discounted_cash": 172.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 249.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 182.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 253.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 305.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 75.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR sacrum/coccyx, minimum of 2 views 72220", "code_information": [{"code": "72220", "type": "CPT"}, {"code": "38329825", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR, Eye, detection of foreign body 70030", "code_information": [{"code": "70030", "type": "CPT"}, {"code": "42873592", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 30.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 30.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 37.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 27.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 38.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 45.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCE XR, Shoulder; 1 view 73020", "code_information": [{"code": "73020", "type": "CPT"}, {"code": "42667221", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 339.0, "discounted_cash": 118.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 171.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 125.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 174.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 210.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 34.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 37.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCG VACCINE INTRAVESICAL", "code_information": [{"code": "90586", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCG VACCINE PERCUT", "code_information": [{"code": "90585", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCKDHB GENE", "code_information": [{"code": "81205", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 118.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 380.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 380.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 380.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE MAJOR BP", "code_information": [{"code": "81206", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 253.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 418.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 657.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 657.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 657.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 236.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 236.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE MAJOR BP QUAN", "code_information": [{"code": "40U", "type": "CPT"}], "standard_charges": [{"minimum": 590.26, "maximum": 1643.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1045.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1643.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1643.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1643.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 590.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 590.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE MINOR BP", "code_information": [{"code": "81207", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 223.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 369.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 580.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 580.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 580.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 208.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 208.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE OTHER BP", "code_information": [{"code": "81208", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 268.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 547.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 860.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 860.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 860.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 309.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 309.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BD Bone Density DEXA Body Comp 76499", "code_information": [{"code": "76499", "type": "CPT"}, {"code": "675631", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BDY SRF MPG PM/CVDFB TM IMPL", "code_information": [{"code": "695T", "type": "CPT"}], "standard_charges": [{"minimum": 2518.28, "maximum": 3960.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2518.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3960.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3960.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3960.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BDY SURF MAPG PM/CVDFB F/UP", "code_information": [{"code": "696T", "type": "CPT"}], "standard_charges": [{"minimum": 96.98, "maximum": 152.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 96.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 152.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 152.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 152.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEACH CHAIR STRAP", "code_information": [{"code": "111309", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BEAM SALVATION FULL THREAD 7 X 130MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB170130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3348.0, "discounted_cash": 1171.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BEAR HUGGER UPPER BODY 62200", "code_information": [{"code": "62200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING 10MM X 75MM TIBIAL ANTERIOR STABILIZED VE189080", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "VE189080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8065.0, "discounted_cash": 2822.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING 36MM +3 RET VITE HMRL 110031426", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110031426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2450.0, "discounted_cash": 857.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING 4 X 75MM LEFT ULNA WITH E PLUS 540-54-075", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "540-54-075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7868.0, "discounted_cash": 2753.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING HMRL 36MM STD VITE 110031424", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110031424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2450.0, "discounted_cash": 857.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING INSERT - TIBIAL CS SIZE 6 9MM 5531-G-609-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-609-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING POLY 46H DUAL MOBILITY EMPOWR 952-28-46H", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "952-28-46H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING SIZE 3 8MM VIT-E UKA TIBIAL AR-521-TBC8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-521-TBC8", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBIAL SIZE D RM UNIVERSAL D6 LL PARTIAL KNEE SYSTEM OXFORD VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "154725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 10MM X 59MM PRIMARY AGC TRADITION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "151000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 11.0MM SZ 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 12MM VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2142.0, "discounted_cash": 749.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 4.0MM X 9.0MM POST STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2243.0, "discounted_cash": 785.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 9.0MM SZ 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2243.0, "discounted_cash": 785.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 1 8MM IBALANCE UKA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-501-TBA8", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 3 LG ANATOMIC LFT OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1947.0, "discounted_cash": 681.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 3 UNICOMPARTMENTAL KNEE SYS TIBIA BASE LM RL JOURNEY IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71422423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BEBTELOVIMAB INJECTION", "code_information": [{"code": "M0222", "type": "HCPCS"}], "standard_charges": [{"minimum": 1545.71, "maximum": 2428.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1545.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2428.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2428.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2428.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEBTELOVIMAB INJECTION HOME", "code_information": [{"code": "M0223", "type": "HCPCS"}], "standard_charges": [{"minimum": 2427.71, "maximum": 3814.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2427.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3814.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3814.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3814.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEHAV CHNG SMOKING 3-10 MIN", "code_information": [{"code": "99406", "type": "CPT"}], "standard_charges": [{"minimum": 55.61, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEHAV CHNG SMOKING > 10 MIN", "code_information": [{"code": "99407", "type": "CPT"}], "standard_charges": [{"minimum": 116.03, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 116.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEHAVRAL QUALIT ANALYS VOICE", "code_information": [{"code": "92524", "type": "CPT"}], "standard_charges": [{"minimum": 398.93, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 398.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 626.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 626.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 626.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BENEF REFUSES SERVICE, MOD", "code_information": [{"code": "G2022", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [{"code": "725", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7819.7, "maximum": 13424.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7819.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11183.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12302.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13424.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [{"code": "726", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4530.01, "maximum": 7776.9, "estimated_discounted_cash": 39064.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4530.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6478.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7126.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7776.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BENZODIAZEPINES 13 OR MORE", "code_information": [{"code": "80347", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BENZODIAZEPINES1-12", "code_information": [{"code": "80346", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BERKELEY VACURETTE CANNULA CURVED 8MM 022108-10", "code_information": [{"code": "22108-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEST PCT PT SAFETY EM MVP", "code_information": [{"code": "G0057", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BETA AMYL AB40&AB42 LC-MS/MS", "code_information": [{"code": "346U", "type": "CPT"}], "standard_charges": [{"minimum": 134.29, "maximum": 134.29, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 134.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 134.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BETA NOT GIVEN NO REASON", "code_information": [{"code": "G9188", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BETA PRES OR ALREADY TAKING", "code_information": [{"code": "G9189", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BETA-2 GLYCOPROTEIN ANTIBODY", "code_information": [{"code": "86146", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BETA-BLOC RX PT W/ABN LVEF", "code_information": [{"code": "G8450", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BETAMETHASONE (CELESTONE SOLUSPAN) 30MG/5ML VIAL", "code_information": [{"code": "MED0028", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BFB TRAINING 1ST 15 MIN", "code_information": [{"code": "90912", "type": "CPT"}], "standard_charges": [{"minimum": 200.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 200.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BFB TRAINING EA ADDL 15 MIN", "code_information": [{"code": "90913", "type": "CPT"}], "standard_charges": [{"minimum": 111.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BHV ID ASSMT BY PHYS/QHP", "code_information": [{"code": "97151", "type": "CPT"}], "standard_charges": [{"minimum": 120.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BHV ID SUPRT ASSMT BY 1 TECH", "code_information": [{"code": "97152", "type": "CPT"}], "standard_charges": [{"minimum": 120.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BI-CRUCIATE STABILIZED FEMORAL COMPONENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74024924", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 3850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BI-CRUCIATE STABILIZED FEMORAL COMPONENT SZ 5 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74024215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BIA WHOLE BODY", "code_information": [{"code": "358T", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 159.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILAT MAST/HX BI /UNILAT MAS", "code_information": [{"code": "G9708", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILAT MAST/HX BI /UNILAT MAS", "code_information": [{"code": "M1280", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "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": 36994.98, "maximum": 63511.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36994.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52910.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58201.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63511.19, "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": 19109.14, "maximum": 32805.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19109.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27330.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30063.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32805.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS CHOLYLGLYCINE", "code_information": [{"code": "82240", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 67.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 106.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 106.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 106.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS TOTAL", "code_information": [{"code": "82239", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE DUCT ENDOSCOPY ADD-ON", "code_information": [{"code": "47550", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE DUCT REVISION", "code_information": [{"code": "47701", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDO PERQ DX W/SPECI", "code_information": [{"code": "47552", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47553", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47554", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47556", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7469.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "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": 12874.06, "maximum": 22101.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12874.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18412.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20253.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22101.57, "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": 22828.89, "maximum": 39191.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22828.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32650.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35915.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39191.53, "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": 9539.97, "maximum": 16377.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9539.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13644.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15008.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16377.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL TRANSCUT", "code_information": [{"code": "88720", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILOBECTOMY", "code_information": [{"code": "32482", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BINDER 12 INCH SIZE L/XL PREMIUM 4-PANEL ABDOMINAL ORT21310LXL", "code_information": [{"code": "ORT21310LXL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL", "code_information": [{"code": "13653008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 12 MED", "code_information": [{"code": "13652067", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.81, "discounted_cash": 13.58, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 12 XL 13654009", "code_information": [{"code": "13654009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 12IN WIDE STRETCHES TO FIT 30IN TO 45IN WHT", "code_information": [{"code": "H8410 810", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 3 PANEL", "code_information": [{"code": "13661056", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 35.08, "discounted_cash": 12.28, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 3 PANEL", "code_information": [{"code": "13661056", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.08, "discounted_cash": 12.28, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 30IN TO 45IN UNIVERSAL ELASTIC STRETCH MATERIAL EASYGRIP", "code_information": [{"code": "810", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 30IN TO 45IN WHT UNIVERSAL UNISEX ELASTIC LF", "code_information": [{"code": "H84104101", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 46IN TO 62IN WHT UNIVERSAL UNISEX ELASTIC LF", "code_information": [{"code": "411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 9IN WIDE 30IN TO 45IN WHT DALE LF", "code_information": [{"code": "H8410 410", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 9IN WIDE STRECTHES TO FIT 46IN X 62IN WHT DALE", "code_information": [{"code": "H8410 411", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 9IN WIDE STRETCHES TO FIT 60IN TO 75IN 3 PANEL DALE", "code_information": [{"code": "H8410 418", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL 9IN X 60IN TO 75IN THREE PANEL EASYGRIP LF", "code_information": [{"code": "418", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOBRACE REINFORCED BIOINDUCTIVE SHOESTRING BB5X250-FA", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "BB5X250-FA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 1400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOCOMPOSITE SPEEDBRIDGE IMPLANT SYSTEM W/BIOCOMPOSITE SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2600SBS-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4661.2, "discounted_cash": 1631.42, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOCOMPOSITE SWIVELLOCK 5.5 X 15MM TENODESIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1555CDS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOFEEDBACK TRAIN ANY METH", "code_information": [{"code": "90901", "type": "CPT"}], "standard_charges": [{"minimum": 90.58, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 90.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 142.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 142.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 142.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOIMPEDANCE CV ANALYSIS", "code_information": [{"code": "93701", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "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": 14346.15, "maximum": 24628.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14346.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20518.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22569.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24628.77, "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": 20432.19, "maximum": 35076.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20432.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29222.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32144.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35076.99, "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": 11007.19, "maximum": 18896.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11007.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15742.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17316.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18896.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY BONE 20220", "code_information": [{"code": "20220", "type": "CPT"}, {"code": "1480143", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY BONE TROCAR OR NEEDLE DEEP 20225", "code_information": [{"code": "20225", "type": "CPT"}, {"code": "5109149", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 620.48, "maximum": 8450.0, "gross_charge": 1282.0, "discounted_cash": 448.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 620.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY BONE; OPEN; DEEP 20245", "code_information": [{"code": "20245", "type": "CPT"}, {"code": "1480144", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY BONE; OPEN; SUPERFICIAL 20240", "code_information": [{"code": "20240", "type": "CPT"}, {"code": "1480145", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY BREAST INCISIONAL 19101", "code_information": [{"code": "19101", "type": "CPT"}, {"code": "1480146", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY BREAST PERCUTANEOUS 19102", "code_information": [{"code": "1480147", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY COLON 44100", "code_information": [{"code": "44100", "type": "CPT"}, {"code": "1480148", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY DEEP AXILLARY LYMPH NODE 38525", "code_information": [{"code": "38525", "type": "CPT"}, {"code": "1480156", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY EXTERNAL AUDITORY CANAL 69105", "code_information": [{"code": "69105", "type": "CPT"}, {"code": "31939601", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 149.07, "maximum": 8450.0, "gross_charge": 308.0, "discounted_cash": 107.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 149.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY EXTERNAL EAR 69100", "code_information": [{"code": "69100", "type": "CPT"}, {"code": "1480149", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 402.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY EYE MUSCLE", "code_information": [{"code": "67346", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS ALLIGATOR LARGE CAPACITY", "code_information": [{"code": "128-5659", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.76, "discounted_cash": 18.47, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.0MM SCOPE CHANNELS Mini Forceps 129-0175 Oval Yellow 160 2", "code_information": [{"code": "BF40021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.0MM SCOPE CHANNELS Mini Forceps 129-0181 Alligator Yellow 160 2", "code_information": [{"code": "BF40141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.0MM SCOPE CHANNELS Mini Forceps With Spike 129-0176 Oval Yellow 160 2", "code_information": [{"code": "BF40051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 128-5668 Oval Blue 230 2.8", "code_information": [{"code": "BF40096", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 128-5670 Alligator Blue 230 2.8", "code_information": [{"code": "BF40206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 129-0179 Oval Orange 180 2.8", "code_information": [{"code": "BF40081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 129-0184 Alligator Orange 180 2.8", "code_information": [{"code": "BF40191", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 129-0677 Oval Blue 230 2.8", "code_information": [{"code": "BF40091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 129-0679 Alligator Blue 230 2.8", "code_information": [{"code": "BF40201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps Serrated 131-2212 Serrated Blue 230 2.8", "code_information": [{"code": "BF40446", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps Serrated 132-9017 Serrated Blue 230 2.8", "code_information": [{"code": "BF40441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps Serrated 132-9020 Serrated Orange 180 2.8", "code_information": [{"code": "BF40431", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 128-5669 Oval Blue 230 2.8", "code_information": [{"code": "BF40126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 128-5671 Alligator Blue 230 2.8", "code_information": [{"code": "BF40236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0180 Oval Orange 180 2.8", "code_information": [{"code": "BF40111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0185 Alligator Orange 180 2.", "code_information": [{"code": "BF40221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0678 Oval Blue 230 2.8", "code_information": [{"code": "BF40121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0680 Alligator Blue 230 2.8", "code_information": [{"code": "BF40231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike Serrated 131-2211 Serrated Blue", "code_information": [{"code": "BF40426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike Serrated 132-9018 Serrated Orang", "code_information": [{"code": "BF40411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike Serrated 132-9019 Serrated Blue", "code_information": [{"code": "BF40421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 3.2MM SCOPE CHANNELS Jumbo Biopsy Forceps 129-0177 Oval Blue 230 3.2", "code_information": [{"code": "BF40061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 3.2MM SCOPE CHANNELS Jumbo Biopsy Forceps 129-0182 Alligator Blue 230 3.2", "code_information": [{"code": "BF40171", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 3.2MM SCOPE CHANNELS Jumbo Biopsy Forceps With Spike 129-0178 Oval Blue 230 3.2", "code_information": [{"code": "BF40071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS HOT Biopsy Forcep Hot Lower 129-0681 Oval Blue 230 2.8", "code_information": [{"code": "HF48521", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS HOT Biopsy Forceps Hot Lower Alligator 131-2213 Alligator Blue 230 2.8", "code_information": [{"code": "HF48541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY INTRANASAL 30100", "code_information": [{"code": "30100", "type": "CPT"}, {"code": "3548589", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY KIDNEY PERCUTANEOUS BY NEEDLE OR TROCAR 50200", "code_information": [{"code": "50200", "type": "CPT"}, {"code": "1480151", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY KIDNEY PERCUTANEOUS VIA ESTABLISHED NEPHROSTOMY 50555", "code_information": [{"code": "50555", "type": "CPT"}, {"code": "1480152", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY KIDNEY-OPEN 50205", "code_information": [{"code": "50205", "type": "CPT"}, {"code": "1480153", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY LAPAROSCOPIC 49321", "code_information": [{"code": "49321", "type": "CPT"}, {"code": "1480154", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY LIVER-NEEDLE PERCUTANEOUS 47000", "code_information": [{"code": "47000", "type": "CPT"}, {"code": "1480155", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY LYMPH NODE OPEN SUPERFICIAL 38500", "code_information": [{"code": "38500", "type": "CPT"}, {"code": "1480157", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY MASS ABDOMINAL OR RETROPERITONEAL-PERCUTANEOUS 49180", "code_information": [{"code": "49180", "type": "CPT"}, {"code": "1480158", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY MUSCLE DEEP 20205", "code_information": [{"code": "20205", "type": "CPT"}, {"code": "1480159", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY MUSCLE PERQ NEEDLE", "code_information": [{"code": "20206", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1439.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY MUSCLE SUPERFICIAL 20200", "code_information": [{"code": "20200", "type": "CPT"}, {"code": "1480160", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY NAIL UNIT", "code_information": [{"code": "11755", "type": "CPT"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 402.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY NASOPHARYNX ; SURVEY FOR UNKNOWN PRIMARY LESION 42806", "code_information": [{"code": "42806", "type": "CPT"}, {"code": "20535003", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE 42804", "code_information": [{"code": "42804", "type": "CPT"}, {"code": "1700106", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF BRAIN OR INTRACRANIAL LESION 61140", "code_information": [{"code": "61140", "type": "CPT"}, {"code": "1480161", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CERVIX 57500", "code_information": [{"code": "57500", "type": "CPT"}, {"code": "1480162", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CONJUNCTIVA 68100", "code_information": [{"code": "68100", "type": "CPT"}, {"code": "1480163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 427.85, "maximum": 8450.0, "gross_charge": 884.0, "discounted_cash": 309.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 427.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CORNEA 65410", "code_information": [{"code": "65410", "type": "CPT"}, {"code": "1480164", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EPIDIDYMIS NEEDLE 54800", "code_information": [{"code": "54800", "type": "CPT"}, {"code": "1480165", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 762.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EYELID 67810", "code_information": [{"code": "67810", "type": "CPT"}, {"code": "1480166", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FLOOR OF MOUTH", "code_information": [{"code": "41108", "type": "CPT"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28050", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28052", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HEART LINING", "code_information": [{"code": "93505", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HIP JOINT", "code_information": [{"code": "27052", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF LACRIMAL GLAND 68510", "code_information": [{"code": "68510", "type": "CPT"}, {"code": "1480167", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF LIP 40490", "code_information": [{"code": "40490", "type": "CPT"}, {"code": "2334762", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 402.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF LIVER-WEDGE 47100", "code_information": [{"code": "47100", "type": "CPT"}, {"code": "1480168", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 736.23, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 736.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF NERVE 64795", "code_information": [{"code": "64795", "type": "CPT"}, {"code": "1480169", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF OVARY 58900", "code_information": [{"code": "58900", "type": "CPT"}, {"code": "1480170", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PALATE / UVULA 42100", "code_information": [{"code": "42100", "type": "CPT"}, {"code": "4040503", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 2143.0, "discounted_cash": 750.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1037.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PANCREAS OPEN", "code_information": [{"code": "48100", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SACROILIAC JOINT", "code_information": [{"code": "27050", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42405", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND; NEEDLE 42400", "code_information": [{"code": "42400", "type": "CPT"}, {"code": "42891950", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 77.92, "maximum": 8450.0, "gross_charge": 161.0, "discounted_cash": 56.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 77.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 402.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27040", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27041", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SPINAL CORD; PERCUTANEOUS NEEDLE 62269", "code_information": [{"code": "62269", "type": "CPT"}, {"code": "43047191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF STOMACH", "code_information": [{"code": "43605", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TEAR SAC", "code_information": [{"code": "68525", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS INCISIONAL 54505", "code_information": [{"code": "54505", "type": "CPT"}, {"code": "1480171", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS NEEDLE 54500", "code_information": [{"code": "54500", "type": "CPT"}, {"code": "1480172", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THE URETHRA 53200", "code_information": [{"code": "53200", "type": "CPT"}, {"code": "9033729", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THYROID", "code_information": [{"code": "60100", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TOE JOINT LINING", "code_information": [{"code": "28054", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE ANTERIOR 2/3 41100", "code_information": [{"code": "41100", "type": "CPT"}, {"code": "2013586", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 63.4, "maximum": 8450.0, "gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 63.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE POSTERIOR 1/3 41105", "code_information": [{"code": "41105", "type": "CPT"}, {"code": "1878241", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINAL MUCOSA;EXTENSIVE 57105", "code_information": [{"code": "57105", "type": "CPT"}, {"code": "1480173", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINAL MUCOSA;SIMPLE 57100", "code_information": [{"code": "57100", "type": "CPT"}, {"code": "1480174", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA OR PERINEUM 56605", "code_information": [{"code": "56605", "type": "CPT"}, {"code": "1480175", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA OR PERINEUM EA. SEPARATE ADD. LESION 56606", "code_information": [{"code": "56606", "type": "CPT"}, {"code": "15114848", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY", "code_information": [{"code": "89291", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY <=5", "code_information": [{"code": "89290", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OR EXCISION OF LYMPH NODE OPEN INGUINOFEMORAL NODES 38531", "code_information": [{"code": "38531", "type": "CPT"}, {"code": "45432589", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OROPHARYNX 42800", "code_information": [{"code": "42800", "type": "CPT"}, {"code": "3532520", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY PANCREAS-PERCUTANEOUS NEEDLE 48102", "code_information": [{"code": "48102", "type": "CPT"}, {"code": "1480177", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY PENIS 54100", "code_information": [{"code": "54100", "type": "CPT"}, {"code": "1480178", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY PENIS-DEEP STRUCTURES 54105", "code_information": [{"code": "54105", "type": "CPT"}, {"code": "1480179", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY PROSTATE;INCISIONAL 55705", "code_information": [{"code": "55705", "type": "CPT"}, {"code": "1480181", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY PROSTATE;NEEDLE OR PUNCTURE 55700", "code_information": [{"code": "55700", "type": "CPT"}, {"code": "1480180", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY RECTUM 45100", "code_information": [{"code": "45100", "type": "CPT"}, {"code": "1480182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE KNEE DEEP 27324", "code_information": [{"code": "27324", "type": "CPT"}, {"code": "1480185", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE NECK/THORAX 21550", "code_information": [{"code": "21550", "type": "CPT"}, {"code": "1480186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF FOREARM AND/OR WRIST DEEP 25066", "code_information": [{"code": "25066", "type": "CPT"}, {"code": "16222626", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1387.47, "maximum": 8450.0, "gross_charge": 2866.69, "discounted_cash": 1003.34, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1387.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF SHOULDER AREA; SUPERFICIAL 23065", "code_information": [{"code": "23065", "type": "CPT"}, {"code": "4218389", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 598.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF THE THIGH OR KNEE AREA SUPERFICIAL 27323", "code_information": [{"code": "27323", "type": "CPT"}, {"code": "1480110", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE SHOULDER DEEP 23066", "code_information": [{"code": "23066", "type": "CPT"}, {"code": "1480187", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE UPPER ARM DEEP 24066", "code_information": [{"code": "24066", "type": "CPT"}, {"code": "1480188", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE UPPER ARM SUPERFICIAL 24065", "code_information": [{"code": "24065", "type": "CPT"}, {"code": "1480189", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY TISSUE BACK DEEP 21925", "code_information": [{"code": "21925", "type": "CPT"}, {"code": "1480190", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY TISSUE BACK SUPERFICIAL 21920", "code_information": [{"code": "21920", "type": "CPT"}, {"code": "1480191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY TISSUE WRIST/FOREARM SUPERFICIAL 25065", "code_information": [{"code": "25065", "type": "CPT"}, {"code": "1480192", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY URETHRA 50955", "code_information": [{"code": "50955", "type": "CPT"}, {"code": "1480194", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY VERTEBRA CERVICAL OR LUMBAR 20251", "code_information": [{"code": "20251", "type": "CPT"}, {"code": "1480195", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY VERTEBRA THORACIC OPEN 20250", "code_information": [{"code": "20250", "type": "CPT"}, {"code": "1480196", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY VESTIBULE OF MOUTH 40808", "code_information": [{"code": "40808", "type": "CPT"}, {"code": "3548707", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 598.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38520", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38530", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOWICK X IMP 6.5MM PEEK 3 SUTURE CM-6265", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CM-6265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2450.0, "discounted_cash": 857.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIPOLAR CORD 12FT DISP", "code_information": [{"code": "286-112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 56.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIPOLAR SEALER AQUAMANTYS 6.0", "code_information": [{"code": "23-305-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1405.0, "discounted_cash": 491.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIS XTRACELL FLUID ANALYSIS", "code_information": [{"code": "93702", "type": "CPT"}], "standard_charges": [{"minimum": 567.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 567.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 891.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 891.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 891.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIT 2.0 FENESTRATION", "code_information": [{"code": "P99-100-2009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT CANNULATED DRIVER 340-15-003", "code_information": [{"code": "340-15-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.6, "discounted_cash": 225.96, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT CUTTING TROCHLEA SIGMA HP", "code_information": [{"code": "202461010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.1MM X 55MM X 40MM FOR QUICK COUPLING SS", "code_information": [{"code": "310.111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.3MM FOR USE W/ 2 MM SCREW", "code_information": [{"code": "323-1113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 141.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.4MM X 27MM TWIST STRYKER ENDINSTR", "code_information": [{"code": "60-14126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 385.0, "discounted_cash": 134.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.5MM DIA MANUAL", "code_information": [{"code": "320-1215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.5MM EVOS AO QUICK CONN", "code_information": [{"code": "71174901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.76, "discounted_cash": 192.07, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.5MM WIRE PASS 2 FLUTE", "code_information": [{"code": "1608259", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 53.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.5MM WIRE PASS REPROCESSINSTR", "code_information": [{"code": "1608259R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.0, "discounted_cash": 39.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.5MM X 110MM QUICK COUPLINGINSTR", "code_information": [{"code": "310.16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.5MM X 125MM STRYKER J LATCH", "code_information": [{"code": "3.503.476", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 502.0, "discounted_cash": 175.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.5MM X 96MM MINI QUICK COUPLING W/ DEPTH MARKINSTR", "code_information": [{"code": "310.507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 503.0, "discounted_cash": 176.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.6MM CANNULATED BIODRIVE MICRO", "code_information": [{"code": "FT230B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 740.0, "discounted_cash": 259.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.6MM ORTHOLOC 3DI", "code_information": [{"code": "52031630", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.02, "discounted_cash": 148.76, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.7MM", "code_information": [{"code": "AR-8916-14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.7MM CANNULATED MINI CUBE", "code_information": [{"code": "CDB 017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.7MM CANNULATED QUICKFIX", "code_information": [{"code": "AR-8737-17", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 510.29, "discounted_cash": 178.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.7MM CANNULATED W/ AO CONNECTIONINSTR", "code_information": [{"code": "AR-1201-7DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.7MM HPS CANNULATED HAND FUSION QR", "code_information": [{"code": "316-1017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 635.51, "discounted_cash": 222.43, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.7MM LOW PROFILE PLATE SCREW SYSINSTR", "code_information": [{"code": "AR-1201.7D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 281.0, "discounted_cash": 98.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.8 CANNULATED MAX VCP", "code_information": [{"code": "231201125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.41, "discounted_cash": 218.19, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.8MM FOR 2.4MM SCREWS", "code_information": [{"code": "FDR 991", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.8MM X 110MM QUICK CONNECT REPROCESS W/ DEPTH MARK", "code_information": [{"code": "ZZZ310509R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.8X90MM STRYKER J-LATCH COUPLING MOD HND SYSINS 317.867", "code_information": [{"code": "317.867", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 265.0, "discounted_cash": 92.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.9MM X 5.5MM CENTERPIECE STERILE INSTRUMENT DISPOSABLE", "code_information": [{"code": "8530605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 100 X 2.2 TRIANGLE END", "code_information": [{"code": "Z402-100-22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 941.5, "discounted_cash": 329.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 10MM ANCHOR-C SYS", "code_information": [{"code": "48328910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 10MM CANN", "code_information": [{"code": "AR-1214L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 162.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 110 X 3.5MM ZPS QC", "code_information": [{"code": "-4806-110-35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 125MM 100MM X 2.7MM THREE FLUTE QUICK COUPLING", "code_information": [{"code": "315.28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 12MM ORTHOFIX", "code_information": [{"code": "86-9012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 140X2MM 03.133.101S", "code_information": [{"code": "3.133.101S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 581.2, "discounted_cash": 203.42, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 14MM 8801-90069", "code_information": [{"code": "8801-90069", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 14MM SPINEFRONTIER", "code_information": [{"code": "S170016-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 160MM X 2.7MM CANNULATED REPROCESSINSTR", "code_information": [{"code": "31067R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.0, "discounted_cash": 190.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 160MM X 4MM 2 FLUTE QUICK COUPLING NON STRL", "code_information": [{"code": "310.401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 17MMINSTR", "code_information": [{"code": "Z402-100-17", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 941.5, "discounted_cash": 329.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 190MM X 2MM CALIBRATED W/ AO QUICK CONNECT PERI-LOC", "code_information": [{"code": "71173501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.0 X 120MM CANN", "code_information": [{"code": "P99-110-2112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.0 X 152MM 76308833", "code_information": [{"code": "76308833", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1070.08, "discounted_cash": 374.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.0 X 65MM CANNULATED AO", "code_information": [{"code": "110027744", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.0/125/100 AO QC", "code_information": [{"code": "OS200120L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 722.0, "discounted_cash": 252.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.0MM 125MM REPROCESS", "code_information": [{"code": "310.21R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.0MM CALIBRATED QC STAND", "code_information": [{"code": "-2360-175-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 580.0, "discounted_cash": 203.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.0MM CANNULATED SQC", "code_information": [{"code": "3-4000-18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.0MM FAST", "code_information": [{"code": "FOB20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 81.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.0MM VARIAX AO SCALED", "code_information": [{"code": "703690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 471.0, "discounted_cash": 164.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.0MM X 30MM SPEEDGUIDE AO", "code_information": [{"code": "703891", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 448.0, "discounted_cash": 156.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.2MM CANN", "code_information": [{"code": "MSN10003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.2MM DVR CROSSLOCKINSTR", "code_information": [{"code": "2312-00-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 273.0, "discounted_cash": 95.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.2MM FOR 3 MM LOCKING SCREW", "code_information": [{"code": "AR-8944-22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 303.0, "discounted_cash": 106.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.2MM X 87MM TWIST CANNULATED INSTRUMENT", "code_information": [{"code": "A-3736", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1362.0, "discounted_cash": 476.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.3MM", "code_information": [{"code": "702741", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 165.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.3MM QUICK RELEASE", "code_information": [{"code": "80-0627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 671.0, "discounted_cash": 234.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.4 MAX VPC CANN", "code_information": [{"code": "231201030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 997.0, "discounted_cash": 348.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.4MM CORTEX PROXIMAL", "code_information": [{"code": "316-0323", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 695.0, "discounted_cash": 243.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.4MM FLUTE QC", "code_information": [{"code": "310.53", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.4MM INBONE", "code_information": [{"code": "COL00LA02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.4MM INSTRUMENT", "code_information": [{"code": "211093", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 497.0, "discounted_cash": 173.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.4MM MANUAL SCREW", "code_information": [{"code": "320-0018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.4MM PROXIMAL CANN", "code_information": [{"code": "212-24-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.4MM STND", "code_information": [{"code": "MFT-072-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 671.0, "discounted_cash": 234.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5 X 127MM GLENOID", "code_information": [{"code": "1395-1025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5 X 85 X 111MM TWIST QC", "code_information": [{"code": "KM166-310-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 32.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.55 CANNULATED", "code_information": [{"code": "45503055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 657.0, "discounted_cash": 229.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM CALIBRATED FOR SM JOINT REPAIR", "code_information": [{"code": "AR-8943-13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM CANN", "code_information": [{"code": "MSN10004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM CANNULATED", "code_information": [{"code": "829029070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM CANNULATEDINSTR", "code_information": [{"code": "AR-8737-09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM DISP INNOVATIONS", "code_information": [{"code": "DB2.5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 81.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM EMERGE", "code_information": [{"code": "310.25EM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM FORINTERNAL FXTN FOR TIBIA ANGULA DEFORMITYINSTR", "code_information": [{"code": "AR-8943-42", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 303.0, "discounted_cash": 106.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM INSTRUMENT", "code_information": [{"code": "DSDS0025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 482.0, "discounted_cash": 168.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM REPROCESSINSTR", "code_information": [{"code": "DB25R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 56.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM SLIM", "code_information": [{"code": "2000-100-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 837.0, "discounted_cash": 292.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM W/ GUIDEINSTR", "code_information": [{"code": "1000-10-025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM X 110MM GOLD QUICK COUPLING REPROCESS", "code_information": [{"code": "31025R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM X 110MM QUICK COUPLING GOLD FOR LCP SYS", "code_information": [{"code": "310.25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM X 110MMINSTR", "code_information": [{"code": "XF0082501-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 759.0, "discounted_cash": 265.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM X 110MMINSTR DISP", "code_information": [{"code": "AR-8943-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 303.0, "discounted_cash": 106.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM X 115MM", "code_information": [{"code": "PL922115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 99.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM X 11MM STANDARD", "code_information": [{"code": "XFO082501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 570.28, "discounted_cash": 199.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM X 12MM CANNULATED STEPPED AO", "code_information": [{"code": "XFO051201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM X 180MM QUICK COUPLING GOLDINSTR", "code_information": [{"code": "310.23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 393.0, "discounted_cash": 137.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM X 32MM CANNULATED", "code_information": [{"code": "XFO073200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 605.25, "discounted_cash": 211.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM X 70MM CANNULATEDINSTR DISP", "code_information": [{"code": "8290-20-070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MMR QC", "code_information": [{"code": "7402-100-17", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 875.0, "discounted_cash": 306.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.65 CANNULATED", "code_information": [{"code": "45303065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 657.0, "discounted_cash": 229.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.6MM", "code_information": [{"code": "703934", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.6MM CANNULATED FOR SM JOINT REPAIR", "code_information": [{"code": "AR-8943-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 510.29, "discounted_cash": 178.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.6MM VARIAX AO SCALED", "code_information": [{"code": "703691", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 471.0, "discounted_cash": 164.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7 MM AOS", "code_information": [{"code": "4026-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1011.0, "discounted_cash": 353.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7 X 110MM BONE SOLID LONG", "code_information": [{"code": "P99-100-2711", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7 X 110MM CANNULATED", "code_information": [{"code": "P99-110-2712", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.75MM", "code_information": [{"code": "P40-920-2707", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.75MM 0.066 CANNULATION SHOULDER ORTHO", "code_information": [{"code": "AR-7000-14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM CANNULATED", "code_information": [{"code": "814227070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM CANNULATED QUICK RELEASE", "code_information": [{"code": "316-0427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 956.0, "discounted_cash": 334.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM COMPREHENSIVE", "code_information": [{"code": "405889", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 430.65, "discounted_cash": 150.73, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM DIA", "code_information": [{"code": "CSS-072-27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 162.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM QUICK COUPLING REPROCESSINSTR", "code_information": [{"code": "31026R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.0, "discounted_cash": 37.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM S&N", "code_information": [{"code": "71173503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 304.0, "discounted_cash": 106.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM SCREW BIO COMPRESSION", "code_information": [{"code": "AR-5025TD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM SHRT QUICK COUPLINGINSTR", "code_information": [{"code": "71173502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 637.0, "discounted_cash": 222.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM SOLANA", "code_information": [{"code": "DR-2.7", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 936.0, "discounted_cash": 327.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM VARIAX AO SCALED", "code_information": [{"code": "703695", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 471.0, "discounted_cash": 164.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM X 100MM QUICK COUPLINGINSTR", "code_information": [{"code": "310.26", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM X 125MM 3 FLUTES QUICK COUPLING REPROCESSINSTR", "code_information": [{"code": "315.28R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.0, "discounted_cash": 76.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM X 155MM CANNULATED QUICK CONNECT SHRTINSTR", "code_information": [{"code": "7117-3581", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3120.75, "discounted_cash": 1092.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM X 160MM CANNULATED QUICK COUPLING", "code_information": [{"code": "310.67", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1244.69, "discounted_cash": 435.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM X 160MM CANNULATED QUICK COUPLINGINSTR REPROCESS", "code_information": [{"code": "310.67R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 294.0, "discounted_cash": 102.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.8MM 165MM REPROCESS", "code_information": [{"code": "310.288R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.8MM 80-0387", "code_information": [{"code": "80-0387", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 302.0, "discounted_cash": 105.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.8MM CALIBRATED QUICK COUPLING 250.0 MM 95.0 MM", "code_information": [{"code": "3.113.024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 155.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.8MM COUNTERSINK CANNULATED DART FIRE", "code_information": [{"code": "DSDS1028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.8MM SHRT CALIBRATED W/ DRILL STOP", "code_information": [{"code": "3.112.003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 422.0, "discounted_cash": 147.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.8MM SOLID", "code_information": [{"code": "2129-57-010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.8MM SONIC ANCHOR", "code_information": [{"code": "1910-1270S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 916.0, "discounted_cash": 320.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.8MM X 165MM QUICK COUPLING FOR AO/ASIFINSTR", "code_information": [{"code": "310.288", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 302.0, "discounted_cash": 105.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.9MM FOR JUGGERKNOT SOFT ANCHOR STRL", "code_information": [{"code": "912091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 293.0, "discounted_cash": 102.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.9MM SHRT JUGGERKNOT SOFT ANCHOR STRL", "code_information": [{"code": "110005306", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 94.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.9MM X 70MM CANNULATEDINSTR DISP", "code_information": [{"code": "8290-30-070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 603.0, "discounted_cash": 211.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 20MM BIOCOMPRESSION CANNULATED", "code_information": [{"code": "AR-5025TDC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 109.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM AO", "code_information": [{"code": "XFO012002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 577.0, "discounted_cash": 201.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM CANNULATED AO", "code_information": [{"code": "110008402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 629.0, "discounted_cash": 220.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM CANNULATED FOR LOW PROFILE MTP PLATE SM JOINT REPAIR", "code_information": [{"code": "AR-8933-20C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 510.29, "discounted_cash": 178.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM FAST", "code_information": [{"code": "FDB20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM FPS FOR 2.7 MM SCREW PILOT", "code_information": [{"code": "323-1120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 394.0, "discounted_cash": 137.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM GRADUATEDINSTR", "code_information": [{"code": "AR-8943-16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 328.51, "discounted_cash": 114.98, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM HUMERAL", "code_information": [{"code": "AR-7720-2.0", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 155.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM PROXIMAL ORTHOINSTR", "code_information": [{"code": "XFO112001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM REPROCESS SMITH AND NEPHEWINSTR", "code_information": [{"code": "71173501R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 167.0, "discounted_cash": 58.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM SHRTINSTR", "code_information": [{"code": "71173588", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM SONOMA", "code_information": [{"code": "CS0032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM TO 2.4MM DIA CANNULATED QUICK RELEASE", "code_information": [{"code": "316-0013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 789.0, "discounted_cash": 276.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM X 100MM QUICK CONNECT REPROCESS", "code_information": [{"code": "31019R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM X 100MM QUICK COUPLING SSINSTR", "code_information": [{"code": "310.19", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.09, "discounted_cash": 25.58, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM X 120MM", "code_information": [{"code": "DC6106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 129.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM X 125MM QUICK COUPLINGINSTR", "code_information": [{"code": "310.21", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 114.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM X 150MM 1.2MM CANNULATED QUICK COUPLINGINSTR", "code_information": [{"code": "310.221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1336.0, "discounted_cash": 467.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM X 65MM QUICK COUPLING FOR 1 MM THROUGH 2.4 MM SCREWINSTR", "code_information": [{"code": "310.201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM X 85MM W/ AO CONNECTIONINSTR", "code_information": [{"code": "IFI-491458", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 313.0, "discounted_cash": 109.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MM X 91MM AO QUICK COUPLING", "code_information": [{"code": "A-3733/1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 341.33, "discounted_cash": 119.47, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2MMINSTR", "code_information": [{"code": "323-2227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 852.0, "discounted_cash": 298.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.0MM CANNULATED", "code_information": [{"code": "MSN10005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.0MM CANNULATED SMALL CUBE", "code_information": [{"code": "CDB 030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.0MM DISP", "code_information": [{"code": "AR-8943-36", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 132.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2 MM CALIBRATED 3 FLUTE", "code_information": [{"code": "3.010.060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 733.0, "discounted_cash": 256.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2 X 145MM 3 FLUTE NAIL-EX CALIBRATED QC", "code_information": [{"code": "3.010.103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 182.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM 145MM REPROCESS", "code_information": [{"code": "310.31R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM 170MM CANNULATED REPROCESS", "code_information": [{"code": "310.65R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM CALIBRATED SYNTHES", "code_information": [{"code": "3.010.060S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM CENTRAL COMPREHENSIVE REVERSE", "code_information": [{"code": "405883", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 331.76, "discounted_cash": 116.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM FOR 4MM PIN INSTRUMENT", "code_information": [{"code": "5085-2-032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 395.0, "discounted_cash": 138.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM STRT CANN LONG", "code_information": [{"code": "AR-8750-04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM STRYKER", "code_information": [{"code": "700356", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 759.0, "discounted_cash": 265.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM SYNTHES", "code_information": [{"code": "3.010.103S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 534.0, "discounted_cash": 186.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM X 170.0MM CANNULATED", "code_information": [{"code": "310.65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM X 20MM QUICK CONNECT RINGLOC", "code_information": [{"code": "31-323220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM X 230MM CALIBRATED AO TWIST", "code_information": [{"code": "700357", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 344.0, "discounted_cash": 120.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM X 30MM QUICK CONNECT ORTHO RINGLOC", "code_information": [{"code": "31-323230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.3MM CANN", "code_information": [{"code": "71177136", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1290.0, "discounted_cash": 451.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.3MM CANNULATED", "code_information": [{"code": "MSN10006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.3MM CANNULATED ST", "code_information": [{"code": "NC5-DR33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 337.0, "discounted_cash": 117.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM 110MM QC", "code_information": [{"code": "310.35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 311.0, "discounted_cash": 108.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM A", "code_information": [{"code": "MS-DL35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM QUICK COUPLINGINSTR", "code_information": [{"code": "71173505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 158.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM TARGETER QUICK COUPLINGINSTR", "code_information": [{"code": "71173402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 183.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM V GUIDE", "code_information": [{"code": "AR-7750-3.5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM W/ DRILL GUIDE", "code_information": [{"code": "1000-10-035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM X 110MM QUICK COUPLING REPROCESSINSTR", "code_information": [{"code": "31035R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM X 130MM AO FITTING STRL", "code_information": [{"code": "1806-3550S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 812.0, "discounted_cash": 284.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM X 15MM", "code_information": [{"code": "71173504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 759.0, "discounted_cash": 265.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM X 195MM QUICK COUPLINGINSTR", "code_information": [{"code": "310.37", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 393.0, "discounted_cash": 137.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM X 230MM AO FITTING STRL", "code_information": [{"code": "1806-3540S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 812.0, "discounted_cash": 284.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.5MM X 5MM CANNULATED AO", "code_information": [{"code": "110008406", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 672.0, "discounted_cash": 235.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.7MM AR-8973-37", "code_information": [{"code": "AR-8973-37", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 449.53, "discounted_cash": 157.34, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.7MM DIA", "code_information": [{"code": "CSS-072-37", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 225.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.8MM NON STRL", "code_information": [{"code": "2810-17-115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3MM CANNULATED FOR AC ACROMIOCLAVICULAR JOINT REPAIRINSTR", "code_information": [{"code": "AR-2257D-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 842.0, "discounted_cash": 294.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3MM CANNULATED PROXIMAL", "code_information": [{"code": "212-30-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3MM CANNULATEDFT ANKLE MINI HUDSON", "code_information": [{"code": "AR-8945-30C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 337.0, "discounted_cash": 117.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3MM QUICK RELEASEINSTR", "code_information": [{"code": "80-1088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 671.0, "discounted_cash": 234.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3MM SCREW GRIDLOCK", "code_information": [{"code": "310-30-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 637.0, "discounted_cash": 222.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3MM TO 4MM CANNULATEDINSTR", "code_information": [{"code": "FS-3050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 808.0, "discounted_cash": 282.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3MM TO 4MM CORTEX PROXIMAL QUICK RELEASE EXTREMIFIX", "code_information": [{"code": "316-0321", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 776.0, "discounted_cash": 271.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3MM X 220MM DISP", "code_information": [{"code": "DWD055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.0MM CALIBRATED", "code_information": [{"code": "356.982", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.0MM FAST LONGINSTR", "code_information": [{"code": "FDB40L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.2MM X 180.0MM T2 D", "code_information": [{"code": "1806-4270S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 602.56, "discounted_cash": 210.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.2MM X 3.0MM T 2", "code_information": [{"code": "1806-4260S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 562.21, "discounted_cash": 196.77, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.3 X 200MM CANNULATED QUICK COUPLING", "code_information": [{"code": "310.634", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1048.0, "discounted_cash": 366.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.3MM CANNULATED", "code_information": [{"code": "310.634.EM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1048.0, "discounted_cash": 366.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.3MM QUICK COUPLINGINSTR", "code_information": [{"code": "310.431", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.3MM X 320MM CALIBRATEDINSTR", "code_information": [{"code": "41010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 467.0, "discounted_cash": 163.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM", "code_information": [{"code": "700359S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 755.0, "discounted_cash": 264.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM 145MM QC", "code_information": [{"code": "310.44", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 286.0, "discounted_cash": 100.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM 145MM REPROCESS", "code_information": [{"code": "310.44R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.0, "discounted_cash": 40.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM CANNNULATED", "code_information": [{"code": "MSN10007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM CANNNULATED SHORT", "code_information": [{"code": "MSN10009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM CANNULATED ENDO KNEE STRLINSTR DISP", "code_information": [{"code": "7207315", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM CANNULATED MINI HUDSON", "code_information": [{"code": "AR-8945-45C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM CANNULATEDINSTR", "code_information": [{"code": "AR-1204.5L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 182.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM HUMERAL TUNNEL", "code_information": [{"code": "AR-7710-4.5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 155.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM QUICK COUPLINGINSTR", "code_information": [{"code": "71173506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.0, "discounted_cash": 159.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM STRYKER", "code_information": [{"code": "700354 (STRYKER)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 205.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM TAP JC", "code_information": [{"code": "310.45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM W/ DRILL GUIDE", "code_information": [{"code": "1000-10-045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1288.0, "discounted_cash": 450.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.5MM X195MM QUICK COUPLINGINSTR", "code_information": [{"code": "310.48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4.7MM DIA", "code_information": [{"code": "CSS-072-47", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4MM CANN", "code_information": [{"code": "AR-1204L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 182.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4MM CANNULATED S&N", "code_information": [{"code": "71119007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2504.0, "discounted_cash": 876.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4MM CANNULATEDFT ANKLE", "code_information": [{"code": "AR-8967-40C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4MM LNG PILOT AO COUPLING", "code_information": [{"code": "7163-1121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1193.0, "discounted_cash": 417.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 4MM SHRT PILOT AO COUPLING", "code_information": [{"code": "71631123", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1061.0, "discounted_cash": 371.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 5.0MM SALVATION SS", "code_information": [{"code": "SB080050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 236.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 5.5MM X 4MM CANNULATED", "code_information": [{"code": "AR-8955C-40PD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 50MM X 1MM MINI QUICK COUPLINGINSTR", "code_information": [{"code": "316.396", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 55MM 40MM X 1.3MM MINI QUICK COUPLINGINSTR", "code_information": [{"code": "316.402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 284.0, "discounted_cash": 99.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 5MM AND DEPTH PROSTEP MIS STERILE LTX-FREE DISPOSABLE 57DRDEP5", "code_information": [{"code": "57DRDEP5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2360.82, "discounted_cash": 826.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 5MM CANNULATED", "code_information": [{"code": "AR-1205L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 729.0, "discounted_cash": 255.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 5MM X 300MM LG QUICK COUPLING CANNULATEDINSTR", "code_information": [{"code": "310.63", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1186.0, "discounted_cash": 415.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 6.5MM 4.9MM CANNULATED LG AO FITTING ASNIS III", "code_information": [{"code": "702601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1151.94, "discounted_cash": 403.18, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 60MM 35MM X 1MM J LATCH FOR STRYKER COUPLING", "code_information": [{"code": "316.236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 80MM 66MM X 1.8MM 2 FLUTE FOR MINI QUICK COUPLINGINSTR", "code_information": [{"code": "317.861", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 273.0, "discounted_cash": 95.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 80MM 66MM X2.4MM 2 FLUTE FOR MINI QUICK COUPLINGINSTR", "code_information": [{"code": "317.871", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 273.0, "discounted_cash": 95.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 8MMINSTR", "code_information": [{"code": "48328908", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 90MM 65MM X 2.4MM FOR USE W/ THE MODULAR HND SYSINSTR", "code_information": [{"code": "317.872", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.0, "discounted_cash": 78.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL ACUTAK LONG STANDARD", "code_information": [{"code": "AT2-62515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1311.0, "discounted_cash": 458.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL APTUS 122MM STOP TWIST CANN", "code_information": [{"code": "A-3838", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1362.0, "discounted_cash": 476.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL ASNIS 3.0 CANNULATED JFX", "code_information": [{"code": "705357", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.76, "discounted_cash": 192.07, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL ASNIS III CANN AO COUPLING 2.7MM", "code_information": [{"code": "702449", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 828.52, "discounted_cash": 289.98, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL BIODRIVE2.0MM-3.0MM MICRO SOLID SCREWS", "code_information": [{"code": "FT301B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 574.0, "discounted_cash": 200.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL BONE 1.7MM REUNITE", "code_information": [{"code": "950086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL BONE 3.5 X 122MM OVERDRILL AO CONNECTION", "code_information": [{"code": "703694", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 903.0, "discounted_cash": 316.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL BONE LATEX FREE STAINLESS STEEL QUICK COUPLING DEPTH MARK NONSTERILE REUSABLE 110 X 1.8MM", "code_information": [{"code": "KM166-310-509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 230.0, "discounted_cash": 80.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL BONE SHORT 2.0MM", "code_information": [{"code": "2142-88-008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 58.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL BONE STAINLESS STEEL QUICK COUPLING NONSTERILE DISPOSABLE 2 X 100MM", "code_information": [{"code": "KM166-310-19", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL BONE VILEX", "code_information": [{"code": "24XX-150-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CALIBRATED 2.5MM", "code_information": [{"code": "3.113.023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CALIBRATED 2.7MM", "code_information": [{"code": "214227070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CALIBRATED CMP FT 2.0MM", "code_information": [{"code": "AR-8737-34", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.61, "discounted_cash": 199.01, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CALIBRATED GRADUATED DEPTH MARK 4MM", "code_information": [{"code": "804-03-049", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANN 2.0MM", "code_information": [{"code": "210-24-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANN 2.5MM", "code_information": [{"code": "IS1112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 710.16, "discounted_cash": 248.56, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANN 2.6MM BLUE", "code_information": [{"code": "IS1114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 774.72, "discounted_cash": 271.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANN 3.0MM", "code_information": [{"code": "IS1113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 731.0, "discounted_cash": 255.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANN 4.5MM", "code_information": [{"code": "3.010.089", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1127.0, "discounted_cash": 394.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANN FLWR 1.7MM", "code_information": [{"code": "CDB-017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 743.0, "discounted_cash": 260.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANN FLWR 2.0MM", "code_information": [{"code": "CDB-020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 743.0, "discounted_cash": 260.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANN FLWR 2.4MM", "code_information": [{"code": "CDB-024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 743.0, "discounted_cash": 260.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANN FLWR 2.6MM", "code_information": [{"code": "CDB-026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANN FLWR 3.0MM", "code_information": [{"code": "CDB-030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANNULATED 1.7 MM", "code_information": [{"code": "DSDS-0017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 718.0, "discounted_cash": 251.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANNULATED 2.0MM", "code_information": [{"code": "703933", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANNULATED 2.2MM X 100MM", "code_information": [{"code": "2402-100-22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANNULATED 2.7MM", "code_information": [{"code": "1147-26", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 923.0, "discounted_cash": 323.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANNULATED 3.1MM", "code_information": [{"code": "JF1010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 266.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANNULATED 4.8 X 200", "code_information": [{"code": "110008408", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANNULATED 7.0MM", "code_information": [{"code": "400146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1097.0, "discounted_cash": 383.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANNULATED TIGER 2.0MM", "code_information": [{"code": "210-24-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CANULATED TWIST 3.0 MM L87MM", "code_information": [{"code": "A-3836", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 963.02, "discounted_cash": 337.06, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CMP FT CALIBRATED 2.7MM", "code_information": [{"code": "AR-8737-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL CORTICAL LOCKING 2.5MM", "code_information": [{"code": "8290-29-070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL DARCO 5.0MM", "code_information": [{"code": "77707514", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 429.0, "discounted_cash": 150.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL DARTFIRE 2.2MM", "code_information": [{"code": "DSDS1022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 429.0, "discounted_cash": 150.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL DISP 1.5", "code_information": [{"code": "KM166-310-16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL DISP 2.0MM X 100MM", "code_information": [{"code": "KM166-310-21", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL DISP 3.2MM X 147MM", "code_information": [{"code": "KM166-310-31", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL DISP 4.5MM X 147MM", "code_information": [{"code": "KM166-310-44", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL DRIVER VOLAR 2.0MM", "code_information": [{"code": "FPD20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL F.A.S.T. 2.0MM QC", "code_information": [{"code": "FBD20", "type": "CDM"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 81.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL FUSION 24MM", "code_information": [{"code": "ATF-024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 110.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL GRIDLOCK 2.4MM", "code_information": [{"code": "310-24-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL HAND 1.2 X 10 X 66MM APTUS TWIST", "code_information": [{"code": "A-3231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 582.0, "discounted_cash": 203.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL HAND APTUS TWIST 2.3 X 66 X 10MM", "code_information": [{"code": "A-3531", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 466.0, "discounted_cash": 163.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL INION 1.5MM", "code_information": [{"code": "IFS-2001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL INION 2.0MM", "code_information": [{"code": "IFS-2002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL JACOBS CHUCK 1.1 X 45MM", "code_information": [{"code": "310.1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 242.0, "discounted_cash": 84.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL JET-X 3.5MM AO", "code_information": [{"code": "71063006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1308.0, "discounted_cash": 457.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL LNG MICRO FOR ACUTRAK 2INSTR", "code_information": [{"code": "80-1522", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1541.0, "discounted_cash": 539.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL LOCKING 3.1 X 238MM MEDIUM", "code_information": [{"code": "705077", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL LOCKING 3.1MM X 216MM SHORT", "code_information": [{"code": "705031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL NON LOCKING 2.5MM X 216MM SHORT", "code_information": [{"code": "705025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 257.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL ORTHO 2.0MM", "code_information": [{"code": "S-200QD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 732.0, "discounted_cash": 256.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL ORTHOHELIX 1.6MM", "code_information": [{"code": "MXM-072-16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL ORTHOHELIX 1.9MM", "code_information": [{"code": "MXM-072-19", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL OVER 2.5MM", "code_information": [{"code": "320-2025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 637.0, "discounted_cash": 222.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL OVER 2.7MM", "code_information": [{"code": "320-2027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 169.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL OVER 3.0MM", "code_information": [{"code": "320-2030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 637.0, "discounted_cash": 222.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL PERIARTICULAR 2.5MM X 110MM", "code_information": [{"code": "-4806-110-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL PHALINX 2.22MM CANNULATED X-SML", "code_information": [{"code": "45303025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 656.0, "discounted_cash": 229.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL PHALINX 2.45MM CANNULATED SML", "code_information": [{"code": "45303045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 213.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL QUICK RELEASE 2.0MM", "code_information": [{"code": "80-1796", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.53, "discounted_cash": 119.19, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL SHORT 2.0MM", "code_information": [{"code": "71173555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL SHORT 2.7MM", "code_information": [{"code": "71173362", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL SHOULDER 3.2MM PERFO", "code_information": [{"code": "MWJ126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL SOLID 2.25MM", "code_information": [{"code": "5-618", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL SOLID 2.55", "code_information": [{"code": "5-613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL SOLID 2.65MM", "code_information": [{"code": "5-615", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL SPEED GUIDE AO 2.0MM", "code_information": [{"code": "703936", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL SPEED GUIDE AO 2.6MM", "code_information": [{"code": "703937", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL STANDARD AO 2.0MM X 110MM", "code_information": [{"code": "XFO082001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 570.28, "discounted_cash": 199.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL STANDARD LONG ACUTRAK 2", "code_information": [{"code": "AT2-L2515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1538.0, "discounted_cash": 538.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL STD PROFILE", "code_information": [{"code": "AT2-2515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1180.0, "discounted_cash": 413.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL SURG 3.2MMX230MM FIXOS", "code_information": [{"code": "705232STRYKER", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 868.87, "discounted_cash": 304.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL TALAR PEG 4MM", "code_information": [{"code": "IB200020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL TEMPUS 12MM", "code_information": [{"code": "10-90-015-012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL TEMPUS 14MM", "code_information": [{"code": "10-90-015-014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL TRIM-IT 3.5MM GRADUATED NONSTR", "code_information": [{"code": "AR-4160-35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.0, "discounted_cash": 59.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL TWIST 2.8 X 101MM APTUS FOOT AO QUICK COUPLING", "code_information": [{"code": "A-3832", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 341.33, "discounted_cash": 119.47, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL TWIST 2.9 X 10MM APTUS FOOT AO QUICK COUPLING", "code_information": [{"code": "A-3834", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 214.0, "discounted_cash": 74.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL VARIAX 2.0 X 135MM SCALED", "code_information": [{"code": "703896", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 471.0, "discounted_cash": 164.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL WITHOUT DRILL STOP", "code_information": [{"code": "DU-265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1100.0, "discounted_cash": 385.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL WITHOUT DRILL STOP KII", "code_information": [{"code": "DU-200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 889.0, "discounted_cash": 311.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL/COUNTERSINK 2MM X 17MM AO CANNULATED", "code_information": [{"code": "XFO041701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRIVER 1.5MM ALPS HAND SYSTEM", "code_information": [{"code": "2312-20-209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 41.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRIVER 2.2MM ARSENAL 330-07-003", "code_information": [{"code": "330-07-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 232.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRIVER 2MM / 2.5MM MODULE COMPONENTINSTR", "code_information": [{"code": "2312-20-211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 293.0, "discounted_cash": 102.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL .76MM X 44.5MM MINI QUICK COUPLING FOR USE W/ MODULAR HND SYS W/ 14 MM", "code_information": [{"code": "316.294", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 0.76MM X 44.5MM MINI QUICK COUPLING FOR USE W/ MODULAR HND SYS W/ 10 MM", "code_information": [{"code": "316.29", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 431.0, "discounted_cash": 150.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 0.76MM X 44.5MM MINI QUICK COUPLING FOR USE W/ MODULAR HND SYS W/ 12 MM", "code_information": [{"code": "316.292", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 0.76MM X 44.5MM MINI QUICK COUPLING FOR USE W/ MODULAR HND SYS W/ 6 MM", "code_information": [{"code": "316.286", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 0.76MM X 44.5MM MINI QUICK COUPLING FOR USE W/ MODULAR HND SYS W/ 8 MM", "code_information": [{"code": "316.288", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 1.1MM X 65MM STRYKER J LATCH COUPLING FOR USE W/ MODULAR HND SYS FOR 1", "code_information": [{"code": "310.113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 1.5MM X 65MM MINI QUICK COUPLING MODULAR HND SYS FOR 1 MM THROUGH 2.4 M", "code_information": [{"code": "310.141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 1.5MM X 75MM STRYKER J LATCH COUPLING FOR USE W/ MODULAR HND SYS FOR 1", "code_information": [{"code": "310.143", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 1.8MM X 110MM MINI QUICK COUPLING NON STRL W/ DEPTH MARKINSTR", "code_information": [{"code": "310.509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 514.54, "discounted_cash": 180.09, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 2.0MM WIRE PASS FOR USE W/ TPS DRILL SET AND FOR MANDIBULAR/CRANIOFACIA", "code_information": [{"code": "1608261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 2MM 140/115MM 3 FLUTE QUICK COUPLING W/ DOUBLE DEPTH MARKINGINSTR", "code_information": [{"code": "323.062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 503.0, "discounted_cash": 176.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 2MM X 75MM STRYKER J LATCH COUPLING FOR USE W/ MODULAR HND SYS FOR 1 MM", "code_information": [{"code": "310.203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.68, "discounted_cash": 42.24, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT PILOT DRILL LONG 3.0MM QUICK RELEASE TI", "code_information": [{"code": "320-2130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 637.0, "discounted_cash": 222.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT PRE-DRILL 4.4MM", "code_information": [{"code": "77706514", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.85, "discounted_cash": 155.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT SCREWDRIVER 2.0MM", "code_information": [{"code": "212-20-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT SCREWDRIVER 3.5MM HEXAGONAL", "code_information": [{"code": "DWD167", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT SCREWDRIVER CANNULATED 3.0 X 4.0MM", "code_information": [{"code": "210-40-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT SCREWDRIVER VARIAX 2.0MM", "code_information": [{"code": "XTV006002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 648.0, "discounted_cash": 226.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT T8 DRIVER SOLID AO STERILE P04 S0051", "code_information": [{"code": "P04S0051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 807.0, "discounted_cash": 282.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BK PAIN NO VAS", "code_information": [{"code": "G9946", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BK PAIN VAS 6-20WK <= 3", "code_information": [{"code": "G2136", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BK PAIN VAS 6-20WK > 3", "code_information": [{"code": "G2137", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BK PAIN VAS 9-15MO <= 3", "code_information": [{"code": "G2138", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BK PAIN VAS 9-15MO > 3", "code_information": [{"code": "G2139", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BK PN NT MSR VAS SCL PRE/PST", "code_information": [{"code": "G9943", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BKBENCH PREP DON UTER ALGRFT", "code_information": [{"code": "668T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER ARTL", "code_information": [{"code": "670T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER VEN", "code_information": [{"code": "669T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BKK 10ML SYRINGE: KETOROLAC 30MG/ML (.34ML), KETAMINE 10MG/ML (1M), Marcaine 0.5% W EPI 5ML, BACTERI", "code_information": [{"code": "MED0030", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BKK 150 MG-60 MG-60 MG/50 ML INJ SOLN", "code_information": [{"code": "MED0844", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BKK 60ML SYRINGE: KETOROLAC 30GM/ML (2ML), KETAMINE 10MG/ML (6ML), MARCAINE 0.5% WEPI 30ML, BACTERI", "code_information": [{"code": "MED0029", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BL DONOR SEARCH MANAGEMENT", "code_information": [{"code": "38204", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BL DRAW < 3 YRS FEM/JUGULAR", "code_information": [{"code": "36400", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BL DRAW <3 YRS OTHER VEIN", "code_information": [{"code": "36406", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BL DRAW <3 YRS SCALP VEIN", "code_information": [{"code": "36405", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BL SMEAR W/DIFF WBC COUNT", "code_information": [{"code": "85007", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BL SMEAR W/O DIFF WBC COUNT", "code_information": [{"code": "85008", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT INC. RETENTION TIME 51720", "code_information": [{"code": "51720", "type": "CPT"}, {"code": "3226445", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1199.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1199.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1479.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1085.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLADE 5.5 INCISOR PLUS ELITE 72200081", "code_information": [{"code": "72200081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE AKIN YOCO SINGLE CD-OP-1003-S1", "code_information": [{"code": "CD-OP-1003-S1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1917.0, "discounted_cash": 670.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ARTHRO 3.5MM BURNT ORANGE LG HUB REPROCESS STERILING GATORINSTR", "code_information": [{"code": "C9264R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ARTHRO 3.5MM BURNT ORANGE SM JOINT GATOR MICROBLADE REPROCESS LINVATECINST", "code_information": [{"code": "C9962R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ARTHROSCOPY 2.9MM WHT SM JOINT GATOR MICRO HUB REPROCESSINSTR", "code_information": [{"code": "C9961R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ARTHROSCOPY 4.8MM MAGENTA CUDA LG HUB REPROCESS STERLINGINSTR", "code_information": [{"code": "C9258R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ARTHROSCOPY 5.5MM 13CM CUDA", "code_information": [{"code": "C9255", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 55.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE BEAVER 6900", "code_information": [{"code": "176900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE BIOPSY 3MM X 32MM MINI CERVICAL 6200 MINI STRL", "code_information": [{"code": "374562", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE BOVIE 2.5 COATED P0012M", "code_information": [{"code": "P0012M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.12, "discounted_cash": 4.59, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE BOVIE 6.5MM COATED", "code_information": [{"code": "P0014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.39, "discounted_cash": 6.44, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CHISEL 10 X 40 X 1MM STRT RENOVATION", "code_information": [{"code": "75100517", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CHISEL 12 X 60 X 1MM BONE RENOVATION STRAIGHT STERILE SINGLE USE SM", "code_information": [{"code": "75100520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CHISELL 3MM FLAT EDGE", "code_information": [{"code": "795511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE COOLCUT TORPEDO 4.0MM X 13CM AR-8400TD", "code_information": [{"code": "AR-8400TD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.25, "discounted_cash": 83.74, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE COOLCUTDOUBLE CUT 4.0MM X 13CM AR-8400DC", "code_information": [{"code": "AR-8400DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 67.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CORE CRESCENTIC 9.5MM", "code_information": [{"code": "5400031415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 304.0, "discounted_cash": 106.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CUTTER 5.0MM REPROCESS AGGRESSIVE PLUS", "code_information": [{"code": "375-554-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CUTTER 5.5MM SHAVER FORMULA REPROCESS AGGRESSIVE PLUS", "code_information": [{"code": "375-564-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CUTTER 5.5MM SHAVER FORMULA RESECTOR", "code_information": [{"code": "375-562-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DRIVER CANNULATED QC", "code_information": [{"code": "901-1017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 963.0, "discounted_cash": 337.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DRIVER T10 FOR 4.0MM SCREW", "code_information": [{"code": "IS1108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 642.0, "discounted_cash": 224.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DRIVER T8 FOR 2.5MM SCREW", "code_information": [{"code": "IS1106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 642.0, "discounted_cash": 224.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DRMTM 3.25IN BLADE CORROSION RESISTING SURG STEEL STRL", "code_information": [{"code": "880000010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DYONICS FLYER PATINUM 4.0MM 72205292", "code_information": [{"code": "72205292", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DYONICS SYNOVATOR PLATINUM 4.5MM", "code_information": [{"code": "72203523", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 55.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ELECTRODE 2.5IN PTFEINSULATED ROUNDED NON STICK BLUE SILK", "code_information": [{"code": "ES0012M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE END CUTTER 3.5MM LG HUB", "code_information": [{"code": "C9283", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 55.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENDO 2MM BLUE LATCH FULL RADIUS POWERMINI DISP", "code_information": [{"code": "72201507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "discounted_cash": 54.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENDO 3.5MM BEIGE SHAVER FULL RADIUS STRAIGHT SHAFT STRL DISP", "code_information": [{"code": "7205305", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENDO 4.5MM YELLOW SHAVER FULL RADIUS STRAIGHT SHAFT STRL DISP", "code_information": [{"code": "7205306", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENDO 4MM SAGE GRN SHVR STRAIGHT SHAFT EP-1 ACROMINOBLASTER STRLINSTR DISP", "code_information": [{"code": "7205668", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENDO 5.5MM ORANGE SHVR FULL RADIUS SERIES 3001 STRLINSTR DISP", "code_information": [{"code": "7206010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENDO 5.5MM TEAL SHVR STR ORBIT SHAFTINCISOR PLUS STRLINSTR DISP", "code_information": [{"code": "7205459", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENDO GASTROC RECESSION", "code_information": [{"code": "AR-8855DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2188.0, "discounted_cash": 765.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENDO PLANTAR FASCIA RELEASE SYSTEM", "code_information": [{"code": "AR-8856DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENDOSCOPIC", "code_information": [{"code": "AM96-BLD1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1780.0, "discounted_cash": 623.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENDOSCOPIC CARPAL TUNNEL CTR-455", "code_information": [{"code": "CTR-455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 311.03, "discounted_cash": 108.86, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE EXCALIBER 17106-20", "code_information": [{"code": "17106-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1022.2, "discounted_cash": 357.77, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE FEATHERRASP SM SN31", "code_information": [{"code": "SN31", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 941.5, "discounted_cash": 329.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE FORMULA SHAVER 4MM RESECTOR CUTTER", "code_information": [{"code": "375-542-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE FULL 54MM EXPLANT", "code_information": [{"code": "-7053-054-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE GRINDLESS 64NO MINI ROUND TIP BEAVER VISITEC LFINSTR", "code_information": [{"code": "BEAVER6400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.54, "discounted_cash": 3.69, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HARMONIC 3MM 10CM TO 14CM HOOK TIP FOR USE WITH HPBLUE HANDPIECE SYNERGY BRAND", "code_information": [{"code": "SNGHK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 683.0, "discounted_cash": 239.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HARMONIC 3MM 4CM TO 9CM HOOK TIP FOR USE WITH HPBLUE HANDPIECE SYNERGY BRAND", "code_information": [{"code": "SNGHK2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 804.0, "discounted_cash": 281.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HIP-PAC CAP-FIX CURVED 72205319", "code_information": [{"code": "72205319", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1241.0, "discounted_cash": 434.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HOOK REPROCESS STRLINSTR DISP", "code_information": [{"code": "3055R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HOOK TRIANGLE SET STRL DISP 6 PACK", "code_information": [{"code": "3056-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 376.0, "discounted_cash": 131.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HOOK/TRIANGLE PLANTAR REPROCESS", "code_information": [{"code": "3056R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 80.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HUB 4.0MM LG OVAL BURR", "code_information": [{"code": "H9101RH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE INCISOR 2.92", "code_information": [{"code": "72202536", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1284.0, "discounted_cash": 449.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KHOOK DUAL", "code_information": [{"code": "KDB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1143.25, "discounted_cash": 400.14, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE 10MM PARALLEL GRAFT FOR HARVESTING DISP", "code_information": [{"code": "AR-2285-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 77.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE 4MM (SINGLE)", "code_information": [{"code": "9900C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LAMELLAR MINI ANGLE 60 DEG SMT BEAVER6600", "code_information": [{"code": "BEAVER6600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LARGE BONE KM-326R", "code_information": [{"code": "KM-326R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LARGE BONE SAGITTAL BR1-2590-39F", "code_information": [{"code": "BR1-2590-39F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LARYNGOSCOPE POLARIS DISPOSABLE MAC 1 4150110", "code_information": [{"code": "4150110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.41, "discounted_cash": 7.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LARYNGOSCOPE POLARIS DISPOSABLE MAC 2 4150120", "code_information": [{"code": "4150120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.41, "discounted_cash": 7.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LARYNGOSCOPE POLARIS DISPOSABLE MAC 3 4150130", "code_information": [{"code": "4150130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.41, "discounted_cash": 7.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LARYNGOSCOPE POLARIS DISPOSABLE MILLER 1 4150010", "code_information": [{"code": "4150010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.41, "discounted_cash": 7.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LARYNGOSCOPE POLARIS DISPOSABLE MILLER 2 4150020", "code_information": [{"code": "4150020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.41, "discounted_cash": 7.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LARYNGOSCOPE SZ 4 MAC MCGRATH", "code_information": [{"code": "350-013-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.41, "discounted_cash": 17.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LONG MEDIUM KM33-111", "code_information": [{"code": "KM33-111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE MENISCUS 3.5MM LG CUTTER HUB", "code_information": [{"code": "C9760", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 55.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE MINI BEAVER CURVED TIP(REPLACES 376700)", "code_information": [{"code": "BEAVER6700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.49, "discounted_cash": 3.67, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE MYRINGOTOMY FINE SPEAR", "code_information": [{"code": "17-7120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE MYRINGOTOMY SPEAR TIP NARROW SHAFT LF", "code_information": [{"code": "377120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.7, "discounted_cash": 17.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE MYRINGOTOMY SPOON ANGL", "code_information": [{"code": "17-7200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 22.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE NARROW SAW 200138107S", "code_information": [{"code": "200138107S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE NARROW SHORT KM3-410", "code_information": [{"code": "KM3-410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OPHTHALMIC MINI ROUNDED TIP SHARP ON ONE SIDE NUMBER 64 STRL", "code_information": [{"code": "376400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OPTH MNI-BLDE SS SM ALT TO 15 BLDE STRL DISP", "code_information": [{"code": "B-D376700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSCILLATING 40MM X 1MM LINVATEC", "code_information": [{"code": "ZMS-4011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEOTOME 8.0MM FLEXIBLE THIN SHORT", "code_information": [{"code": "47-9986-021-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEOTOME 8MM X 2.5IN FLEXIBLE CHISEL", "code_information": [{"code": "270904018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1277.0, "discounted_cash": 446.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEOTOME LATARJET", "code_information": [{"code": "AR-7000-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 173.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEOTOME THIN 10MM X3IN", "code_information": [{"code": "71369210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 71.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEOTOME THIN 12 X 3", "code_information": [{"code": "71369212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 71.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE PACK 50MM ACET CUP EXTENSION 7812-050-001K", "code_information": [{"code": "7812-050-001K", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2703.05, "discounted_cash": 946.07, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE PREC 2.0 FALC 25 X 1.27 X 105", "code_information": [{"code": "6725-127-105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 763.0, "discounted_cash": 267.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE PREC FALC 19.5X1.33X105 6625-127-105", "code_information": [{"code": "6625-127-105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 763.0, "discounted_cash": 267.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE PRECISION THIN 9.0 X 0.35 X18.5", "code_information": [{"code": "2296-003-155", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.39, "discounted_cash": 31.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE QUADCUT 3.4MM X 13CM ROTATABLE FUSION", "code_information": [{"code": "1883480EM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 336.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RAD 120D MAXILLARY SINUS CURVED 1883517", "code_information": [{"code": "1883517", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RAD40 M4 ROTATE 4MM", "code_information": [{"code": "1884006EM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 669.81, "discounted_cash": 234.43, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RECIPROCATING 70MM X .64MM X 12.5MM X 3.56MM X 7.87CM DOUBLE SIDED REPROCE", "code_information": [{"code": "27796275R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RECIPROCATING 77.5MM HVY DTY", "code_information": [{"code": "277-96-325", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RECIPROCATING HVY DTY REPROCESS", "code_information": [{"code": "27796325R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGGITAL 25MM MED REPROCESS", "code_information": [{"code": "2296-3-111R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL 11.5MM X 5.5MM SHRT NARROW REPROCESS", "code_information": [{"code": "2296-3-410R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL 25X1.19X90MM 6125-137-090", "code_information": [{"code": "6125-137-090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 167.0, "discounted_cash": 58.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL 9.5MM X 25.5MM COARSE REPROCESS HALL MICROCHOICE", "code_information": [{"code": "5023143R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL 9MM X 31.0MM X 4MM MICRO", "code_information": [{"code": "502324900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL REPROCESS GROUND FLARED HVY DTY", "code_information": [{"code": "21083935R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL THICK NARROW REPROCESS", "code_information": [{"code": "2108-152R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL THIN NARROW REPROCESS", "code_information": [{"code": "2108-150R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 32.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW", "code_information": [{"code": "KM-3005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW .38MM X 7MM PRECISION THIN MICRO FOR OSCILLATING AND SAGITTAL", "code_information": [{"code": "2296-3-111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 1.27 X 13 X 70MM PRESERVATION OSCILLATING", "code_information": [{"code": "562787601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 521.0, "discounted_cash": 182.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 1.47 X 70MM STABLECUT OSCILLATING", "code_information": [{"code": "950501924", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 521.0, "discounted_cash": 182.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 1/2IN STABLECUTINSTR", "code_information": [{"code": "562744601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 482.0, "discounted_cash": 168.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 10 X 9.0 X X .43MM OSCILLATING SAGITTAL THIN SM BONE PNEUMICRO STRL", "code_information": [{"code": "KM-3101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 10MM X 12MM OSCILLATING MICRO FINE TOOTH REPROCESSINSTR", "code_information": [{"code": "5023-161R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 10MM X 18MM OSCILLATING FINE TOOTH REPROCESS MICROPOWERINSTR", "code_information": [{"code": "5023163R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 11.5X5.5X38MM MICRO SAGITTAL OSCILLATING 2 CUT 5400-003-410", "code_information": [{"code": "5400-003-410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 12MM X 10MM X.6MM OSCILLATING FINE MICRO M-POWER STRL", "code_information": [{"code": "502316100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 12MM X 5.5MM X .4MM HALL OSCILLATING FLAT MICRO FINE STRL", "code_information": [{"code": "502316000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 13MM X 34.5MM X .38MM OSCILLATING MINI RECIPROCATING AGGRESSIVE TOOTH", "code_information": [{"code": "22963506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 13MM X 90MM X 1.37MM SAGITTAL HVY DTY BEVELED EDGE SYS 6", "code_information": [{"code": "6221-137-090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.0, "discounted_cash": 60.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 15.0MM AGGRESSIVE THIN", "code_information": [{"code": "2296-003-103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.39, "discounted_cash": 31.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 18.5MM X 10MM X .4MM MICRO OSCILLATING STRL", "code_information": [{"code": "502316300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 18.5MM X 5.5MM X .4MM HALL FINE MICRO OSCILLATING SS STRL", "code_information": [{"code": "502316200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 18.5MM X 9MM DOWN OFFFSET SAGITTAL HEAVY TPS", "code_information": [{"code": "2296-003-105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 1IN STABLECUTINSTR", "code_information": [{"code": "562710601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 25.0MM X 1.04MM X 81.5MM SAGITTAL HVY DTY AGGRESSIVE TOOTH", "code_information": [{"code": "2108393000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 25.5MM X 5.5MM X .4MM OSCILLATING SAGITTAL MICRO FINE FLAT STRLINSTR", "code_information": [{"code": "502316400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 25.5MM X 9.5MM X .4MM MICRO SAGITTAL CROSS HALL", "code_information": [{"code": "502314300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 25.5MM X 9.5MM X 4MM HALL MICRO SAGITTAL FINE M-PWR MICRO100 SS", "code_information": [{"code": "502313800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 25MM X 5.5MM NARROW LNG TPS SAFEEDGE", "code_information": [{"code": "2296-003-114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 25MM X 89.5MM X .96MM SAGITTAL HVY DTY", "code_information": [{"code": "2108-393-005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 25MM X 9MM MED AGGRESSIVE THIN SAGITTAL", "code_information": [{"code": "2296-003-511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 25MMX9MM MEDIUM LONG SAGITTAL 2296-033-111", "code_information": [{"code": "2296-033-111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 31.0MM X 9.0MM SAGITTAL MICRO LONG", "code_information": [{"code": "5400003125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 43.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 31MM X 9MM SAGITTAL AGGRESSIVE THIN", "code_information": [{"code": "2296003525", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 31MM X 9MM TEAR AGGRESSIVE TOOTH TPS", "code_information": [{"code": "2296-3-525", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.39, "discounted_cash": 31.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 4.2MM LG HUB REPROCESS ULTRACUTINSTR", "code_information": [{"code": "C9405AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 4.5MM X 15MM X .63MM SAGITTAL OSCILLATING SM BONE", "code_information": [{"code": "KM3-105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.04, "discounted_cash": 16.81, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 5.5MM X .38MM X 18MM PRECISION THIN FOR MICRO SAGITTAL AND OSCILLATING", "code_information": [{"code": "2296-003-412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.39, "discounted_cash": 31.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 5.5MM X .38MM X 25MM PRECISION THIN FOR MICRO SAGITTAL AND OSCILLATI", "code_information": [{"code": "2296-003-414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.39, "discounted_cash": 31.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 5.5MM X 12MM X .4MM OSCILLATING REPROCESS SSINSTR", "code_information": [{"code": "5023160R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 5.5MM X 15MM X .56MM OSCILLATING SM BONE", "code_information": [{"code": "KM-3006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 5.5MM X 18.5MM X .4MM OSCILLATING SS", "code_information": [{"code": "5023-162", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 5.5X0.25X18.0MM MEDIUM MICRO 2 CUT SAGITTAL OSCILLATE 5400-003-412", "code_information": [{"code": "5400-003-412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 70MM X .64MM X 12.5MM RECIPROCATING DOUBLE SIDED CUT EDGE", "code_information": [{"code": "277096275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 70MM X .64MM X 12.5MM X 3.56MM DOUBLE SIDED FOR RECIP", "code_information": [{"code": "27796275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 70MM X .64MM X 12.5MM X 3.56MM DOUBLE SIDED FOR RECIP DOUBLE", "code_information": [{"code": "277-96-275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.55, "discounted_cash": 37.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 73.0MM X .64MM SAGITTAL HVY DTY", "code_information": [{"code": "2108-150-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.36, "discounted_cash": 27.78, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 79.5MM X 1.24MM SAGITTAL HVY DTY", "code_information": [{"code": "2108118000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 7MM X .38MM X 29MM MICRO OSCILLATING SAGITTAL", "code_information": [{"code": "2296-3-115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.39, "discounted_cash": 31.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 7MM X 38MM X 29MM PRECISION MICRO NARROW SAFEEDGE TPS", "code_information": [{"code": "22963115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 9MM", "code_information": [{"code": "OSB-9M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 9MM X 25MM SAGITTAL REPROCESSED INSTRUMENT", "code_information": [{"code": "5023-138R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 9MM X 25MM X .54MM THIN BLADE SAGITTAL OSCILLATING SM BONE", "code_information": [{"code": "KM3-511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW BONE 6 SAGITTAL STAINLESS STEEL FULL INSERT HEAVY DUTY DUAL CUT STERILE REPROCESSED 25 X 9", "code_information": [{"code": "BR1-2590-54", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW BONE MICRO BENT COARSE 5.5 X 9 X 0.64MM", "code_information": [{"code": "2296-033-234", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW BONE RECIPROCATING STAINLESS STEEL DOUBLE SIDE OFFSET HEAVY DUTY STERILE 77.5 X 0.76 X 11.", "code_information": [{"code": "KM-325R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW BONE RECIPROCATING STAINLESS STEEL TEAR CROSS CUT STERILE DISPOSABLE LG 14 X 7.0MM", "code_information": [{"code": "KM5100-37-114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW BONE SAGITTAL STAINLESS STEEL COURSE 0.40 X 0.60 X 9.5 X 25.5MM", "code_information": [{"code": "KM-3101C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW BONE SAGITTLA 90 X 25MM BR4125-137-090", "code_information": [{"code": "BR4125-137-090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.36, "discounted_cash": 28.48, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW BONE SYSTEM 6 STAINLESS STEEL HIGH PERFORMANCE STERNUM NONSTERILE REUSABLE 90 X 21 X 1.27M", "code_information": [{"code": "BR1-2190-50F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW BONESYSTEM 6HIGH PERFORMANCE BR1-2190-54F", "code_information": [{"code": "BR1-2190-54F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW LAPIPLASTY 40MM X 11MM", "code_information": [{"code": "SM-4011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW MED 5MM BONE MILL DISP", "code_information": [{"code": "5400701000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1182.98, "discounted_cash": 414.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW OSCILLATING.", "code_information": [{"code": "KM-3000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW OSCILLATING/SAGITTAL 90 X 25MM BRI-2590-39F", "code_information": [{"code": "BRI-2590-39F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW OXFORD PARTIAL KNEE CEMENTED", "code_information": [{"code": "506298", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1214.0, "discounted_cash": 424.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW PRECISION THIN 9MM X .38MM X 25MM", "code_information": [{"code": "2296-003-111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW RECIPCATING DBL SIDE MITKR CAS", "code_information": [{"code": "229910002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 186.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW SAGITTAL FLARED GROUND HVY DTYINSTR", "code_information": [{"code": "2108-393-5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW SAGITTAL HEAVY REPROCESSINSTR", "code_information": [{"code": "22963105R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW SAGITTAL LG BONE 75MM 25MM 1.27 THICKNESS BR2108-118", "code_information": [{"code": "BR2108-118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.7, "discounted_cash": 27.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW WIDE GENESIS IIINSTR", "code_information": [{"code": "71440375", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SCLERAL #57 BEAVER", "code_information": [{"code": "17-5700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SCREW REMOVAL 2.3MM", "code_information": [{"code": "62-23335", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 183.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SCREWDRIVER 1.7MM CROSS PININSTR", "code_information": [{"code": "62-17333", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 779.0, "discounted_cash": 272.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SCREWDRIVER 1.8/2.3", "code_information": [{"code": "5030040425", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.0, "discounted_cash": 387.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SCREWDRIVER 2.0 X 2.3 X 2.7MM DISTAL RADIUS", "code_information": [{"code": "62-27007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 921.0, "discounted_cash": 322.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SCREWDRIVER 2.3MM X 2.7MM T7", "code_information": [{"code": "62-27015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2111.0, "discounted_cash": 738.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SCREWDRIVER AO T10", "code_information": [{"code": "45-35015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 766.0, "discounted_cash": 268.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SCREWDRIVER CANNULATED", "code_information": [{"code": "7-40220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1224.0, "discounted_cash": 428.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SCREWDRIVER SLF RETAINING AO T10", "code_information": [{"code": "703667", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 941.0, "discounted_cash": 329.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SCREWDRIVER SLF RETAINING AO T8", "code_information": [{"code": "703663", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 939.0, "discounted_cash": 328.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVE 5.0MM TOMCAT", "code_information": [{"code": "375-555-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 220.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVE CULL RADIUS RESECTOR 2.0MM", "code_information": [{"code": "C9943A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 2.0 MM X 7 CM SABRE", "code_information": [{"code": "AR-9200SR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 2.0MM FULL RADIUS", "code_information": [{"code": "C9940", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 2.0MM LG HUB CUDA", "code_information": [{"code": "C9951A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 2.0MM STERLING GATOR", "code_information": [{"code": "C9960A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 2.9MM LG HUB GATOR", "code_information": [{"code": "C9961A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 2.9MM PEACH ENDOINCISOR PLUS ELITE DYONICS POWERMINI STRL", "code_information": [{"code": "72201513", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "discounted_cash": 54.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 2.9MM STERLING SPHERICAL BURR", "code_information": [{"code": "C9911A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 58.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 2MM X 7 CM SABRE SM JOINT", "code_information": [{"code": "AR-7200SR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.0MM X 7CM DISSECTOR", "code_information": [{"code": "AR-9300DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.38, "discounted_cash": 49.83, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.5MM 110MM 60DEG CURVED FRONTAL SINUS RADINSTR", "code_information": [{"code": "1883516HRE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.5MM BEIGE FULL RADIUS CONCAVE", "code_information": [{"code": "7210980", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "discounted_cash": 54.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.5MM END CUTTER REPROCESS AGGRESSIVE PLUS", "code_information": [{"code": "375-534-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.5MM GREY ARTHROSCOPIC REPROCESSINCISOR STRL DISP", "code_information": [{"code": "7205312R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.5MM MED GRAY ENDO STRAIGHT SHAFTINCISOR DISP", "code_information": [{"code": "7205312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.5MM WHT GREAT REPROCESSINSTR", "code_information": [{"code": "9399AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.14, "discounted_cash": 30.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.5MM X 13 CM DISSECTOR ORTHO STRL", "code_information": [{"code": "AR-8350DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.8MM X 13 CM BONE CUTTER ORTHO", "code_information": [{"code": "AR-8380BC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3MM X 7 CM SABRE SM JOINT", "code_information": [{"code": "AR-7300SR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3MM X 7 CM SM JOINT DISSECTOR", "code_information": [{"code": "AR-7300DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 4.2MM 13 CM DUAL FUNCTION ULTRACUT", "code_information": [{"code": "C9405A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 219.0, "discounted_cash": 76.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 4.2MM FULL RADIUS LG HUB REPROCESSINSTR", "code_information": [{"code": "9247AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 4.2MM GATOR LG HUB REPROCESSINSTR", "code_information": [{"code": "9263AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 4.2MM LG HUB CUDA", "code_information": [{"code": "C9254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 55.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 4.2MM LG HUB GATOR", "code_information": [{"code": "9263A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 4.2MM WHT GREAT LG HUB REPROCESSINSTR", "code_information": [{"code": "9299AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 4.5MM INCISOR PLUS ELITE SLATE STRT", "code_information": [{"code": "7210976", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 229.0, "discounted_cash": 80.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 5.5MM BONE CUTTER MOST AGGRESSIVE", "code_information": [{"code": "AR-8550BC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 5.5MM CYCLONE BURR REPROCESSINSTR", "code_information": [{"code": "H9119R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 5.5MM LG HUB FILL RADIUS REPROCESSINSTR", "code_information": [{"code": "9246AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 5.5MM LG HUB GATOR", "code_information": [{"code": "9260A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 55.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 5.5MM LG HUB GREAT WHT", "code_information": [{"code": "9599A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 5.5MM WHT GREAT LG HUB REPROCESSINSTR", "code_information": [{"code": "9599AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.97, "discounted_cash": 27.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 5MM EXCALIBURINSTR", "code_information": [{"code": "AR-8550EX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 5MM X 13 CM EXCALIBURINSTR", "code_information": [{"code": "AR-8500EX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER NANO SABRE 2.8MM X 11CM AR-9280NSR", "code_information": [{"code": "AR-9280NSR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 322.19, "discounted_cash": 112.77, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHUVER 6MM OVAL BURR REPROCESSINSTR", "code_information": [{"code": "H9102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 2.9MM 110MMINFERIOR TURBINATE M4 ROTATABLE STRAIGHT REPROCESS STRLINS", "code_information": [{"code": "18-82940HRR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 286.0, "discounted_cash": 100.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 2.9MM X 7 CM RED ENDO BARREL ABRADER FULL RADIUS POWERMINI STRL DISP", "code_information": [{"code": "72201509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "discounted_cash": 54.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 2MM X 110MM STRAIGHT TURBINATE M4 ROTATABLE ENDO REPROCESS SS STRLINS", "code_information": [{"code": "18-82040HRR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 215.0, "discounted_cash": 75.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 3.5MM X 7CM BEIGE ARTHROSCOPIC STR REPROCESS DYONICS STRLINSTR DISP", "code_information": [{"code": "7205305R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4.5MM 18 CM SLATE FULL RADIUS HIP ARTHROSCOPIC DYONICSINCISOR PLUS EL", "code_information": [{"code": "72200414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4.5MM LIME GRN STRINCISOR REPROCESS STRLINSTR DISP", "code_information": [{"code": "7205313R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4.5MM NAVY BLUE ENDO STRAIGHT SHAFT ARTHROSCOPIC TURBOWHISKER STRL DI", "code_information": [{"code": "7205316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4.5MM VIOLET ENDO STRAIGHT SHAFTINCISOR PLUS STRLINSTR DISP", "code_information": [{"code": "7205345", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4.5MM YELLOW STR FULL RADIUS REPROCESS DYONICS STRLINSTR DISP", "code_information": [{"code": "7205306R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4MM LILAC STR REPROCESS NOTCHBLASTER STRLINSTR DISP", "code_information": [{"code": "7205328R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4MM SAGE GRN STR REPROCESS ACROMIOBLASTER DYONICS STRLINSTR DISP", "code_information": [{"code": "7205668R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4MM X 110MM STRAIGHT TURBINATE M4 ROTATABLE ENDO REPROCESS STRLINSTR", "code_information": [{"code": "18-84004HRR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 217.0, "discounted_cash": 75.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4MM X 13 CM DSSCTR FOR AGGRESSIVE RESECTION OF MENISCUS SYNOVIUM CART", "code_information": [{"code": "AR-8400DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 67.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4MM X 13 CM EXCALIBUR FOR EXTENSIVE SOFT TISSUE DEBRIDEMENTINSTR", "code_information": [{"code": "AR-8400EX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 5.5MM OLIVE STR ARTHROSCOPIC REPROCESS STONECUTTER STRLINSTR DISP", "code_information": [{"code": "7205331R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 5.5MM ORANGE ENDO FULL RADIUS SERIES 3001 PLATINUM BONECUTTER STRL DI", "code_information": [{"code": "72202530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 286.0, "discounted_cash": 100.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 5.5MM TEAL STR ARTHROSCOPIC REPROCESS DYONICS STRL DISP", "code_information": [{"code": "7205459R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SIGMA 1/2IN SYS 6 TSS BL", "code_information": [{"code": "562710652", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 435.0, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SINUS XPS 3.4 X 13CM TURBINATE STRAIGHTSHOT M4 QUADCUT", "code_information": [{"code": "1884380EM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 336.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SPIRAL FOR TI HUM NAIL 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "462.640S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1561.0, "discounted_cash": 546.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE STERILE HOOK VILEX YB-HS01", "code_information": [{"code": "YB-HS01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 452.98, "discounted_cash": 158.54, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE STERILE TRIANGLE VILEX YB-TS01", "code_information": [{"code": "YB-TS01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE STERLING 3.5MM GREAT WHT", "code_information": [{"code": "9399A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE STERLING GREAT WHITE 4.2MM 9299A", "code_information": [{"code": "9299A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE STRAIGHT 8 X 40 X 1MM CHISEL 75100516", "code_information": [{"code": "75100516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 15MM X 7MM AGGRESSIVE THIN", "code_information": [{"code": "22963103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 2.9MM 11 CM TURBINATE", "code_information": [{"code": "1882940HR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 709.0, "discounted_cash": 248.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 3.5MM 11 CM STR OFFSET CUTTING SURFACE FOR ETHMOIDECTOMY TRICUTINSTR", "code_information": [{"code": "18-83504HRE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 3.5MM 11 CM STRAIGHT SHAFT ROTATES 360 DEGREE TRICUT", "code_information": [{"code": "1883504HR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 584.0, "discounted_cash": 204.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 3.5MM FULL RADIUS STRAIGHT ELITE DISP", "code_information": [{"code": "7210751", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 4.2MM LG HUB REPROCESS CUDAINSTR", "code_information": [{"code": "C9254R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 4MM 11 CM 40DEG CURVED SHAFT M4 ROTATES BALADE TIP 360 DEGREE WITHOUT", "code_information": [{"code": "1884006HR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 204.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 4MM 11 CM 60DEG CURVED SHAFT M4 ROTATES BLADE TIP 360 DEGREE WITHOUT", "code_information": [{"code": "1884016HR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 569.02, "discounted_cash": 199.16, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 4MM 11 CM APPLICATION ETHMOIDECTOMY 04 ROTATESIN 360 DEGREE STRAIGHT", "code_information": [{"code": "1884004HR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 414.7, "discounted_cash": 145.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 4MM 13 CM STRAIGHT SHAFT M4 ROTATES THROUGH 360 DEGREE ENT EAR NOSE T", "code_information": [{"code": "1884080EM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 742.0, "discounted_cash": 259.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 4MM MINI MENISCUS FLAT ARTHO-LOK BEAVERINSTR", "code_information": [{"code": "379081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 275.0, "discounted_cash": 96.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 4MM OVAL BURR LG HUB REPROCESSINSTR", "code_information": [{"code": "H9101RHR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 5.5MM ARTHROSCOPIC REPROCESS CUDAINSTR", "code_information": [{"code": "C9255R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 84MM X 5MM LNG STRAIGHT SICKLE EDGE TYMPANOPLASTY OPHTHALMIC ARTHRO-L", "code_information": [{"code": "377300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG BEAVER MINI 6200", "code_information": [{"code": "BEAVER6200", "type": "CDM"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG MED 31MM X 9MM LNG STRL DISP", "code_information": [{"code": "2296-003-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG MICRO HOOK EDINTRAK II STRL DISP", "code_information": [{"code": "4058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 159.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG MINI 180 DEGREE CUTTING SURFACE BEVEL BLADE BEAVER 6900", "code_information": [{"code": "BEAVER6900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.22, "discounted_cash": 13.03, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURGICAL CLIPPER PREPARATION STANDARD DISP", "code_information": [{"code": "PH-2602-3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURGICAL QUADCUT FOR STRAIGHTSHOT M4", "code_information": [{"code": "1884380HR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 414.7, "discounted_cash": 145.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURGICAL STAINLESS STEEL", "code_information": [{"code": "795510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURGICAL SZ 11", "code_information": [{"code": "D2862-11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 182.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TENDON STRIPPER 9MM ACL RECONSTRUCTION", "code_information": [{"code": "AR-2385-09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 184.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TRUCLEAR ULTRA MINI DEVICE 72204064", "code_information": [{"code": "72204064", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2009.0, "discounted_cash": 703.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TURBINATE 2MM X 11 CM M4 ROTATES 360DEGINFERIOR XPS ENT STRAIGHT SHAFT W/", "code_information": [{"code": "1882040HR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 350.9, "discounted_cash": 122.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ULTRACUT 5.5MM", "code_information": [{"code": "C9415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 219.0, "discounted_cash": 76.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE WRENCH HARMONIC CURVED W/TORQUE SNGCB", "code_information": [{"code": "SNGCB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 683.0, "discounted_cash": 239.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE, ENDOSCOPIC SCOPE 4.0MM", "code_information": [{"code": "9900-B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADES SIZE 3 MCGRATH MAV VIDEO LARYNGOSCOPE 350-005-000", "code_information": [{"code": "350-005-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.41, "discounted_cash": 17.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLAKE 15FR ROUND WITHOUT TORCAR 2228", "code_information": [{"code": "2228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BLAKE 7MM FLAT (F/FLTD) 2212", "code_information": [{"code": "2212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLAKE DRN 15FR R/F 2229", "code_information": [{"code": "2229", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 193.0, "discounted_cash": 67.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET OPERATING ROOM 24IN X 74IN UPPER BODY ALLIANCE BAIR HUGGER", "code_information": [{"code": "42268", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARM FULL POST-OP WHITE ALLIANCE 40068", "code_information": [{"code": "40068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING LOWER BODY 52500", "code_information": [{"code": "52500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING OPERATING ROOM LOWER BODY BAIR HUGGER LF", "code_information": [{"code": "42568", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.94, "discounted_cash": 8.38, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING UPPERBODY HEADRAPE BAIR HUGGER LF DISP", "code_information": [{"code": "52200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLASTOMYCES ANTIBODY", "code_information": [{"code": "86612", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ NEWBORN", "code_information": [{"code": "36450", "type": "CPT"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ OTH THN NB", "code_information": [{"code": "36455", "type": "CPT"}], "standard_charges": [{"minimum": 789.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD PUSH TFUJ 2 YR/<", "code_information": [{"code": "36440", "type": "CPT"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD TYPING SEROLOGIC RH PHNT", "code_information": [{"code": "86906", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEEDING TIME TEST", "code_information": [{"code": "85002", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEPHAROPLASTY REVISION LOWER EYELID 15820", "code_information": [{"code": "15820", "type": "CPT"}, {"code": "1480197", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEPHAROPLASTY REVISION LOWER EYELID EXTENSIVE 15821", "code_information": [{"code": "15821", "type": "CPT"}, {"code": "1480198", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEPHAROPLASTY REVISION UPPER EYELID 15822", "code_information": [{"code": "15822", "type": "CPT"}, {"code": "1480199", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEPHAROPLASTY REVISION UPPER EYELID EXTENSIVE 15823", "code_information": [{"code": "15823", "type": "CPT"}, {"code": "1480200", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEPHAROTOMY 67700", "code_information": [{"code": "67700", "type": "CPT"}, {"code": "11628643", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLIND COR SINUS REDUCER IMPL", "code_information": [{"code": "C9783", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLIND INTERATRIAL SHUNT IDE", "code_information": [{"code": "C9758", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLIND MYOCAR TRPL BON MARROW", "code_information": [{"code": "C9782", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 6045.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLIND/NONBLIND TRANS ATRIAL", "code_information": [{"code": "C9792", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLINDED CONV. TX MDD CLIN TR", "code_information": [{"code": "G2000", "type": "HCPCS"}], "standard_charges": [{"minimum": 2141.54, "maximum": 3365.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLINK REFLEX TEST", "code_information": [{"code": "95933", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLM GENE", "code_information": [{"code": "81209", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 49.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 157.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 157.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 56.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCK BITE 60FR LF", "code_information": [{"code": "712812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK BITE LG BLUE LF", "code_information": [{"code": "1429", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUTTING VISIONAIRE NON STRL", "code_information": [{"code": "V0200023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2707.0, "discounted_cash": 947.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK ORTHO SOCKET 32MM HXE INSERT RSP MONO STANDARD HUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "509-00-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1580.0, "discounted_cash": 553.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SACROILIAC JOINT 27096", "code_information": [{"code": "27096", "type": "CPT"}, {"code": "1480201", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCKER CAP XIA 3 TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48230000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOOC CLOT FACTOR V TEST", "code_information": [{"code": "85220", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 70.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 70.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 70.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT LYSIS TIME", "code_information": [{"code": "85175", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 81.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 81.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 81.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT RETRACTION", "code_information": [{"code": "85170", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD CULTURE FOR BACTERIA", "code_information": [{"code": "87040", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD FUNGUS CULTURE", "code_information": [{"code": "87103", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES ANY COMBINATION", "code_information": [{"code": "82803", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 104.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 104.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 37.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 37.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES O2 SAT ONLY", "code_information": [{"code": "82810", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES W/O2 SATURATION", "code_information": [{"code": "82805", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 98.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 200.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 315.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 315.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 315.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 113.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 113.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD MUCOPROTEIN", "code_information": [{"code": "P2038", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 19.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD PH", "code_information": [{"code": "82800", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 44.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 44.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 44.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD PRESUURE BP AIR HOSES 12 INC LONG 3.6 M 2058203-002", "code_information": [{"code": "2058203-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.35, "discounted_cash": 49.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOOD PRODUCT/IRRADIATION", "code_information": [{"code": "86945", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD SMEAR INTERPRETATION", "code_information": [{"code": "85060", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 101.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 101.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 101.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD THYMOL TURBIDITY", "code_information": [{"code": "P2033", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 7.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPE ANTIGEN DONOR EA", "code_information": [{"code": "86902", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING ANTIGEN SYSTEM", "code_information": [{"code": "86911", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 47.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING PATERNITY TEST", "code_information": [{"code": "86910", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 133.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 209.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 209.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 209.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 34.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING PATIENT SERUM", "code_information": [{"code": "86904", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING RBC ANTIGENS", "code_information": [{"code": "86905", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING SEROLOGIC RH(D)", "code_information": [{"code": "86901", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD VISCOSITY EXAMINATION", "code_information": [{"code": "85810", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD VOLUME", "code_information": [{"code": "78122", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 335.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 527.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 527.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 527.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 190.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 203.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLS DEFIBRILLATION SUPPLIES", "code_information": [{"code": "A0384", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLS-EMERGENCY", "code_information": [{"code": "A0429", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLUE LIGHT CYSTO IMAG AGENT", "code_information": [{"code": "C9738", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLUEPRINT GLENOID PERFORM GUIDE", "code_information": [{"code": "MWJ003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1579.0, "discounted_cash": 552.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLUEPRINT PERFORM + GLENOID GUIDE", "code_information": [{"code": "MWJ021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1579.0, "discounted_cash": 552.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLUEPRINT REVERSED GLENOID GUIDE NS", "code_information": [{"code": "MWJ004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1579.0, "discounted_cash": 552.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLUNT PIN 3.2 MM 500374", "code_information": [{"code": "500374", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "BMI DOC ONL FUP NOT CMPLTD", "code_information": [{"code": "G9716", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BMI DOC ONL FUP NOT CMPLTD", "code_information": [{"code": "M1286", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BMI NOT CALCULATED", "code_information": [{"code": "G8421", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BMI NOT CALCULATED", "code_information": [{"code": "M1314", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BMI NOT DOC MEDRSN PTREF", "code_information": [{"code": "G2181", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BMI NOT DOC MEDRSN PTREF", "code_information": [{"code": "M1297", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BN DEN 2YR/GOT OST MED/THER", "code_information": [{"code": "G9769", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BODY CONE 21MM +10MM PROXIMAL MODULAR RESTORATION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6276-1-121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6372.0, "discounted_cash": 2230.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BODY FLUID CELL COUNT", "code_information": [{"code": "89050", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BODY FLUID SPECIFIC GRAVITY", "code_information": [{"code": "84315", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BODY HUMERAL SZ 10 135DEG COMPONENT GLOBAL UNITE IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110030000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2373.0, "discounted_cash": 830.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLSTER RETENTION FOR SUT", "code_information": [{"code": "450G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT 16MM BOLT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-16-B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT 16MM DSF-600-16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-600-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT 20MM DSF-600-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-600-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 161.0, "discounted_cash": 56.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT 30MM DSF-600-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-600-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 161.0, "discounted_cash": 56.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT BONE 12MM ORTHO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-1050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT FXTN UNIVERSAL WIRE ANKLE DISTRACTION ARTHROPLASTY TRUELOK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-1152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT MODULUS ALIF \u00c3\u02dc5.0X22.5MM FIXATION 1450225", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1450225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1407.0, "discounted_cash": 492.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT UNIVERSAL HALF PIN FIXATION DNE-1000-HFB", "code_information": [{"code": "DNE-1000-HFB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT UNIVERSAL WIRE FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-WFB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT WIRE DSF-600-50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-600-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 161.0, "discounted_cash": 56.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT WITH HEX 20MM DNE-20-B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-20-B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT WITH HEX 30MM DNE-30-B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-30-B", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE ANCHOR CITREFIX 3.5 X 15.5MM 30-110-7035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-110-7035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1836.0, "discounted_cash": 642.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE ANCHOR CITREFIX IMPLANT 2.9MM X 12.5MM 30-110-7029", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-110-7029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1891.0, "discounted_cash": 661.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE ANCHOR CITREFIX XPRESS IMPLANT SYSTEM 3.5 X 15.5 70-810-3515", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-810-3515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3963.0, "discounted_cash": 1387.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE ANCHOR DBL LOADED KNEE FIBERTAK W/NEEDLES AR-3730SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3730SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE ANCHOR PUSHLOCK 3.5MM BIOCOMP SELF-PUNCHING AR-1926BCSP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1926BCSP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3672.0, "discounted_cash": 1285.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE ANCHOR TOGGLELOC WITH ZIPLOOP 904753", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "904753", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 886.0, "discounted_cash": 310.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CANCELLOUS 1-4 30CC STERIL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "500718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2880.0, "discounted_cash": 1008.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CANCELLOUS CRUSHED 1-4MM 30CC 306", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1040.0, "discounted_cash": 364.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CRUSHED CANCELLOUS CHIPS 1-4MM 30CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "CB-30G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1751.0, "discounted_cash": 612.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CUTTER 4.0 X 13CM", "code_information": [{"code": "AR-8400BC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [{"code": "553", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7734.53, "maximum": 13278.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7734.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11062.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12168.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13278.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [{"code": "554", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4820.78, "maximum": 8276.08, "estimated_discounted_cash": 43398.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4820.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6894.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7584.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8276.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT 1.5CC AUGMENT K300-015-10", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "K300-015-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRAFT 2..5CC OSTEOFLO NANOPUTTY QUADPHASIC SYNTHETIC ONP-S-02", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "ONP-S-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRAFT 3CC AUGMENT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "K20003010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7200.0, "discounted_cash": 2520.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRAFT 5CC OSTEOFLO SYNTHETIC NANOPUTTY SYRINGE ONP-S-05", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ONP-S-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRAFT CALCIUM PHOSPHATE SUBSTITUTE 6000041", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6000041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5057.0, "discounted_cash": 1769.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRAFT SUBSTITUTE 3CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3-MOR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 850.0, "discounted_cash": 297.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GUIDE MED PARTIAL KNEE ARTHROPLASTY SIGNATURE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-411562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE HARVESTER 9MM COREX HSD", "code_information": [{"code": "300-090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5301.0, "discounted_cash": 1855.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE IMAGING 3 PHASE", "code_information": [{"code": "78315", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1348.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2119.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2119.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2119.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 634.25, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 674.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING LIMITED AREA", "code_information": [{"code": "78300", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 905.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1423.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1423.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1423.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 418.83, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 445.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING MULTIPLE AREAS", "code_information": [{"code": "78305", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1088.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1710.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1710.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1710.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 502.41, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 534.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING WHOLE BODY", "code_information": [{"code": "78306", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1182.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1859.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1859.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1859.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 540.99, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 575.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATION FOR BONE GRAFTING; SPINE SURGERY /SEPARATE INCISION 20939", "code_information": [{"code": "20939", "type": "CPT"}, {"code": "44897314", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST ALLOGEN", "code_information": [{"code": "38230", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVESTING FOR TRANSPLANTATION; AUTOLOGOUS 38232", "code_information": [{"code": "38232", "type": "CPT"}, {"code": "26440562", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1189.18, "maximum": 9357.0, "gross_charge": 2457.0, "discounted_cash": 859.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1189.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING BODY", "code_information": [{"code": "78104", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 952.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1497.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1497.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1497.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 454.99, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 484.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING LTD", "code_information": [{"code": "78102", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 652.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1025.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1025.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1025.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 323.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 345.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING MULT", "code_information": [{"code": "78103", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 829.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1304.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1304.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1304.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 336.01, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 358.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW INTERPRETATION", "code_information": [{"code": "85097", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MATRIX 1.0CC CELLULAR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "P01-V92-0100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2163.0, "discounted_cash": 757.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MATRIX 1CC DBM BEAST 100 DEMINERALIZED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "P01-DBM-1001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 958.0, "discounted_cash": 335.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MATRIX 2.5CC CELLULAR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "P01-V92-0250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4223.0, "discounted_cash": 1478.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MATRIX 5CC CELLULAR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "P01-V92-0500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9373.0, "discounted_cash": 3280.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MINERAL DUAL PHOTON", "code_information": [{"code": "78351", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 108.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 108.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 108.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL SINGLE PHOTON", "code_information": [{"code": "78350", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 96.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 151.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 151.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 151.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE PLANGE", "code_information": [{"code": "P40-900-0801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 817.0, "discounted_cash": 285.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PUTTY 2CC MONTAGE OS-MON-1604", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "OS-MON-1604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1288.0, "discounted_cash": 450.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PUTTY STIMUBLAST DBM 1CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ABS-2001-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PUTTY STIMUBLAST DBM 2.5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ABS-2001-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 317.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PUTTY SYNTHETIC MEDIUM 7.5G", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "MSBG0750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW 2.3 X 15MM 663815", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW 2.7MM 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27218E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW 5.0MM X 32.0MM W/ T25 SRATDRIVE RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.21", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 297.0, "discounted_cash": 103.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW 6.5X25MM ACETABULAR 940-00-025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "940-00-025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW SHANK 07.5X45MM 20-SDS-7545", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-SDS-7545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW T8 FULL THREAD 2.4MM/L18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 83.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE STAPLE COMPRESSION SYSTEM DYNAMIC EASY FUSE 20 X 20MM FFS22020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS22020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3546.0, "discounted_cash": 1241.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE STAPLE DYMANIC COMPRESSION SYSTEM 20 X 15MM FFS22015", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS22015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3546.0, "discounted_cash": 1241.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SUBSTITUTE DELIVERY CANNULA INJECTABLE 4000050", "code_information": [{"code": "4000050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE TAP 5.5MM AO CANNULATED TAP-5.5C AO", "code_information": [{"code": "TAP-5.5C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 864.0, "discounted_cash": 302.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE TAP CANNULATED 5.5MM", "code_information": [{"code": "AR-8956C-55T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 184.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE VOID FILLER AGRIX TE 10CC RESORBABLE ATM0110", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ATM0110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6695.0, "discounted_cash": 2343.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE WAX LUKENS 901", "code_information": [{"code": "901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT GREAT TOE", "code_information": [{"code": "20973", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT ILIAC CREST", "code_information": [{"code": "20970", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT METATARSAL", "code_information": [{"code": "20972", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT MICROVASC", "code_information": [{"code": "20969", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORDETELLA ANTIBODY", "code_information": [{"code": "86615", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORRELIA ANTIBODY", "code_information": [{"code": "86619", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORRELIA MIYAMOTOI AMP PRB", "code_information": [{"code": "87478", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTOX 100 U INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0585", "type": "HCPCS"}, {"code": "MED0031", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1300.0, "discounted_cash": 455.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOTOX 100 U INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0585", "type": "HCPCS"}, {"code": "MED0031", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1300.0, "discounted_cash": 455.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOTTLE SALINE STERILE SOLUTION 250ML PCS1650", "code_information": [{"code": "PCS1650", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 7.03, "discounted_cash": 2.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BOTULINUM ANTITOXIN", "code_information": [{"code": "90287", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTULINUM TOXIN TYPE B 5000 UNITS/1ML VIAL (MYOBLOC)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0587", "type": "HCPCS"}, {"code": "MED0032", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1168.0, "discounted_cash": 408.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BOTULINUM TOXIN TYPE B 5000 UNITS/1ML VIAL (MYOBLOC)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0587", "type": "HCPCS"}, {"code": "MED0032", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1168.0, "discounted_cash": 408.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BOTULISM IG IV", "code_information": [{"code": "90288", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOVIE CAURTERIES A-TIP", "code_information": [{"code": "ARNH112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BOVIE FOOT SUCTION 10FR", "code_information": [{"code": "130187", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOVIE TIP 4 INCH COATED INSULATED", "code_information": [{"code": "E1455B4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWEL TO BOWEL FUSION", "code_information": [{"code": "44130", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOWL MIXING CEMENT HIP W/ FEMORAL NOZZLE", "code_information": [{"code": "606-573-000 STRYKR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWL MIXING CEMENT VACUUM SMARTMIX CTS", "code_information": [{"code": "5401-76-501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWL MIXING PURPLE CEMENT TOWER SMARTMIX CTS", "code_information": [{"code": "5401-98-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWL MIXING VACUUM VORTEX", "code_information": [{"code": "71270068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 134.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BP NOT PERFORMED/DOC", "code_information": [{"code": "G8478", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BP OUT OF NRML LIMITS", "code_information": [{"code": "G9274", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BP SCRN NO PERF AT INTERVAL", "code_information": [{"code": "G8785", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BP SCRN NO PERF AT INTERVAL", "code_information": [{"code": "M1281", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BP SCRN PERF REC INTERVAL", "code_information": [{"code": "G8783", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BP SCRN PERF REC INTERVAL", "code_information": [{"code": "M1294", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BP SYS <140 AND DIAS <90", "code_information": [{"code": "G8476", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BP SYS>=140 AND/OR DIAS >=90", "code_information": [{"code": "G8477", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BPCI ADVANCED IN HOME VISIT", "code_information": [{"code": "G9987", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRA POST SURGICAL LG LF 46518-03LF", "code_information": [{"code": "46518-03LF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 43.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA POST SURGICAL MD LF 46518-02LF", "code_information": [{"code": "46518-02LF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 43.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA POST SURGICAL XL LFL X-LARGE 46518-04LF", "code_information": [{"code": "46518-04LF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 169.0, "discounted_cash": 59.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA POSTOPERATIVE EXTRA XL 42IN TO 44IN SPANDEX W/ PADDED SHOULDER STRAPS VELCO", "code_information": [{"code": "46518-05LF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA POSTOPERATIVE SM 34IN TO 36IN SPANDEX W/ PADDED SHOULDER STRAPS VELCO CLOSUR", "code_information": [{"code": "46518-01LF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 114.0, "discounted_cash": 39.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACHIOPLASTY 15836", "code_information": [{"code": "15836", "type": "CPT"}, {"code": "1480203", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHY LINEAR, NON-STR,P-103", "code_information": [{"code": "C2636", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.45, "maximum": 247.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 157.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE COMPLEX", "code_information": [{"code": "77318", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 565.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1033.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1624.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1624.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1624.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 748.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 797.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE INTERMED", "code_information": [{"code": "77317", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 565.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 762.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1198.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1198.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1198.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 553.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 588.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77316", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 565.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 579.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 911.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 911.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 911.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 419.62, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 446.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX PLANAR, P-103", "code_information": [{"code": "C2645", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.5, "maximum": 32.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, GOLD-198", "code_information": [{"code": "C1716", "type": "HCPCS"}], "standard_charges": [{"minimum": 508.93, "maximum": 800.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 508.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 800.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 800.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 800.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, HA, I-125", "code_information": [{"code": "C2634", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.95, "maximum": 1249.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 794.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1249.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1249.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1249.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, HA, P-103", "code_information": [{"code": "C2635", "type": "HCPCS"}], "standard_charges": [{"minimum": 246.38, "maximum": 387.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 246.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 387.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 387.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 387.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR,HDR IR-192", "code_information": [{"code": "C1717", "type": "HCPCS"}], "standard_charges": [{"minimum": 1407.23, "maximum": 2212.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1407.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2212.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2212.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2212.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR,YTTRIUM-90", "code_information": [{"code": "C2616", "type": "HCPCS"}], "standard_charges": [{"minimum": 74690.16, "maximum": 117419.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74690.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117419.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117419.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117419.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED, NOS", "code_information": [{"code": "C2699", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.75, "maximum": 244.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 155.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 244.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 244.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 244.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED,C-131", "code_information": [{"code": "C2643", "type": "HCPCS"}], "standard_charges": [{"minimum": 418.3, "maximum": 657.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 418.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 657.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 657.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 657.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED,I-125", "code_information": [{"code": "C2639", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.75, "maximum": 244.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 155.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 244.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 244.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 244.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED,P-103", "code_information": [{"code": "C2641", "type": "HCPCS"}], "standard_charges": [{"minimum": 303.23, "maximum": 476.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 303.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 476.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 476.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 476.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NS, NON-HDRIR-192", "code_information": [{"code": "C1719", "type": "HCPCS"}], "standard_charges": [{"minimum": 275.18, "maximum": 432.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 275.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 432.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 432.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 432.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, C-131", "code_information": [{"code": "C2642", "type": "HCPCS"}], "standard_charges": [{"minimum": 335.22, "maximum": 527.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 335.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 527.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 527.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 527.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, I-125", "code_information": [{"code": "C2638", "type": "HCPCS"}], "standard_charges": [{"minimum": 150.98, "maximum": 237.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 150.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 237.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 237.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 237.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, NOS", "code_information": [{"code": "C2698", "type": "HCPCS"}], "standard_charges": [{"minimum": 150.98, "maximum": 237.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 150.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 237.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 237.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 237.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, P-103", "code_information": [{"code": "C2640", "type": "HCPCS"}], "standard_charges": [{"minimum": 365.33, "maximum": 574.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 574.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 574.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 574.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAF GENE", "code_information": [{"code": "81210", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 219.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 447.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 252.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 252.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61697", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61698", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR SIMPLE", "code_information": [{"code": "61700", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN CANAL SHUNT PROCEDURE", "code_information": [{"code": "61070", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN FLOW IMAGING ONLY", "code_information": [{"code": "78610", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 726.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1141.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1141.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1141.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 352.08, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 375.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE 4+ VIEWS", "code_information": [{"code": "78605", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 784.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1232.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1232.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1232.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 381.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 406.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE < 4 VIEWS", "code_information": [{"code": "78600", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 738.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1161.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1161.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1161.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 352.08, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 375.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW 4 + VIEWS", "code_information": [{"code": "78606", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1356.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2131.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2131.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2131.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 639.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 680.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW < 4 VIEWS", "code_information": [{"code": "78601", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 870.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1369.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1369.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1369.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 417.2, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 444.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78608", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 9450.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2405.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6011.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78609", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 333.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 524.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 524.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 524.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 BRCA2 MRNA SEQ ALYS", "code_information": [{"code": "138U", "type": "CPT"}], "standard_charges": [{"minimum": 674.4, "maximum": 7317.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4653.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7317.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7317.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7317.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 674.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 674.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE FULL DUP/DEL ALYS", "code_information": [{"code": "81166", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 768.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE FULL SEQ ALYS", "code_information": [{"code": "81165", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 721.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81215", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 469.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 956.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 185&5385&6174 VRNT", "code_information": [{"code": "81212", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 550.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1122.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1764.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1764.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1764.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 633.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 633.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GEN FUL DUP/DEL ALYS", "code_information": [{"code": "81164", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2342.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2342.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2342.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 841.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 841.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GEN FULL SEQ DUP/DEL", "code_information": [{"code": "81162", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2816.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4653.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7317.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7317.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7317.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2627.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2627.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GENE FULL SEQ ALYS", "code_information": [{"code": "81163", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1193.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1876.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1876.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1876.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 673.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 673.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE FULL DUP/DEL ALYS", "code_information": [{"code": "81167", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 721.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE FULL SEQ ALYS", "code_information": [{"code": "81216", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 231.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 472.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 742.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 742.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 742.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81217", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 469.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 956.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST BIOPSY NEEDLE LOCALIZATION 19125", "code_information": [{"code": "19125", "type": "CPT"}, {"code": "1480204", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "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": 11172.65, "maximum": 19180.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11172.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15979.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17577.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19180.66, "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": 10581.99, "maximum": 18166.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10581.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15134.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16647.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18166.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST CANCER DX MIN INVSIVE", "code_information": [{"code": "G8875", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77062", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 411.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 646.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 646.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 646.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77063", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 61.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS UNI", "code_information": [{"code": "77061", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 411.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 646.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 646.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 646.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREATH HYDROGEN/METHANE TEST", "code_information": [{"code": "91065", "type": "CPT"}], "standard_charges": [{"minimum": 292.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 292.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 459.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 459.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 459.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH RECORDING INFANT", "code_information": [{"code": "94772", "type": "CPT"}], "standard_charges": [{"minimum": 2141.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH TEST ANALYSIS C-14", "code_information": [{"code": "78268", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 118.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 412.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 648.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 648.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 648.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREATH TST ATTAIN/ANAL C-14", "code_information": [{"code": "78267", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREATHING CAPACITY TEST", "code_information": [{"code": "94010", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN BY MD/QHP, 11-20", "code_information": [{"code": "G2252", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.03, "maximum": 182.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 116.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN, 5-10, NON-E/M", "code_information": [{"code": "G2251", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.37, "maximum": 94.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 60.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF EMOTIONAL/BEHAV ASSMT", "code_information": [{"code": "96127", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIMONIDINE 0.2% (ALPHAGAN) OPHTHALMIC DROP 5ML", "code_information": [{"code": "MED0033", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PLM NRV UNI", "code_information": [{"code": "782T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PULM NRV BI", "code_information": [{"code": "781T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR 1ST", "code_information": [{"code": "31645", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR SBSQ", "code_information": [{"code": "31646", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BROACH HAMMERFUZE ZTH-BRCH", "code_information": [{"code": "ZTH-BRCH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH HEMI SMALL 3S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "101-00-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2318.0, "discounted_cash": 811.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH HEMI SMALL/MEDIUM 3S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "111-00-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH HPI HEMI PHALANGEAL IMPLANTINSTR", "code_information": [{"code": "HP1-1006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1561.0, "discounted_cash": 546.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH IMP FOOT HEMI LARGE 3S", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "100-00-102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH IMPLANT HEMI PHALANGEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HPI-1006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1018.0, "discounted_cash": 356.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH IMPLANT HEMI-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-00-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH IMPLANT SZ 3 AND 4", "code_information": [{"code": "MDBRLG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1341.0, "discounted_cash": 469.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MDI SZ 3-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "MDBTLG", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 997.0, "discounted_cash": 348.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH METACARPAL SZ 20 MCP IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "17-0823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH METACARPAL SZ 30 IMP", "code_information": [{"code": "17-0824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH PHALANGEAL SZ 20 MCP IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "17-0830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH PHALANGEAL SZ 30 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "17-0831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH SURGICAL HEMI LG-XL", "code_information": [{"code": "111-00-007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 213.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BRONCH EBUS IVNTJ PERPH LES", "code_information": [{"code": "31654", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 1/2 NODE", "code_information": [{"code": "31652", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 3/> NODE", "code_information": [{"code": "31653", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH LAVAGE W/EBUS", "code_information": [{"code": "C7556", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 1 LOBE", "code_information": [{"code": "31660", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 2/> LOBES", "code_information": [{"code": "31661", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH W RX ANTIBX 30D", "code_information": [{"code": "G2177", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH W/BALLOON OCCLUSION", "code_information": [{"code": "31634", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ EBUS", "code_information": [{"code": "C7512", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ NAVIGATION", "code_information": [{"code": "C7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH/LAVAG W/ NAVIGATION", "code_information": [{"code": "C7510", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL BRUSH BIOPSY", "code_information": [{"code": "31717", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1416.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE ADDL INSERT", "code_information": [{"code": "31651", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE INIT INSERT", "code_information": [{"code": "31647", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV ADDL", "code_information": [{"code": "31649", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2537.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV INIT", "code_information": [{"code": "31648", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITH CC/MCC", "code_information": [{"code": "202", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5882.26, "maximum": 10098.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5882.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8412.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9254.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10098.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITHOUT CC/MCC", "code_information": [{"code": "203", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4300.68, "maximum": 7383.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4300.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6150.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6765.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7383.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY BRONCH STENTS", "code_information": [{"code": "31636", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE W/STENT", "code_information": [{"code": "31631", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE/FX REPR", "code_information": [{"code": "31630", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DX W/ OR W/O CELL WASH OR BRUSH 31622", "code_information": [{"code": "31622", "type": "CPT"}, {"code": "1643972", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY REVISE STENT", "code_information": [{"code": "31638", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY STENT ADD-ON", "code_information": [{"code": "31637", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY TREAT BLOCKAGE", "code_information": [{"code": "31641", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/BIOPSY(S)", "code_information": [{"code": "31625", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/FB REMOVAL", "code_information": [{"code": "31635", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/MARKERS", "code_information": [{"code": "31626", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/TUMOR EXCISE", "code_information": [{"code": "31640", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX ADDL", "code_information": [{"code": "31632", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX EACH", "code_information": [{"code": "31628", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX ADDL", "code_information": [{"code": "31633", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX EACH", "code_information": [{"code": "31629", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BROTH CULTURE IVD ELEVATOR EPF Y205", "code_information": [{"code": "Y205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BRST CNCR STAGE > T1N0M0", "code_information": [{"code": "G8881", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1 PDCL TRAM FLAP", "code_information": [{"code": "19367", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1PDCL TRAM ANAST", "code_information": [{"code": "19368", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 2 PDCL TRAM FLAP", "code_information": [{"code": "19369", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ FREE FLAP", "code_information": [{"code": "19364", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ LATSMS DRSI FLAP", "code_information": [{"code": "19361", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRT CA DX I, NO T1/T1A/T1B", "code_information": [{"code": "G9832", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRUCELLA ANTIBODY", "code_information": [{"code": "86622", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 35.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRUSH CLEANING 2MM TO 4.2MM ENDO FLEXIBLE NON STRL DISP", "code_information": [{"code": "BW-2201T.B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSH CYTOLOGY STERILE 2.8MM X 29MM", "code_information": [{"code": "711499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSH SCRUB NON STRL W/ PCMX DETERENT E Z SCRUB", "code_information": [{"code": "371163", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSHES CHANNEL CLEANING 1.5IN X 8IN", "code_information": [{"code": "BR-08-118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BSO OMENTECTOMY W/TAH", "code_information": [{"code": "58956", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BSS 15ML OPHTHALMIC SOLUTION", "code_information": [{"code": "MED0034", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BSS 30ML OPHTHALMIC SOLUTION", "code_information": [{"code": "MED0035", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BTK GENE COMMON VARIANTS", "code_information": [{"code": "81233", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 447.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 252.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 252.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUCCAL/LABIAL FRENECTOMY", "code_information": [{"code": "D7961", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BULB LRNSCP LG FRST REPL NS LF", "code_information": [{"code": "8622300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BULKAMID URETHERAL BULKING SYSTEM 50050", "code_information": [{"code": "L8606", "type": "HCPCS"}, {"code": "50050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2150.0, "discounted_cash": 752.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BUN", "code_information": [{"code": "84520", "type": "CPT"}, {"code": "633605", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 13.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUNDLE OF HIS RECORDING", "code_information": [{"code": "93600", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 40787.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25955.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUNIONECTOMY; W/SESAMOIDECTOMY; W/DISTAL METATARSAL OSTEOTOMY 28296", "code_information": [{"code": "28296", "type": "CPT"}, {"code": "1480032", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUNIONECTOMY; W/SESAMOIDECTOMY; W/DOUBLE OSTEOTOMY 28299", "code_information": [{"code": "28299", "type": "CPT"}, {"code": "1481600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUNIONECTOMY; W/SESAMOIDECTOMY; W/FIRST METATARSAL OSTEOTOMY 28297", "code_information": [{"code": "28297", "type": "CPT"}, {"code": "1481301", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUNIONECTOMY; W/SESAMOIDECTOMY; W/PROXIMAL PHALANX OSTEOTOMY 28298", "code_information": [{"code": "28298", "type": "CPT"}, {"code": "1481601", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUNIONECTOMY; W/SESAMOIDECTOMY; W/RESEC. PROXIMAL PHALANX BASE 28292", "code_information": [{"code": "28292", "type": "CPT"}, {"code": "1480034", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.25% (SENSORCAINE) 10ML", "code_information": [{"code": "MED0036", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.25% (SENSORCAINE) 30ML", "code_information": [{"code": "MED0037", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.5% (SENSORCAINE) 10ML", "code_information": [{"code": "MED0041", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.5% 50ML VIAL", "code_information": [{"code": "MED0218", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.5% PF (SENSORCAINE) 30ML", "code_information": [{"code": "MED0042", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.5% PF 10ML", "code_information": [{"code": "MED0355", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE DEXTROSE 0.75% 2ML VIAL (MARCAINE SPINAL)", "code_information": [{"code": "MED0047", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE PF 0.75% 10ML (SENSORCAINE-MPF)", "code_information": [{"code": "MED0046", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/DW 0.75% INTRATHECAL 2ML (MARCAINE SPINAL)", "code_information": [{"code": "MED0043", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.25% (SENSORCAINE) 50ML", "code_information": [{"code": "MED0040", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.25% (SENSORCAINE/EPI) 30ML", "code_information": [{"code": "MED0039", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.25% 10ML (SENORCAINE)", "code_information": [{"code": "MED0038", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.5% (SENSORCAINE/EPI) 30ML", "code_information": [{"code": "MED0045", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.5% 1:200,000 PF 10ML VIAL", "code_information": [{"code": "MED0357", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.5% 50ML VIAL", "code_information": [{"code": "MED0219", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.5%-1:200K PF INJ 10ML", "code_information": [{"code": "MED0044", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI DENTAL 0.5% 1.8ML CARTRIDGE (VIVACAINE)", "code_information": [{"code": "MED0048", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR - WEDGE 3.1MM DIA X 13 X 65MM R52-420", "code_information": [{"code": "R52-420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.55, "discounted_cash": 466.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR 3.0 MM MATCH HEAD LESS AGGRESSIVE BR5820-107-430SI", "code_information": [{"code": "BR5820-107-430SI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR 3.0MM STRYKER CARBIDE MATCH HEAD 5820-107-530C", "code_information": [{"code": "5820-107-530C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 694.34, "discounted_cash": 243.02, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR BONE MATCHSTICK FLUTED LONG 3MM", "code_information": [{"code": "L-8NS-G1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 434.0, "discounted_cash": 151.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR CARBIDE MICRO OVAL MEDIUM 8 FLUTES 4MM X 8MM LIN5091-236", "code_information": [{"code": "5091-236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR CARBIDE OVAL 4.0 X 44.5MM", "code_information": [{"code": "277-10-62", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR CARBIDE OVAL 4.0 X 48MM CUTTING 8 FLUTES", "code_information": [{"code": "2296-100-026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR DRILL BONE LINVATEC CARBIDE OVAL 2.35MM STRIGHT SHANK 8 FLUTE 4.0 X 48MM", "code_information": [{"code": "3-C0901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR DRILL LEGEND 70 DEG 4MM X 13CM REV TAPERED DIAMOND CUT", "code_information": [{"code": "1884070RTD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 699.56, "discounted_cash": 244.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR HELICCOIDAL RASP MED 3.2MM 5120-080-030", "code_information": [{"code": "5120-080-030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 388.64, "discounted_cash": 136.02, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR KWIRE OLIVE 0.062 X 2.4IN P02 S0131", "code_information": [{"code": "P02 S0131", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR OVAL 4MM CARBIDE", "code_information": [{"code": "277-010-062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR PRECISION ROUND MICRO 5.0MM", "code_information": [{"code": "5820-009-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR REAL INTELLIGENCE 5MM CYLINDRICAL ROB10035", "code_information": [{"code": "ROB10035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1076.0, "discounted_cash": 376.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR ROUND 2.0 5820-10-120", "code_information": [{"code": "5820-10-120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR SHANNON 2.0MM X 12MM R52-212", "code_information": [{"code": "R52-212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.55, "discounted_cash": 466.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR SHANNON 2.0MM X 22MM R52-320", "code_information": [{"code": "R52-320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.55, "discounted_cash": 466.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR SHANNON 2.0MMX12MM R52-312", "code_information": [{"code": "R52-312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.55, "discounted_cash": 466.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR SHANNON 2.5MM", "code_information": [{"code": "1900-015-025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR SHAVER 5.5MM BRICK RED DYONICS ELITE ACROMIOBLASTER", "code_information": [{"code": "72200731", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR TELESCOPING 3.0MM MATHED HEAD LESS AGGRESSIVE SPECIAL BR5820-107-430S1", "code_information": [{"code": "BR5820-107-430S1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 12X2MM STRAIGHT CUTTING FLUTED DI201265R", "code_information": [{"code": "DI201265R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 995.3, "discounted_cash": 348.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 2.0X12 D1201265R", "code_information": [{"code": "D1201265R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 995.3, "discounted_cash": 348.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 2.2MM X 20MM TM12220", "code_information": [{"code": "TM12220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 788.17, "discounted_cash": 275.86, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 3.0X20MM SHANNON LONGA CRE13020", "code_information": [{"code": "CRE13020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1311.0, "discounted_cash": 458.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 4.0 EGG 16-S0903", "code_information": [{"code": "16-S0903", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 5.5MM ELITE NOTCHBLASTER 72200727", "code_information": [{"code": "72200727", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ABRADER 2.9MM ORANGE ENDO POWERMINI STRL DISP", "code_information": [{"code": "72201518", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "discounted_cash": 54.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ABRADER 5.5MM DYONICS HIGH VISIBILITY SHEATH", "code_information": [{"code": "72203127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 359.0, "discounted_cash": 125.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR BARREL 4.0MM 12FLUTE BLADE SHAVER FORMULA REPROCESS", "code_information": [{"code": "375-941-012R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CARBIDE 2.1MM SIDE CUTTING REPROCESS", "code_information": [{"code": "16082101R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CARTILAGE CYLINDER 4 X 16MM PROSTEP MIS 58CC4016", "code_information": [{"code": "58CC4016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1258.92, "discounted_cash": 440.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CARTILAGE FLAME 4X8MM PROSTEP MIS ARTHRODESIS 58CF4008", "code_information": [{"code": "58CF4008", "type": "CDM"}], "standard_charges": [{"gross_charge": 1789.0, "discounted_cash": 626.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CORTICAL SPHERE 4MM PROSTEP MIS ARTHRODESIS 58RSPH40", "code_information": [{"code": "58RSPH40", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1789.0, "discounted_cash": 626.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTING LONG 3MM X 30MM", "code_information": [{"code": "57SC320L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1019.51, "discounted_cash": 356.83, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CYCLONE 5.5MM BLADE", "code_information": [{"code": "H9119", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CYLINDER CARTILAGE 2X8MM PROSTEP MIS ARTHRODESIS BURRS 58CC2008", "code_information": [{"code": "58CC2008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1258.92, "discounted_cash": 440.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CYLINDER CARTILAGE 3X12MM PROSTEP MIS ARTHRODESIS BURRS 58CC3012", "code_information": [{"code": "58CC3012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1258.92, "discounted_cash": 440.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CYLINDER SCULPTING 3 X 12MM 58SC3012", "code_information": [{"code": "58SC3012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1258.92, "discounted_cash": 440.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND 2.5MM 110MM ENDO DCR DACRYOCYSTORHINOSTOMY HIGH SPEED STRLINSTR", "code_information": [{"code": "1882569HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 706.0, "discounted_cash": 247.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND 3MM ROUND ELITE", "code_information": [{"code": "5820-012-030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND ALL SIZE 16-0202/16/18", "code_information": [{"code": "16-0202/16/18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1223.95, "discounted_cash": 428.38, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND ALL SIZE 16-0206/16/18", "code_information": [{"code": "16-0206/16/18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1223.95, "discounted_cash": 428.38, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DRILL 3.0MM X 3.8MM ELITE NUERO LESS AGGRESSIVE", "code_information": [{"code": "5820-107-430S1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 109.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DRILL 3.0MM X 3.8MM ELITE NUERO LESS AGGRESSIVE BR5820-107-430", "code_information": [{"code": "BR5820-107-430", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DRILL 5MM OVAL 12 FLUTE", "code_information": [{"code": "AR-8550OBT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.38, "discounted_cash": 49.83, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR EGG 4.0MM RESURFACING TOOL", "code_information": [{"code": "1900-015-040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR EGG 4MM 10 FLUTE MICRO REPROCESS SSINSTR", "code_information": [{"code": "1608235R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR EGG 4MM SHRT FLUTED REPROCESS", "code_information": [{"code": "5110015040R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ENDO 5.5MM BRICK RED SHVR STRAIGHT SHAFT ACROMINOBLASTER STRLINSTR DISP", "code_information": [{"code": "7205669", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR EXCALIBUR 4.2MM X 19MM SHAVER HIP LEN", "code_information": [{"code": "AR-6420EX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR FLUTE SOFTTOUCH ROUND 3.0MM", "code_information": [{"code": "5820-10-130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR HOLE FOR PUNCTURE", "code_information": [{"code": "61120", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURR HOLE(S) SUPRATENTORIAL EXPLORATORY 61250", "code_information": [{"code": "61250", "type": "CPT"}, {"code": "1480206", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURR HOLE(S) WITH EVACUATION OF HEMATOMA 61154", "code_information": [{"code": "61154", "type": "CPT"}, {"code": "1480207", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURR HOLES W/ASPIRATION OF HEMATOMA FOR IMPLANTING CEREBRAL MONITORING DEVICE 61210", "code_information": [{"code": "61210", "type": "CPT"}, {"code": "1480208", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURR ISHAM SHORT STRAIGHT", "code_information": [{"code": "DI208065R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 995.3, "discounted_cash": 348.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MICA 2X8", "code_information": [{"code": "57SC0208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1019.51, "discounted_cash": 356.83, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MICRO 2.3MM SERRATED DRILL TAPERED 4 FLUTE SS", "code_information": [{"code": "1608002021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 52.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MICRO 4.0MM X 54MM EGG 10 FLUTE SS", "code_information": [{"code": "1608-2-35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 52.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MICRO 4MM 54MM EGG 10 FLUTE SS", "code_information": [{"code": "1608-002-035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MICRO 8MM 4MM MED OVAL GUARD CARBIDE M-PWR STRL", "code_information": [{"code": "509123600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MR8 CLEARVIEW 14CM PROXIMAL BEND MR8-SP14MH30T", "code_information": [{"code": "MR8-SP14MH30T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1177.0, "discounted_cash": 411.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MR8 MIDAS 14CM SP MH 2.5MM MR8-SP14MH25", "code_information": [{"code": "MR8-SP14MH25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1142.66, "discounted_cash": 399.93, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MR8 MIDAS REX CLEARVIEW STEALH-MIDAS TOOLS 12CM SP MH 3F 3MM MR8-SP12MH30T", "code_information": [{"code": "MR8-SP12MH30T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1177.0, "discounted_cash": 411.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MR8 MIDAS REX TOOL 14CM 3MM MR8-SP14MH30", "code_information": [{"code": "MR8-SP14MH30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1142.66, "discounted_cash": 399.93, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR NEURO 3MM MATCHSTICK", "code_information": [{"code": "5820-107-530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR OVAL 4MM REPROCESS STERLINGINSTR", "code_information": [{"code": "H9101R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR OVAL 4MM X 13 CM EIGHT FLUTE FOR RAPID AGGRESSIVE RESECTIONIN NOTCHPLASTY D", "code_information": [{"code": "AR-8400OBE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR OVAL 6.0MM STERLING", "code_information": [{"code": "H9102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR RAD 55 HIGH SPEED CURVED 30K", "code_information": [{"code": "1883655BRC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1067.0, "discounted_cash": 373.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ROUND 10 FLUTE 3.0MM", "code_information": [{"code": "AR-9300RBT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ROUND 3MM FLUTED AGGRESSIVEINSTR", "code_information": [{"code": "5820-010-230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ROUND 4.5MM AGGRESSIVEINSTR", "code_information": [{"code": "5820-10-245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ROUND 4MM FLUTED OSTEON SOFT TOUCH ELITE", "code_information": [{"code": "5820-012-040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ROUND 4MM HEAD SOFT TOUCH TPS ELITEINSTR", "code_information": [{"code": "5820-10-140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ROUND 4MM X 19 CM EIGHT FLUTE HIP LEN", "code_information": [{"code": "AR-6400RBE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 109.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR RTR 4.5MM 125MM AGGRESSIVE SINUS DRILLING STRAIGHT SHAFT CANNULATED TIP STR", "code_information": [{"code": "1884562HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SCULPTING CYLINDER 4X16MM 58SC4016", "code_information": [{"code": "58SC4016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1258.92, "discounted_cash": 440.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SCULPTING PROSTEP MIS ARTHRODESIS 58SC2008", "code_information": [{"code": "58SC2008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1258.92, "discounted_cash": 440.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SHANNON LONGA \u00c3\u02dc2.2 X 22MM CRE12222", "code_information": [{"code": "CRE12222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1062.55, "discounted_cash": 371.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SHANNON LONGA \u00c3\u02dc3.1 X 13MM", "code_information": [{"code": "CRE23113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1184.0, "discounted_cash": 414.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SHANNON RECTA 2.0 X 13MM MBUR2013", "code_information": [{"code": "MBUR2013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 928.05, "discounted_cash": 324.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SHANNON RECTA 2.0MM LG 12 CRE12012", "code_information": [{"code": "CRE12012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1062.55, "discounted_cash": 371.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SHAVER 3.5MM X 13CM BLUE SPHERICAL LG HUB REPROCESSINSTR", "code_information": [{"code": "H9110R", "type": "CDM"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SHVR 4MM X 13CM ARTHROSCOPIC STR REPROCESS STONECUTTER LF STRLINSTR DISP", "code_information": [{"code": "7205330R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SHVR MRN 4MM DYNC ELITE STNCTR STR STRL DISP 72200728", "code_information": [{"code": "72200728", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.46, "discounted_cash": 47.41, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SIDE CUTTING 2.1MM 16-S1401", "code_information": [{"code": "16-S1401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.38, "discounted_cash": 22.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SPHERICAL 4.5MM STERLING", "code_information": [{"code": "H9111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SPHERICAL 5.5MM STERLING", "code_information": [{"code": "H9112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR STR 5.5MM BROWN SHAVER BLADE REPROCESS ARTHROSCOPIC ELITE ACROMIONIZER STRL", "code_information": [{"code": "72200725R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR STR 5.5MM PEACH ABRADER ENDO SNGL USE DYONICS NOTCHBLASTER DISP", "code_information": [{"code": "7205329", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR STRAIGHT 2MM X 13MM AR-300-B001", "code_information": [{"code": "AR-300-B001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR STRAIGHT 2MM X 8MM AR-300-B002", "code_information": [{"code": "AR-300-B002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR STRAIGHT 4MM AQUA ABRADER SNGL USE ENDO DYONICS DISP", "code_information": [{"code": "7205324", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 49.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 2.1MM SHANNON-STYLE CUTTING MICRO CARBIDE SS", "code_information": [{"code": "1608-2-101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 53.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 2.4MM X 54MM 8 FLUTE MICRO ROUND 3A SSINSTR", "code_information": [{"code": "1608-2-9", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 52.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 3MM BALL MIDAS REX MEDNEXTINSTR", "code_information": [{"code": "7BA30-MN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 159.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 4.0MM AGGRESSIVE ROUND FLUTED ELITE", "code_information": [{"code": "5820-010-240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 4.5MM ROUND DIAMOND FOR STRYKER TPS ELITEINSTR", "code_information": [{"code": "58201245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 4.5MM SPHERICAL REPROCESS STERLINGINSTR", "code_information": [{"code": "H9111R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 4MM MAUVE ACROMIONIZER ARTHROSCOPIC STRAIGHT REPROCESS STRLINSTR DISP", "code_information": [{"code": "7205326R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 4MM SAGE GRN STR 10000 MAXIMUM RPM ELITE ACROMIOBLASTER STRL DISP", "code_information": [{"code": "72200730", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 5.5MM SPHERICAL REPROCESS STERLINGINSTR", "code_information": [{"code": "H9112R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 5.5MM X 13 CM ROUND 8 FLUTE", "code_information": [{"code": "AR-8550RBE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 5MM BALL MIDAS REX MEDNEXTINSTR", "code_information": [{"code": "7BA50-MN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 160.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 5MM X 13 CM OVAL 8 FLUTEINSTR", "code_information": [{"code": "AR-8500OBE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 67.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 7MM BALL MIDAS REX MEDNEXTINSTR", "code_information": [{"code": "7BA70-MN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 159.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 8MM 4MM MED OVAL REPROCESS CARBIDE STRLINSTR", "code_information": [{"code": "5091136R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG PFJ MILLING", "code_information": [{"code": "-5927-050-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURGICAL 2.0 X LG8 CRE12008", "code_information": [{"code": "CRE12008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1062.55, "discounted_cash": 371.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR WEDGE 3 2.9 X 13MM MBUR2913", "code_information": [{"code": "MBUR2913", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.65, "discounted_cash": 362.48, "setting": "both", "billing_class": "facility"}]}, {"description": "BURSECTOMY ELBOW 24105", "code_information": [{"code": "24105", "type": "CPT"}, {"code": "1480209", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURSECTOMY KNEE 27340", "code_information": [{"code": "27340", "type": "CPT"}, {"code": "1480210", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURSECTOMY TROCHANTERIC 27062", "code_information": [{"code": "27062", "type": "CPT"}, {"code": "1480211", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTORPHANOL (STADOL) INJ 1MG/ML 1 ML", "code_information": [{"code": "MED0049", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY", "code_information": [{"code": "27027", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY W/DBRDMT", "code_information": [{"code": "27057", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTTON CANNULA PASSPORT LOW PROFILE 8MM X 4CM", "code_information": [{"code": "AR-6592-08-40", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON OVAL HF-RES 24FR12-30DEG", "code_information": [{"code": "WA22566S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1377.0, "discounted_cash": 481.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON RIPCORD SYNDESMOSIS STA001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "STA001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3945.0, "discounted_cash": 1380.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON SUT 7.5MM X 12MM 4 HOLE STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.8, "discounted_cash": 75.88, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON SUT DOG BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE 144MM ROUND ABS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 478.0, "discounted_cash": 167.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE 8MM X 12MM ABS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE ABS 11MM ROUND CONCAVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE ABS 12MM ROUND CONCAVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE ABS 14MM ROUND CONCAVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION MR IMAG", "code_information": [{"code": "19085", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION STRTCTC", "code_information": [{"code": "19081", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION US IMAG", "code_information": [{"code": "19083", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION MR IMAG", "code_information": [{"code": "19086", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION STRTCTC", "code_information": [{"code": "19082", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION US IMAG", "code_information": [{"code": "19084", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST PERCUT W/O IMAGE", "code_information": [{"code": "19100", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1439.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX DONE W/COLPOSCOPY ADD-ON", "code_information": [{"code": "58110", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BYPASS GRAFT PATENCY/PATCH", "code_information": [{"code": "35685", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BYPASS GRAFT/AV FIST PATENCY", "code_information": [{"code": "35686", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Balloon Catheter Enlargement Of Opening Between Two Upper Heart Chambers", "code_information": [{"code": "92992", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Basic Metabolic Panel", "code_information": [{"code": "80048", "type": "CPT"}, {"code": "633628", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 27.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 33.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 33.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Beta Human Chorionic Gonadotropin Qualitative", "code_information": [{"code": "84703", "type": "CPT"}, {"code": "633663", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 67.0, "discounted_cash": 23.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 24.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 30.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 30.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Beta Human Chorionic Gonadotropin Qualitative Urine", "code_information": [{"code": "81025", "type": "CPT"}, {"code": "633664", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Beta Human Chorionic Gonadotropin Quantitative", "code_information": [{"code": "84702", "type": "CPT"}, {"code": "633665", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Beta-amyloid; 1-40 (Abeta 40)", "code_information": [{"code": "82233", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Beta-amyloid; 1-42 (Abeta 42)", "code_information": [{"code": "82234", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Bilirubin Body Fluid", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "633669", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 78.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Bilirubin Total", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "633672", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 78.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Binocular microscopy (separate diagnostic procedure) 92504", "code_information": [{"code": "92504", "type": "CPT"}, {"code": "44933689", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 42.91, "maximum": 8450.0, "gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Bone marrow aspirate &biopsy", "code_information": [{"code": "G0364", "type": "HCPCS"}], "standard_charges": [{"minimum": 225.0, "maximum": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Breast Enlargement Without A Prosthesis", "code_information": [{"code": "19324", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "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": 67.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 67.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 105.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 105.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 105.68, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C Arm, Vertebral Body 72291", "code_information": [{"code": "2616138", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.0, "discounted_cash": 544.95, "setting": "both", "billing_class": "facility"}]}, {"description": "C DIFF AMPLIFIED PROBE", "code_information": [{"code": "87493", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 95.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 149.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 149.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 149.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 53.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 53.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C DIFF TOX AG DETCJ IA STOOL", "code_information": [{"code": "107U", "type": "CPT"}], "standard_charges": [{"minimum": 23.04, "maximum": 64.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C MOTOR EVOKED LWR LIMBS", "code_information": [{"code": "95929", "type": "CPT"}], "standard_charges": [{"minimum": 646.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 646.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1016.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1016.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1016.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C MOTOR EVOKED UPPR LIMBS", "code_information": [{"code": "95928", "type": "CPT"}], "standard_charges": [{"minimum": 624.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 624.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 981.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 981.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 981.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C MOTOR EVOKED UPR&LWR LIMBS", "code_information": [{"code": "95939", "type": "CPT"}], "standard_charges": [{"minimum": 1768.94, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1768.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2779.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2779.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2779.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-ARM DRAPE 42\" W X 72\" L WITH BANDS/CLIPS 07-CA105", "code_information": [{"code": "7-CA105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.82, "discounted_cash": 5.19, "setting": "both", "billing_class": "facility"}]}, {"description": "C-ARMOR DRAPE 42X74 5523", "code_information": [{"code": "5523", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.07, "discounted_cash": 46.22, "setting": "both", "billing_class": "facility"}]}, {"description": "C-LENS FITG CORNEOSCLRL LENS", "code_information": [{"code": "92313", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH APHAKIA 1", "code_information": [{"code": "92315", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH APHAKIA OU", "code_information": [{"code": "92316", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH CORNEOSCLRL", "code_information": [{"code": "92317", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH OU", "code_information": [{"code": "92314", "type": "CPT"}], "standard_charges": [{"minimum": 158.94, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 158.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 249.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 249.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 249.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-REACTIVE PROTEIN HS", "code_information": [{"code": "86141", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-Reactive Protein", "code_information": [{"code": "86140", "type": "CPT"}, {"code": "633716", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 111.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C/M HUMERAL ASSEMBLY 4IN XSML", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "32-8105-027-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6592.0, "discounted_cash": 2307.2, "setting": "both", "billing_class": "facility"}]}, {"description": "C/M ULNA ASSEMBLY 3IN XSML LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "32-8105-043-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6592.0, "discounted_cash": 2307.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CA 125", "code_information": [{"code": "86304", "type": "CPT"}, {"code": "1550542", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 29.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA SCREEN;PELVIC/BREAST EXAM", "code_information": [{"code": "G0101", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.97, "maximum": 194.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 123.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 194.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 194.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 194.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ART-VEIN SIX OR MORE", "code_information": [{"code": "33523", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL FOUR OR MORE", "code_information": [{"code": "33536", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL SINGLE", "code_information": [{"code": "33533", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL THREE", "code_information": [{"code": "33535", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL TWO", "code_information": [{"code": "33534", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FIVE", "code_information": [{"code": "33522", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FOUR", "code_information": [{"code": "33521", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN SINGLE", "code_information": [{"code": "33517", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN THREE", "code_information": [{"code": "33519", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN TWO", "code_information": [{"code": "33518", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FIVE", "code_information": [{"code": "33514", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FOUR", "code_information": [{"code": "33513", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SINGLE", "code_information": [{"code": "33510", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SIX OR MORE", "code_information": [{"code": "33516", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN THREE", "code_information": [{"code": "33512", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN TWO", "code_information": [{"code": "33511", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABLE 1120 1121 1122", "code_information": [{"code": "1120.A", "type": "CDM"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 236.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE ACCORD 2.0MM COCR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71340020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 208.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE BIPOLAR WET FIELD STRLINSTR DISP", "code_information": [{"code": "22135010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.0, "discounted_cash": 65.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE CERCLAGE 1MM X 750MM W/ CRIMP SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "298.800.01S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1124.0, "discounted_cash": 393.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE CONNECTING FOR HNS 11 F STIMUPLEX", "code_information": [{"code": "333576", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 163.0, "discounted_cash": 57.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE EKG 10FT CLR 3 LEAD TRUNK SHIELD AAMI", "code_information": [{"code": "545302-HEL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE EKG 30IN LEAD CLIP CONVERSION MCKESSON", "code_information": [{"code": "545317-HEL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE EXTENSION 1 X 16 OR OPERATING ROOM PRECISION SPECTRA", "code_information": [{"code": "SC-4116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE LIGHT RELIEVA LUMA ILLUMINATION GUIDE 8FT", "code_information": [{"code": "SISLGC208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1189.0, "discounted_cash": 416.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE MULTI LEAD TRIALING FOR NUEROSTIM", "code_information": [{"code": "355531", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 790.0, "discounted_cash": 276.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE MULTILEAD TRIAL", "code_information": [{"code": "3013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE NEUROMONITORING AVS ARIA", "code_information": [{"code": "48755008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE OR 2 CM X 8 CM SURG SPARE", "code_information": [{"code": "SC-4108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE OR SURG SPARE", "code_information": [{"code": "SC-4100A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 432.0, "discounted_cash": 151.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE PROCISE MAX W/ INTEGRATED EICA8898-01", "code_information": [{"code": "EICA8898-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 823.0, "discounted_cash": 288.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE STAINLESS STEEL W/CRIMP 72580000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72580000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2970.0, "discounted_cash": 1039.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE VERIFY TEST 357501", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "357501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE W/CLAMP ACC 2.0MM SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71340008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 880.8, "discounted_cash": 308.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE WITH CLAMP CO-OR 2.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71340007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLEINTERCONNECT 10FT NO LIMIT W/ DATEX CONNECTOR TRUSIGNAL", "code_information": [{"code": "TS-N3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 79.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CACNA1A FULL GENE ANALYSIS", "code_information": [{"code": "231U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 1218.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1218.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1218.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACNA1A GEN DETC ABNOR ALLEL", "code_information": [{"code": "81184", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACNA1A GEN KNOWN FAMIL VRNT", "code_information": [{"code": "81186", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 472.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACNA1A GENE FULL GENE SEQ", "code_information": [{"code": "81185", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2157.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3393.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3393.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3393.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1218.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1218.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAD BREAST MRI", "code_information": [{"code": "C8937", "type": "HCPCS"}], "standard_charges": [{"minimum": 81.89, "maximum": 128.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAD CXR REMOTE", "code_information": [{"code": "175T", "type": "CPT"}], "standard_charges": [{"minimum": 81.89, "maximum": 128.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAD CXR WITH INTERP", "code_information": [{"code": "174T", "type": "CPT"}], "standard_charges": [{"minimum": 81.89, "maximum": 128.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10MMX22MMX50MM 8D 48863210", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48863210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8652.0, "discounted_cash": 3028.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 11X12X14X4DEG ANCHOR-C CAGE 48321114", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48321114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4300.0, "discounted_cash": 1505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12MM X 14MM X 6MM 7DEG DEXA-C CERV HI DENSITY 116-12147-06-HD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "116-12147-06-HD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12MM X 14MM X 7MM 116-12147-07-HD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "116-12147-07-HD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12MM X 14MM X 8MM 7D 116-12147-08-HD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "116-12147-08-HD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12MM X 14MM X8MM 7D 116-12147-08-LD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "116-12147-08-LD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 12W X 12H X 45L - 8DEG LXL18124508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LXL18124508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14 X16X 08MMX 8 DEGREES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CH141608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14MM X 16MM X7MM X 7D 116-14167-07-LD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "116-14167-07-LD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14MMX16MMX8MM 7D 116-14167-08-LD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "116-14167-08-LD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14X16X07MMX8DEGREES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CH141607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 14X36X14D AXTI TI 6AI 4V HYDROXYAPATITE AXTI143614", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AXTI143614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18 X 50 X 12MM 7D GA185012B", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "GA185012B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18MMX50MM7MM 7D LLIF SPACER GA185007B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GA185007B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7002.0, "discounted_cash": 2450.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18W X 12 X 50L X 8 DEG LXL18125008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LXL18125008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18W X 12H X 55L X 8 DEG LXL18125508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LXL18125508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 2660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18W X 8H X50L X 8DEG LXL18085008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LXL18085008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 2660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 34 X 26 X 13MM 15 DEGREE KA342613B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KA342613B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 1540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 35X13MMX15 DEG 861-F3D-1535-13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "861-F3D-1535-13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28000.0, "discounted_cash": 9800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 3MM CAVUX CERVICAL PD-31-203", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PD-31-203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6.5MM X 10MM WIDE X 24MM LORDOTIC ASSEMBLY 28-3140", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "28-3140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8400.0, "discounted_cash": 2940.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6X14X16X4DEG ANCHOR-C CAGE 48323064", "code_information": [{"code": "48323064", "type": "CDM"}], "standard_charges": [{"gross_charge": 4429.0, "discounted_cash": 1550.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 7MM X 16MM X 14MM 7D 110-PRO-07161407-S", "code_information": [{"code": "110-PRO-07161407-S", "type": "CDM"}], "standard_charges": [{"gross_charge": 1770.0, "discounted_cash": 619.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 7X14X16X4DEG ANCHOR-C CAGE 48323074", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48323074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4429.0, "discounted_cash": 1550.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8 X 16 X 14MM NANO TLS 5366-1408-N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5366-1408-N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8MM X 28MM X 8MM-13MM 5D PROLIFT 58-0828-1508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-0828-1508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9MM LARGE TCS NANO 5386-1609-N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5386-1609-N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 11MM X 26MMX 35MM 8 DEG 861-F3D-0835-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "861-F3D-0835-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28000.0, "discounted_cash": 9800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF PEEK H15MM 13 DEG 41MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XA1315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF PEEK H17MM 13 DEG 41MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XA1317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ANCHOR 4DEG 12MM X 14MM X 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48321084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ARTHREX ECLIPSE CAGE SCREWS MEDIUM 35MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9301-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9116.0, "discounted_cash": 3190.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ATS SPHERE 46MM NO FLAT ATS-46NF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ATS-46NF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42300.0, "discounted_cash": 14805.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE AX ALIF 14MM X 36MM X 08 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX143608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 3850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE AXTIHA 12 X 36 X 14MM HYDROXYAPATITE AXTI123614", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AXTI123614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE BONE 12MM X 14MM X 7MM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "77102074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE BONE 12MM X 14MM X 8MM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "77102084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CAHE PXHA- 10X11X28MM X0DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HA1011280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICAL 5MMX12MMX14MM X6DEG ANTERIOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48982056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICAL 6MM X 12MM X 14MM X 6 DEG ANTERIOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48982066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICAL PEEK CIF 10 DEG -06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-1006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2884.0, "discounted_cash": 1009.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CERVICAL SPACER LORDOTIC 7X20X15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-0720L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CXHA 14LX16WX06HMM 8 DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CH141606", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE CXHA L 12MM X W 14MM X H 007MM 8DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CH121407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE DEXA-C CERVICAL 12MM X 14MM X 7MM 7D 116-12147-07-LD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "116-12147-07-LD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE DUALX PLIF 12 DEG X 10-12MM EXPANDING POSTERIOR LUMBAR INTERBODY FUSION SYSTEM 1282-1001-016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1282-1001-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11536.0, "discounted_cash": 4037.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ELITE EXPANDABLE INTERBODY FUSION DEVICE 10X28MM 10-14MM 6D LORDOSIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "541-0011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ENDOSKELETON TCS IMPLANT 6DEG - SML (14X12) - 8MM 5346-1208-N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5346-1208-N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ENDOSKELETON TCS IMPLANT 6EG - SML (14X12) - 9MM 5346-1209-N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5346-1209-N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE EXPANDABLE INTERBODY 10X28X8-13MM 12 DEG 58-1028-1208K", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-1028-1208K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8600.0, "discounted_cash": 3010.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE EXPANDABLE INTERBODY 10X28X8-13MM 15 DEG 58-1028-1508K", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-1028-1508K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8600.0, "discounted_cash": 3010.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE FOUNDATION LUMBAR 8MM X 10MM X 26MM PM2608", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PM2608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE FUSION FOREA XP 24X10X105", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "28-3144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8400.0, "discounted_cash": 2940.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE HA PEEK 10MM X 10MM X 32MM HA1010320", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HA1010320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE INTERBODY 12 X 17 X 8MM WIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3608-208123W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4300.0, "discounted_cash": 1505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE INTERBODY FUSION SYSTEM DUAL T/PLIF 8 DEG X 9-12MM 1282-1000-005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1282-1000-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11536.0, "discounted_cash": 4037.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE INTERBODY FUSION SYSTEM DUALX T/PLIF 8DEG X 8-11MM 1282-1000-004", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "1282-1000-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11536.0, "discounted_cash": 4037.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE L 12MM X W 14MM X H 06MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CH121406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE L BOX 7 DEG 18 X 50 X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XLB501007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LATERAL 18WX45LX10H 62-1845-10-8-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62-1845-10-8-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LATERAL 18WX50LX12H 8D 62-1850-12-8-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62-1850-12-8-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LATERAL 18X50X14MM 8D PLL1850-0814", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLL1850-0814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LORDOTIC ANGLE 10X11X25MM 5DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HA1011255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR 10 X 28 X 6DEG X 11MM POSTERIOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48955106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR 11MM X 28MM X 6DEG X 11MM POSTERIOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48955116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR 12MM X 28MM X 6DEG X 11MM POSTERIOR TRITANIUM PL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48955126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR ANTERIOR 10H X 15D SMALL SCA-LS 15 10-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCA-LS 15 10-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE LUMBAR ANTERIOR SMALL H10 10D SCA-LS 10 10-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCA-LS 10 10-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE METAL-POLYMER AX 14 X 40 X 14MM AX144014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX144014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10190.0, "discounted_cash": 3566.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE MONTEREY AL STAND-ALONE ANTERIOR LUMBAR ANTERIOR LUMBAR 480112531", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "480112531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9000.0, "discounted_cash": 3150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE OMEGA XP\u00e2\u201e\u00a2 9MM X 28MM X 8MM 0\u00c2\u00b0 LUMBAR EXPANDABLE INTERBODY 72-00-092808-00", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72-00-092808-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 2800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE OMEGA XP\u00e2\u201e\u00a2 9MM X 28MM X 9MM 4\u00c2\u00b0 LUMBAR EXPANDABLE INTERBODY 72-00-092809-04", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "72-00-092809-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 2800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PARALLEL 7MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-72000-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PLIF 10MMX12MMX32MM HA1012320", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "HA1012320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE POST LUMBAR 9MM X 28MM X 6DEG TRITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48955096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PROLIFT EXPANDABLE INTERBODY 8X28X10MM LG 12D TI 58-0828-1210", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-0828-1210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PROLIFT EXPANDABLE SPACER SYSTEM 8MM X 28MM X 8MM-13MM 12DEG 58-0828-1208", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-0828-1208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PX HA TLIF 10WX12HX28LX0D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HA1012280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PXHA 10X10X25MM HA1010255", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HA1010255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PXHA 10X11X32MM 0D HA1011320", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HA1011320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PXHA- 10X10X28MMX0 DEG INNOVASIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HA1010280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE PXHA- 10X13X28MMX 0DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HA1013280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ROZA 8.5X10X24 XP 28-3142", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "28-3142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8400.0, "discounted_cash": 2940.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SA ALIF 27D X 36W X 14H 61-2736-14-14-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "61-2736-14-14-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10190.0, "discounted_cash": 3566.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SA CERVICAL TI INTERBODY 14DX16WX7H 52N-1416-07-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52N-1416-07-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4300.0, "discounted_cash": 1505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SA CERVICAL-TL 14DX16WX8H 52N-1416-08-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52N-1416-08-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4300.0, "discounted_cash": 1505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SCREW SIZER AR-9401-08S", "code_information": [{"code": "AR-9401-08S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SMALL 12MMX28MMX8MM-13MM 12D 58-1228-1208K", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-1228-1208K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINE 10MM X 32MM X 6DEG 11MM POSTERIOR LUMBAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48956106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SPINE 11MM X 32MM X 6DEG 11MM POSTERIOR LUMBAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48956116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI CERVICAL SPACER LORDOTIC 6X14X12 0304-0614L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-0614L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI CERVICAL SPACER LORDOTIC 7X14X12 0304-0714L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-0714L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2575.0, "discounted_cash": 901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI CERVICAL SPACER LORDOTIC 7X16X14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-0716L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI3Z PLIF 9MM X 23MM X 7MM 5D INTERBODY SYSTEM 231-0923-07", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231-0923-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI3Z PLIF 9MM X 23MM X 9MM 5D INTERBODY SYSTEM 231-0923-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231-0923-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TLIF OBLIQUE 30D X 10W X 8H 54M-30-08-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54M-30-08-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 1540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TRUSS INTERBODY SPACER TI 12 DEGREE 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ASTS-SM1210-T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE VARISYNC\u00c2\u00ae ALIF, F3D-Z - 35X12MMX8\u00c2\u00b0 861-F3D-0835-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "861-F3D-0835-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28000.0, "discounted_cash": 9800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE W/ SET SCREW SIZE 12X14MM 26-36MM 0D 7512-21436L0-G3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7512-21436L0-G3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13500.0, "discounted_cash": 4725.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE- MED H12 10 DEG SCARLET AL-T SECURED LUMBAR ANT SCA-LM 10 12-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCA-LM 10 12-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGEINTERVERT 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3608-210123W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4300.0, "discounted_cash": 1505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGEINTERVERT 9MM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3608-209123W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4300.0, "discounted_cash": 1505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CALC BMI ABV UP PARAM F/U", "code_information": [{"code": "G8417", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALC BMI ABV UP PARAM F/U", "code_information": [{"code": "M1293", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALC BMI BLW LOW PARAM F/U", "code_information": [{"code": "G8418", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALC BMI BLW LOW PARAM F/U", "code_information": [{"code": "M1287", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALC BMI NORM PARAMETERS", "code_information": [{"code": "G8420", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALC BMI NORM PARAMETERS", "code_information": [{"code": "M1296", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALC BMI OUT NRM PARAM NOF/U", "code_information": [{"code": "G8419", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALC BMI OUT NRM PARAM NOF/U", "code_information": [{"code": "M1276", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCANECTOMY 28118", "code_information": [{"code": "28118", "type": "CPT"}, {"code": "1480217", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCITONIN STIMUL PANEL", "code_information": [{"code": "80410", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 124.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 204.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 322.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 322.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 322.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 115.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 115.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCIUM CHLORIDE 10% 10ML", "code_information": [{"code": "MED0050", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CALCIUM CHLORIDE 1GRAM/10ML INJECTION FOR PRP", "code_information": [{"code": "MED0051", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CALCIUM INFUSION TEST", "code_information": [{"code": "82331", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCULUS ANALYSIS QUAL", "code_information": [{"code": "82355", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCULUS ASSAY QUANT", "code_information": [{"code": "82360", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCULUS SPECTROSCOPY", "code_information": [{"code": "82365", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALIBRATED DRILL BIT 1.9MM", "code_information": [{"code": "CD-FX-1019", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 787.0, "discounted_cash": 275.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CALORIC VESTIBULAR TEST", "code_information": [{"code": "92533", "type": "CPT"}], "standard_charges": [{"minimum": 38.15, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALORIC VSTBLR TEST W/REC", "code_information": [{"code": "92537", "type": "CPT"}], "standard_charges": [{"minimum": 41.32, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALORIC VSTBLR TEST W/REC", "code_information": [{"code": "92538", "type": "CPT"}], "standard_charges": [{"minimum": 23.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALR GENE COM VARIANTS", "code_information": [{"code": "81219", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 187.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 310.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 487.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 487.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 487.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 175.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 175.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAM CERVIX UTERI DRG COLP", "code_information": [{"code": "57465", "type": "CPT"}], "standard_charges": [{"minimum": 201.85, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 201.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 317.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 317.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 317.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAMPYLOBACTER ANTIBODY", "code_information": [{"code": "86625", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANALITH REPOSITIONING PROC", "code_information": [{"code": "95992", "type": "CPT"}], "standard_charges": [{"minimum": 170.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 170.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANCELLOUS BLOCK 50X10X7MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "DBM-501007SS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CANCELLOUS CHIP 15CC 1-4MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PBC-1415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 132.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CANCELLOUS CHIPS 15CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "53021-1-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CANDIDA ANTIBODY", "code_information": [{"code": "86628", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANDIDA DNA AMP PROBE", "code_information": [{"code": "87481", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANDIDA DNA DIR PROBE", "code_information": [{"code": "87480", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANDIDA DNA QUANT", "code_information": [{"code": "87482", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 69.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 142.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 80.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 80.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANDIDA SPECIES PNL AMP PRB", "code_information": [{"code": "68U", "type": "CPT"}], "standard_charges": [{"minimum": 205.39, "maximum": 571.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 363.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANISTER TUBE 3000CC HIGH FLOW TRUCLEAR", "code_information": [{"code": "72200024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNABINOID SYNTHETIC 7/MORE", "code_information": [{"code": "80352", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS NATURAL", "code_information": [{"code": "80349", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS SYNTHETIC 1-3", "code_information": [{"code": "80350", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS SYNTHETIC 4-6", "code_information": [{"code": "80351", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNULA 19G SUB TENON ANEST", "code_information": [{"code": "AS-7075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 25G DUAL BORE 3240", "code_information": [{"code": "3240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 25GA SOFT TIP", "code_information": [{"code": "587003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 27GA SAUTER HYDROSISSECTION K7-5082", "code_information": [{"code": "K7-5082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 3.5MM X 150MM TWIST AO COUPLING", "code_information": [{"code": "702453", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 165.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 8G IVAS ACCESS 0306-080-000", "code_information": [{"code": "306-080-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.26, "discounted_cash": 55.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 91MM EPF Y212A", "code_information": [{"code": "Y212A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA ADULT DIVIDED W/7FT 02 LINE AND 7FT C02 LINE W/ORAL SAMPLING MALE LUER LOCK CONNECTOR 4797-7", "code_information": [{"code": "7/7/4797", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA AIR INJECT 30 GAUGE ANGLED 45D 5MM BEND TO TIP", "code_information": [{"code": "1030E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.93, "discounted_cash": 23.78, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA AIR INJECTION 30GA", "code_information": [{"code": "K7-3500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.0, "discounted_cash": 37.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA ARTHROSCOPIC 8.5MM X 72MM GRN THRD REPROCESS POLYCARBONATE W/ DISPOSABLE", "code_information": [{"code": "72200903R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA BTTN 10MM X 2 CM SHOULDER KNEE HIP ELBOW ORTHO FOR ARTHROSCOPIC SYS PASS", "code_information": [{"code": "AR-6592-10-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.0, "discounted_cash": 56.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA BTTN 10MM X 3 CM SHLDR LOW PROFILE DUAL FLANGE DESIGN SILICONE PASSPORT", "code_information": [{"code": "AR-6592-10-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA BTTN 10MM X 4 CM SHLDR LOW PROFILE DUAL FLANGE DESIGN SILICONE PASSPORT", "code_information": [{"code": "AR-6592-10-40", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA BTTN 10MM X 5 CM SHOULDER KNEE HIP ELBOW ORTHO FOR ARTHROSCOPIC SYS PASS", "code_information": [{"code": "AR-6592-10-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.6, "discounted_cash": 41.16, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA BTTN 8MM X 5 CM SHOULDER KNEE HIP ELBOW FOR ARTHROSCOPIC SYS PASSPORT SC", "code_information": [{"code": "AR-6592-08-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.67, "discounted_cash": 59.73, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CHANDELIER 25G TOTAL VIEW", "code_information": [{"code": "3269.EB05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 57.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CURETTE 12MM CURVED VACUUM ASPIRATION SEMI-RIGID BERKELEY VACURETTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "215.55", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CURVED 20GA 5MM TC 410 ACTIVE TIP DISP REUSE", "code_information": [{"code": "406-630-115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.12, "discounted_cash": 79.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CVD 100MM 20G 15MM 0406-630-135", "code_information": [{"code": "406-630-135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.12, "discounted_cash": 79.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CVD 150MM 20G 15MM 0406-630-235", "code_information": [{"code": "406-630-235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.12, "discounted_cash": 79.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA DECLOTTING", "code_information": [{"code": "36861", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNULA DELIVERY - END PORT 74388-01M", "code_information": [{"code": "74388-01M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA DILATOR 12MM RADIALLY EXPAND VS101012P", "code_information": [{"code": "VS101012P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.0, "discounted_cash": 164.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA DILATOR 12MM W/ RADIAL SLEEVE LONG VERSASTEP PLUS", "code_information": [{"code": "VS101512P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 432.0, "discounted_cash": 151.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA DILATOR 5MM LONG RADIAL EXP SLV VS101505", "code_information": [{"code": "VS101505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA DILATOR 5MM RADIALLY EXPAND VS101005", "code_information": [{"code": "VS101005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 394.0, "discounted_cash": 137.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA END DELIVERY ACCUPORT 15GA X 60MM", "code_information": [{"code": "308.151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1263.0, "discounted_cash": 442.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA FLEX 8MM X 50MM 210252", "code_information": [{"code": "210252", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.77, "discounted_cash": 51.02, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA FXTN 5MM TROCAR RPF VERSAPORT", "code_information": [{"code": "177092F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA HIP 8.5MM X 110MM HIP ARTHROSCOPIC SURG FOR DISPOSABLE REPAIR KIT CLEAR-", "code_information": [{"code": "72200436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.0, "discounted_cash": 37.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA INSTRUMENT AR-6532", "code_information": [{"code": "AR-6532", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA IVAS ACCESS 11G", "code_information": [{"code": "306-330-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.77, "discounted_cash": 54.52, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA IVAS VERTEPORT CEMENT 11G", "code_information": [{"code": "306-511-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA LESION 20GA X 100MM 10MM V SHAPE ACTIVE TIP", "code_information": [{"code": "406-660-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA LITE BIO DELIVERY SYSTEM 48288214", "code_information": [{"code": "48288214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1151.32, "discounted_cash": 402.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA MEDLINE\u00c2\u00ae HUDSON RCI\u00c2\u00ae OXYGEN WITH ELASTIC HEAD STRAP PEDIATRIC 7' TUBING HUD1101", "code_information": [{"code": "HUD1101", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA MONOPOLAR 100MM 20GA 10MM ACTIVE TIP CURVED RADIOFREQUENCY DISP", "code_information": [{"code": "406-630-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA MONOPOLAR 100MM 20GA 5MM ACTIVE TIP CURVED RADIOFREQUENCY DISP", "code_information": [{"code": "406-630-150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL CO2 SAMPLING MALE LFADULT 10 FT", "code_information": [{"code": "HCS4568", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL DIVIDED 14FT 02 SUP TUBE MALE LUER ADULT 4950-14-14-25", "code_information": [{"code": "4950-14-14-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL DIVIDED 7 FT O2 SUP TUBE MALE LUER ADULT", "code_information": [{"code": "4950-7-7-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL MALE LUER CONNECTOR W/ 7FT OXYGEN SAMPLE LINE SOFTECH", "code_information": [{"code": "1844", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL NON FLARED OVER THE EAR FLEXIBLE W/ 7FT TUBING LF", "code_information": [{"code": "1103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL O2 PEDIATRIC 7\" W/HEAD STRAP 1101", "code_information": [{"code": "1101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA OPHTHALMOLOGY 25GA X32MM VITERORETINAL FLEXTIP HIGHFLOW FLEXIBLE LL 1MM TIP", "code_information": [{"code": "3221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA OPHTHALMOLOGY 27GA X32MM VITERORETINAL FLEXTIP HIGHFLOW FLEXIBLE LL 1MM TIP", "code_information": [{"code": "3258", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA ORTHOPEDIC 11 X 120MM ACCUPORT KNEE SIDE TARGETING", "code_information": [{"code": "307.032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1263.0, "discounted_cash": 442.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA PASSPORT BUTTON AR-6592-08-30", "code_information": [{"code": "AR-6592-08-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA RADIOFREQUENCY 18GA X 10 CM 10MM TIP CURVED STIMJECT", "code_information": [{"code": "SJ-C-1010-18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 189.0, "discounted_cash": 66.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA RADIOFREQUENCY 18GA X 150MM CURVED 10 MM ACTIVE TIP DISP", "code_information": [{"code": "406-840-225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA RADIOFREQUENCY 20GA 10MM TC 415 CURVED ACTIVE TIP", "code_information": [{"code": "406-630-225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 56.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA REP 7MM X 7 CM PLASTIC W/ OBTURATOR", "code_information": [{"code": "AR-6550R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA RETINAL 23GA X 0.8MM SOFT TIP", "code_information": [{"code": "587002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA RF 10CM 10MM 20G SINGLE PIECE", "code_information": [{"code": "CC101020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA RF 10CM 10MM SINGLE PC", "code_information": [{"code": "CC101018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA RFK 18GA 5MM ACTIVE TIP RFK-C10518S-P", "code_information": [{"code": "RFK-C10518S-P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA RFK SIDE KICK SILICONIZED 100MM 10MM TIP 18G", "code_information": [{"code": "RFK-C101018S-ZK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SHOEHORN 6MM X 9 CM W/ OBTURATOR STRL DISP", "code_information": [{"code": "AR-6565", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SILICON GATEWAY 8 X 40 3910-080-040", "code_information": [{"code": "3910-080-040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.92, "discounted_cash": 33.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SILICONE 8MM X 30MM GATEWAY", "code_information": [{"code": "3910-080-030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.92, "discounted_cash": 33.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SINGLE USE GEUDER AEA-049 ODCN", "code_information": [{"code": "AEA-049 ODCN", "type": "CDM"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SOFT TIPPED 25G", "code_information": [{"code": "1272.SD25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA STEVENS SUB-TENON K7-4005", "code_information": [{"code": "K7-4005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 100MM REPROCESS W/ DILATOR", "code_information": [{"code": "VS111012PR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 10GA CEMENT VERTEPORT", "code_information": [{"code": "306-410-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 63.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 20GA 150MM 10MM TIP ANESTHESIA VENOM", "code_information": [{"code": "406-660-225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.52, "discounted_cash": 109.38, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 5.75MM X 7 CM PARTIALLY THREADED ORTHO W/ DISPOSABLE OBTURATOR SCOR", "code_information": [{"code": "AR-6564", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 5.75MM X 7CM REPROCESS", "code_information": [{"code": "AR-6564R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 5MM X 7 CM LOW PROFILE", "code_information": [{"code": "AR-6548", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 7MM X 7 CM SHOULDER ORTHO NO SQUIRT CAP TWIST-IN", "code_information": [{"code": "AR-6570", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 8.25MM X 7 CM REPROCESS TWISTIN STRL", "code_information": [{"code": "AR-6530R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 8.5MM GRAY THREADED REPROCESS W/ OBTURATOR", "code_information": [{"code": "214118R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 8.5MM X 75MM CLR THRD SHLDR FOR GENERAL ARTHROSCOPIC SURG USE", "code_information": [{"code": "214120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 8.5MM X 75MM CLR THREADED REPROCESS", "code_information": [{"code": "214120R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA THRD 5.5MM X 72MM BLUE SHLDR ARTHROSCOPIC W/ DISPOSABLE OBTURATOR CLEAR-", "code_information": [{"code": "72200907", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA THRD 7MM X 72MM GRAY SHLDR ARTHROSCOPIC W/ DISPOSABLE OBTURATOR CLEAR-TR", "code_information": [{"code": "72200905", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.71, "discounted_cash": 5.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA THREADED CLEAR WITH OBTURATOR ORANGE 5.5MM", "code_information": [{"code": "214108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA TWISTIN 8.25MM NOTCHED SHOULDER STRL", "code_information": [{"code": "AR-6530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA TWISTIN 8.25MM X 9 CM BLUE TRANSLUCENT FOR DIRECT VISUALIZATION OFINSTRS", "code_information": [{"code": "AR-6540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA UNIVERSAL 11MM STD FIX UNVCA11STF", "code_information": [{"code": "UNVCA11STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 49.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA VACURETTE 11MM SUCTION ASPIRATION BERKELEY CURVED STRL DISP", "code_information": [{"code": "21554", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA VACURETTE 6MM SUCTION ASPIRATION F TIP BERKELEY STRL DISP", "code_information": [{"code": "21665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA VACURETTE 7MM SUCTION ASPIRATION CURVED BERKELEY STRL DISP", "code_information": [{"code": "21853", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA VACURETTE 8MM SUCTION AND ASPIRATION CURVED BERKELEY STRL DISP", "code_information": [{"code": "20317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA VFI 25G", "code_information": [{"code": "1272.VFI05", "type": "CDM"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA VIAL ACCESS NEEDLELESS BLUE 303367", "code_information": [{"code": "303367", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULAINSTR 5.75MM X 7 CM SMTH OPTIONAL 1-WAY STPCCK POLYCARBONATE W/ OBTURATOR", "code_information": [{"code": "AR-6562", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULAINSTR 7MM X 7CM CLR REPROCESS REPROCESS WITHOUT SQUIRT CAP TWISTIN", "code_information": [{"code": "AR-6570R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULATED 3.5MM TWIST AO COUPLING", "code_information": [{"code": "702450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 812.38, "discounted_cash": 284.33, "setting": "both", "billing_class": "facility"}]}, {"description": "CANTHOPLASTY 67950", "code_information": [{"code": "67950", "type": "CPT"}, {"code": "1480218", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANTHOTOMY 67715", "code_information": [{"code": "67715", "type": "CPT"}, {"code": "1480219", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANULATED COMPR. SCREW 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5880.24/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 656.0, "discounted_cash": 229.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP 62MM CLUSTERHOLE ACETABULAR SHELL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "702-04-62G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP AEQUALIS PERFORM+ SP CORTILOC MEDIUMRIGHT GLENOID AUGMENT 25", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWK404RA25S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP BURR TRIATHLON CR SINGLE USE FEMORAL PREP KIT SIZE 4", "code_information": [{"code": "5555-2204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP ECLIPSE TRUNION 41MM SLOTTED TPS AR-9301-41CPC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9301-41CPC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP END 0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.001.000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 170.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP END SLC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1826-0003S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 446.0, "discounted_cash": 156.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP END STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1832-0003S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 602.0, "discounted_cash": 210.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP ENDOSCOPY SEAL 5MM VESSEL VALVE STPCCK REPROCESS DISP", "code_information": [{"code": "175770R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP FOOT/ANKLE CAP PODIATRY", "code_information": [{"code": "CAP PODIATRY", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41200.0, "discounted_cash": 14420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP HIP REPLACEMENT BIOMET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "98-B001-024-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18025.0, "discounted_cash": 6308.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP HUMERAL HEAD 39MM X 14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7122868", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP JOURNEY II ISRT XLPE DD LT SZ 3-4 15MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74025746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP JOURNEY II ISRT XLPE DD RIGHT SZ 5-6 18MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74025757", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP JOURNEY II XLPE DEEP DISHED ARTICULAR INSERT SIZE 5-6 RIGHT 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74025755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP KIT INTELLIS SENSOR", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "9771IS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42050.0, "discounted_cash": 14717.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP MTP FUSION CAP-MTP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP-MTP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8240.0, "discounted_cash": 2884.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP OXFORD PARTIAL KNEE SYSTEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "98-B002-006-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10599.0, "discounted_cash": 3709.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PATELLA ASYMMETRIC - A29MM X 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5552-L-299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Biolox Delta Head w/ R3 XLPE Liner", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71703600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Bipolar Cemented Fem w/ CoCr Head", "code_information": [{"code": "71701045", "type": "CDM"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Bipolar Porous Fem w/ CoCr Head", "code_information": [{"code": "71701050", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Bipolar Porous Fem w/ Oxinium Head", "code_information": [{"code": "71701055", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Birmingham CAP PRICE Hip ResurfHd & AcetCup", "code_information": [{"code": "71703300", "type": "CDM"}], "standard_charges": [{"gross_charge": 18540.0, "discounted_cash": 6489.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Birmingham CAP PRICE Hip ResurfHd & DysplCup", "code_information": [{"code": "71703305", "type": "CDM"}], "standard_charges": [{"gross_charge": 18540.0, "discounted_cash": 6489.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Ceramic on Ceramic w/ Cemented Fem", "code_information": [{"code": "71702200", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Ceramic on Ceramic w/ Porous Fem", "code_information": [{"code": "71702210", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - CmtFem w/ OxiniumHd & XLPEPolyCup", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71701003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Cmtd Fem w/ CoCr Head & XLPE Liner", "code_information": [{"code": "71701012", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Cmtd Fem w/ OxinHd & R3 XLPE Liner", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71703316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Cmtd Fem w/ OxiniumHd & XLPE Liner", "code_information": [{"code": "71701016", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - CmtdFem w/ CoCrHd & RegReflecLiner", "code_information": [{"code": "71701005", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - CmtdFem w/ CoCrHd & XLPEPolyCup", "code_information": [{"code": "71701001", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - CmtdFem w/ CoCrHd, R3XLPE& R3Multi", "code_information": [{"code": "71705312", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - CmtdFem w/ CoCrHead & AllPolyCup", "code_information": [{"code": "71701000", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - CmtdFem w/ OxiHd, R3XLPE & R3Multi", "code_information": [{"code": "71705316", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - CmtdFem w/ OxiniumHd & RegReflLinr", "code_information": [{"code": "71701007", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Polar Cup Cem Stem CoCr Head", "code_information": [{"code": "71703500", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Polar Cup Cem Stem Delta Head", "code_information": [{"code": "71703510", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Polar Cup Cem Stem Oxi Head", "code_information": [{"code": "71703505", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Polar Cup Por Stem CoCr Head", "code_information": [{"code": "71703515", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Polar Cup Por Stem Delta Head", "code_information": [{"code": "71703525", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Polar Cup Por Stem Oxi Head", "code_information": [{"code": "71703520", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - PorFem w/ CoCrHd,R3XLPE & R3Multi", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71705313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - PorFem w/ OxiHd, R3 XLPE & R3Multi", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71705318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Porous Fem w/ CoCr Hd & R3 XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71703313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 3850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Porous Fem w/ CoCr Hd & XLPE Liner", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71701013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Porous w/Oxi Hd R3 Anteverted Liner", "code_information": [{"code": "71703328", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - PorousFem w/ BioloxDeltaHd R3 XLPE", "code_information": [{"code": "71703613", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - PorousFem w/ CoCrHd & RegReflLiner", "code_information": [{"code": "71701015", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - PorousFem w/ CoCrHd & XLPEPolyCup", "code_information": [{"code": "71701004", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - PorousFem w/ OxinHd & RegReflLiner", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71701020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - PorousFem w/ OxiniumHd & R3 XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71703318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - PorousFem w/ OxiniumHd & XLPELiner", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71701018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - R3 Ceramic on Ceramic", "code_information": [{"code": "71703400", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - R3 XLPE Liner Partial CAP PRICE Hip", "code_information": [{"code": "71703365", "type": "CDM"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - SMF & Neck w/ CoCr Hd & R3 XLPE", "code_information": [{"code": "71705511", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - SMF & Neck w/ CoCrHd&TandShel/Linr", "code_information": [{"code": "71705515", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - SMF & Neck w/ Oxi Hd & XLPE Liner", "code_information": [{"code": "71705520", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - SMF & Neck w/ Oxinium Hd & R3 XLPE", "code_information": [{"code": "71705530", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - SMF & Neck w/ Unipolar Head", "code_information": [{"code": "71705615", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - SMF&Neck w/ OxiHd R3MultHol R3XLPE", "code_information": [{"code": "71705534", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - TandBipolar LowDmd Cmtd Fem CoCrHd", "code_information": [{"code": "71700040", "type": "CDM"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Tandem Bipolar MedDmd Fem w/ CoCr", "code_information": [{"code": "71701445", "type": "CDM"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - TandemBipolar CmtdFem w/ CoCr Head", "code_information": [{"code": "71701440", "type": "CDM"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - TandemBipolar NonPorFem w/ OxiHd", "code_information": [{"code": "71701460", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - TandemBipolar PorousFem w/ CoCrHd", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71701450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - TandemBipolar PorousFem w/ OxiHead", "code_information": [{"code": "71701455", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Uniploar NonPor Fem w/ Unipolar Hd", "code_information": [{"code": "71701030", "type": "CDM"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Unipolar CementedLowDmdFem", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71701025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Unipolar Cemtd Fem w/ Lrg Met Head", "code_information": [{"code": "71701026", "type": "CDM"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Unipolar High Dmd w/ UnipolarHead", "code_information": [{"code": "71701035", "type": "CDM"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Unipolar Low End Cemented Femoral", "code_information": [{"code": "71700025", "type": "CDM"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - Unipolar Porous w/ Lrg Metal Head", "code_information": [{"code": "71701038", "type": "CDM"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Hip - UnipolarPorousFem w/ UnipolrOxiHd", "code_information": [{"code": "71701037", "type": "CDM"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE IMPLANT ASCEND FLEX W PERFORM TOTAL SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP1099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15038.0, "discounted_cash": 5263.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE KWSH MDCR DISCECTOMY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CAP KWSH MDCR DISCECTOMY", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE KWSH MDCR LAMINECTOMY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP PRICE KWSH MDCR LAMINECTOMY", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37080.0, "discounted_cash": 12978.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - JII BCS Oxi w/NP Tib Constr Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71709010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - Journey II CR Oxi Verilast w/NP Tibial", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71701650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - Journey II Oxi w/ VERI & NP Tib", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71709000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 5600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - Journey PFJ Oxinium w/ Resurf Pat", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71701700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - Journey Uni CoCr w/ Jrny All Poly Tib", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71701805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - Jrny Uni CoCr Fem w/ Uni Tib & Insrt", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71701804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - Jrny Uni Oxin Fem w/ Uni Tib&Inst", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71701802", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII CR Cemented Hi Dmd Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII CR Cemented Standard Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII CR Femoral All Poly Tibia", "code_information": [{"code": "71704502", "type": "CDM"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII CR Hybrid Hi Dmd Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII CR Hybrid Standard Insert", "code_information": [{"code": "71704520", "type": "CDM"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII CR Oxi NP Tib Std Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII CR Oxi Por Tib Std Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII CR Porous Hi Dmd Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII CR Porous Standard Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII CR Verilast NP Tib", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII CR Verilast Por Tib", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704585", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII PS Cemented Hi Dmd Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9000.0, "discounted_cash": 3150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII PS Cemented Standard Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII PS Hybrid Hi Dmd Insert", "code_information": [{"code": "71704535", "type": "CDM"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII PS Hybrid Standard Insert", "code_information": [{"code": "71704530", "type": "CDM"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII PS Oxi NP Tib Std Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII PS Oxi Por Tib Std Insert", "code_information": [{"code": "71704590", "type": "CDM"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII PS Porous Hi Dmd Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII PS Porous Standard Insert", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII PS Verilast NP Tib", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGN GII PS Verilast Por Tib", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LGNGII CR Oxi Fem w/ All Poly Tib", "code_information": [{"code": "71701265", "type": "CDM"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE Knee - LgnGII PS Oxi Fem w/ All PolyTib", "code_information": [{"code": "71701272", "type": "CDM"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE LOW TIER KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE REVERSE SHOULDER TORNIER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TOR REV CAP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE RIGHT MEDIAL IDUO G2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M57230600220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9167.0, "discounted_cash": 3208.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE SCREW BONE 14MM PERIPHERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE SCREW BONE 22MM PERIPHERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE SCREW BONE 30MM PERIPHERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE SCREW BONE 5.0MM X 18MM PERIPHERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE SCREW BONE 5.0MM X 26MM PERIPHERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE SPINAL STIMULATOR 9771IP", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "9771IP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 38050.0, "discounted_cash": 13317.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE STRYKER TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP STRYKER KNEE GEN", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8034.0, "discounted_cash": 2811.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE TORNIER FLEX RSA TOTAL SHOULDER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CAP FLEX RSA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24720.0, "discounted_cash": 8652.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE TOTAL HIP 71703330", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71703330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 3850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE TOTAL HIP 98-B001-025-07", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "98-B001-025-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11651.0, "discounted_cash": 4077.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE TOTAL KNEE DJO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DJO-CAPKNEE", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8034.0, "discounted_cash": 2811.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICE TOTAL KNEE JOURNEY II BCS COCR FEM & NP TIBIA 71709020", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71709020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 3850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING ANTERIOR CERVICAL C6-7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAPC6-7ANTCERV", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING BUNIONECTOMY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP BUNION", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6136.0, "discounted_cash": 2147.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING DJO TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAPKNEEDJOTOTAL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8034.0, "discounted_cash": 2811.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING KNEE PRIMARY FLOATINF PLATFORM ATTUNE RP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "KNERPDPSCAP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING MDM TOTAL HIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CAP MDM HIP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17922.0, "discounted_cash": 6272.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING SMITH AND NEPHEW TOTAL KNEE LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP TOTAL KNEE LEFT S-N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12360.0, "discounted_cash": 4326.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING STRYKER TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP TOTAL KNEE", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8034.0, "discounted_cash": 2811.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING TOTAL HIP STRYKER 27222", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAPTOTALHIPSTRYKR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8446.0, "discounted_cash": 2956.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING TOTAL KNEE ATTUNE LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP TOTAL KNEE ATTUNE", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12360.0, "discounted_cash": 4326.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING TOTAL KNEE TRIATHLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAPTTLKNEETRI", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING TOTAL R2 SHOULDER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CAP TOTAL R2 SHOULDER", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15450.0, "discounted_cash": 5407.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING TOTAL SHOULDER FLEX TSA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP TOTAL SHOULDER", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23381.0, "discounted_cash": 8183.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING TOTAL SHOULDER REVERSE SHOULDER TORNIER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAPTTLSHLDRREVERSESHLDR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24720.0, "discounted_cash": 8652.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING TOTAL SHOULDER SIMPLICITI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP1072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24720.0, "discounted_cash": 8652.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING TRIAL SCS MEDTRONIC 37922", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAPTRIALSCSMEDTRONIC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRICING UNI KNEE MED LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP UNI KNEEDEPUY", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PRIMATRIX 6 X 6", "code_information": [{"code": "Q4110", "type": "HCPCS"}, {"code": "607-005-660", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 3954.0, "discounted_cash": 1383.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PROTECTIVE FOR 4.0 MM FXTN PIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "394.991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PROTECTIVE FOR 5.0 MM FXTN PIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "394.993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP REDUCER ENDO ONE SEAL ENDOPATH STRL", "code_information": [{"code": "1SEAL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP SPINAL FOR EXCELLA SPINAL SYS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E2002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP STEM 12 X 122 MM HUMERAL FRACTURE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "12-113562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TANDEM BIOPOLAR HEMI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71703000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TENSION RING", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "D-70374-LEFT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 173.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TOTAL HIP 71703329", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71703329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 5950.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TOTAL HIP 71703332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71703332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 5950.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TOTAL HIP POROUS OR3O X/OXINIUM HEAD 71703495", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71703495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TOTAL KNEE 98-0002-445-00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "98-0002-445-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8484.0, "discounted_cash": 2969.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TOTAL KNEE PERSONA FEM/TM TIB/VE 98-0002-449-00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "98-0002-449-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9571.0, "discounted_cash": 3349.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TOTAL KNEE PR PRM ST/OSS LH CP/XL AA DM LN/CER 98-B001-009-32", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "98-B001-009-32", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11651.0, "discounted_cash": 4077.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TOTAL KNEE REV HUB W/J2 71704628", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 5600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TOTAL KNEE TRIALTHLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TC5551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14838.0, "discounted_cash": 5193.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TOTAL SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ASCEND TSA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20600.0, "discounted_cash": 7210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP TOTAL SHOULDER TSA ASCEND", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TOTAL SHOULDER TSA ASCEND", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15450.0, "discounted_cash": 5407.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP WHITE COMFORT BOUFFANT 24INCH", "code_information": [{"code": "9303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPS SWABCAP NEEDLE-FREE CONNECTOR DISINFECTION CAP200-COUNT CARTON SCXT3-2000", "code_information": [{"code": "SCXT3-2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPSULAR CONTRACTURE RELEASE SHOULDER 23020", "code_information": [{"code": "23020", "type": "CPT"}, {"code": "1481746", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULARY TENSION SEGMENT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "60D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPSULECTOMY BREAST PERIPROSTHETIC 19371", "code_information": [{"code": "19371", "type": "CPT"}, {"code": "1480221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULECTOMY INTERPHALANGAL JOINT 26525", "code_information": [{"code": "26525", "type": "CPT"}, {"code": "1480223", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULECTOMY METACARPOPHALANGAL JOINT 26520", "code_information": [{"code": "26520", "type": "CPT"}, {"code": "1480224", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULODESIS MCP JOINT 2 DIGITS 26517", "code_information": [{"code": "26517", "type": "CPT"}, {"code": "1480225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULODESIS MCP JOINT 3 OR 4 DIGITS 26518", "code_information": [{"code": "26518", "type": "CPT"}, {"code": "1480226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULODESIS MCP JOINT SINGLE DIGIT 26516", "code_information": [{"code": "26516", "type": "CPT"}, {"code": "1480227", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULORRHAPHY ANTERIOR ANY TYPE W/CORACOID PROCESS TRANSFER 23462", "code_information": [{"code": "23462", "type": "CPT"}, {"code": "2034633", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3149.38, "maximum": 9357.0, "gross_charge": 6507.0, "discounted_cash": 2277.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3149.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULORRHAPHY SHOULDER 23450", "code_information": [{"code": "23450", "type": "CPT"}, {"code": "1480228", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULORRHAPHY SHOULDER W/BONE BLOCK 23460", "code_information": [{"code": "23460", "type": "CPT"}, {"code": "1480229", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULORRHAPHY SHOULDER W/GLENOHUMERAL JOINT 23465", "code_information": [{"code": "23465", "type": "CPT"}, {"code": "1480230", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULORRHAPHY SHOULDER W/GLENOHUMERAL JOINT MULTI 23466", "code_information": [{"code": "23466", "type": "CPT"}, {"code": "1480231", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULORRHAPHY SHOULDER W/LABRAL REPAIR 23455", "code_information": [{"code": "23455", "type": "CPT"}, {"code": "1480232", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULORRHAPHY WRIST 25320", "code_information": [{"code": "25320", "type": "CPT"}, {"code": "1480233", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULOTOMY FOOT EXTENSIVE 28262", "code_information": [{"code": "28262", "type": "CPT"}, {"code": "1480234", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULOTOMY FOOT MIDTARSAL 28264", "code_information": [{"code": "28264", "type": "CPT"}, {"code": "1480235", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULOTOMY FOOT W/MEDIAL RELEASE ONLY 28260", "code_information": [{"code": "28260", "type": "CPT"}, {"code": "1480236", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULOTOMY FOOT W/TENDON LENGTHENING 28261", "code_information": [{"code": "28261", "type": "CPT"}, {"code": "1480237", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULOTOMY INTERPHALANGEAL JOINT EA JOINT 28272", "code_information": [{"code": "28272", "type": "CPT"}, {"code": "9467902", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULOTOMY KNEE 27435", "code_information": [{"code": "27435", "type": "CPT"}, {"code": "1480238", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULOTOMY METATARSOPHALANGEAL JOINT W/WO TENORRHAPY 28270", "code_information": [{"code": "28270", "type": "CPT"}, {"code": "1480239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULOTOMY WRIST 25085", "code_information": [{"code": "25085", "type": "CPT"}, {"code": "1480240", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARR CNV LOC MAP", "code_information": [{"code": "746T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARR N-INVAS LOC", "code_information": [{"code": "745T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARRHYT DLVR RAD", "code_information": [{"code": "747T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ACOUS WAVFRM REC CAD RSK", "code_information": [{"code": "716T", "type": "CPT"}], "standard_charges": [{"minimum": 144.97, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 144.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 227.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 227.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 227.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNLPTHY GEN SEQ PNL", "code_information": [{"code": "237U", "type": "CPT"}], "standard_charges": [{"minimum": 700.82, "maximum": 1102.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 10 GNS", "code_information": [{"code": "81413", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 902.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1491.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 2 GNS", "code_information": [{"code": "81414", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 902.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1491.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR OUTP MEAS DRG CATH CHD", "code_information": [{"code": "93598", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR-CAR BP GRFT/ENDOVAS TAA", "code_information": [{"code": "33891", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR-T CLL ADMN AUTOLOGOUS", "code_information": [{"code": "540T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARBACHOL OPTHALMIC 0.01% (MIOSTAT) 1.5ML", "code_information": [{"code": "MED0052", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CARCINOEMBRYONIC ANTIGEN", "code_information": [{"code": "82378", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 76.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 76.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 76.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARD HRT TRNSPL 96 DNA SEQ", "code_information": [{"code": "55U", "type": "CPT"}], "standard_charges": [{"minimum": 4665.6, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4665.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4665.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARD MRI VELOC FLOW MAPPING", "code_information": [{"code": "75565", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 287.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 287.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 287.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 81.19, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 86.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARD MRI W/STRESS IMG & DYE", "code_information": [{"code": "75563", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 692.16, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 735.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARD TAMP W/IN 30D", "code_information": [{"code": "G9408", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [{"code": "297", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4300.68, "maximum": 7383.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4300.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6150.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6765.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7383.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [{"code": "296", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9703.6, "maximum": 16658.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9703.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13878.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15266.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16658.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC", "code_information": [{"code": "298", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2973.37, "maximum": 5104.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2973.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4252.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5104.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [{"code": "309", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4565.29, "maximum": 7837.47, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4565.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6529.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7182.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7837.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [{"code": "308", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7305.07, "maximum": 12541.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7305.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10447.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11492.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12541.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "310", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3401.61, "maximum": 5839.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3401.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4865.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5351.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5839.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [{"code": "306", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9169.51, "maximum": 15741.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9169.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13114.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14425.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15741.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [{"code": "307", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5294.64, "maximum": 9089.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5294.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7572.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8329.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9089.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC DRUG STRESS TEST", "code_information": [{"code": "93024", "type": "CPT"}], "standard_charges": [{"minimum": 1603.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1603.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI FOR MORPH", "code_information": [{"code": "75557", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 413.2, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 439.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI FOR MORPH W/DYE", "code_information": [{"code": "75561", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 589.25, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 626.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI SEG DYS STRAIN", "code_information": [{"code": "C9762", "type": "HCPCS"}], "standard_charges": [{"minimum": 2104.5, "maximum": 3308.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2104.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI SEG DYS STRESS", "code_information": [{"code": "C9763", "type": "HCPCS"}], "standard_charges": [{"minimum": 2104.5, "maximum": 3308.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2104.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI W/STRESS IMG", "code_information": [{"code": "75559", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2104.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 615.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [{"code": "258", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19271.55, "maximum": 33084.47, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19271.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27562.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30318.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33084.47, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [{"code": "259", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5998.0, "maximum": 21817.52, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 7591.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 7591.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5998.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12708.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18176.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19993.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21817.52, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [{"code": "261", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5998.0, "maximum": 20822.3, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 7591.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 7591.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5998.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12128.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17346.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19081.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20822.3, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [{"code": "260", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21699.89, "maximum": 37253.31, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21699.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31035.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34139.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37253.31, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC", "code_information": [{"code": "262", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5998.0, "maximum": 17817.85, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 7591.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 7591.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5998.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10378.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14843.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16328.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17817.85, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB", "code_information": [{"code": "93797", "type": "CPT"}], "standard_charges": [{"minimum": 39.73, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB/MONITOR", "code_information": [{"code": "93798", "type": "CPT"}], "standard_charges": [{"minimum": 63.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC SHUNT IMAGING", "code_information": [{"code": "78428", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 664.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1044.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1044.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1044.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 325.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 346.95, "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": 39439.13, "maximum": 67707.19, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39439.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56406.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62047.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67707.19, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": 61069.06, "maximum": 104840.41, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61069.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 87341.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96076.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104840.41, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": 37162.87, "maximum": 63799.42, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37162.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53150.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58466.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63799.42, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": 32880.44, "maximum": 56447.55, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32880.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47026.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51728.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56447.55, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": 49014.38, "maximum": 84145.52, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49014.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 70101.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 77111.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 84145.52, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": 27859.53, "maximum": 47827.9, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27859.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39845.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43829.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 47827.9, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST EXTERNAL", "code_information": [{"code": "92971", "type": "CPT"}], "standard_charges": [{"minimum": 462.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 462.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST INTERNAL", "code_information": [{"code": "92970", "type": "CPT"}], "standard_charges": [{"minimum": 877.33, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 877.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1378.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1378.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1378.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOKYMOGRAPHY", "code_information": [{"code": "Q0035", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.95, "maximum": 231.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 32.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 35.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLIPIN ANTIBODY EA IG", "code_information": [{"code": "86147", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLOGY HRT TRNSPL MRNA", "code_information": [{"code": "81595", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4050.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4665.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4665.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLOGY SS", "code_information": [{"code": "G0063", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOPULM EXERCISE TESTING", "code_information": [{"code": "94621", "type": "CPT"}], "standard_charges": [{"minimum": 410.04, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 410.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 644.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93015", "type": "CPT"}], "standard_charges": [{"minimum": 319.46, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 319.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 502.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 502.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 502.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93016", "type": "CPT"}], "standard_charges": [{"minimum": 100.11, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93017", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93018", "type": "CPT"}], "standard_charges": [{"minimum": 66.77, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELECTRIC EXT", "code_information": [{"code": "92960", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELECTRIC INT", "code_information": [{"code": "92961", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE AFTER DELIVERY", "code_information": [{"code": "59430", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE COORD AT HOSPICE", "code_information": [{"code": "G9477", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 20 MI", "code_information": [{"code": "G0081", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 30 M", "code_information": [{"code": "G0082", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 45 M", "code_information": [{"code": "G0083", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 60 M", "code_information": [{"code": "G0084", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 75 M", "code_information": [{"code": "G0085", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN HOME CARE PLAN 30 M", "code_information": [{"code": "G0086", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN HOME CARE PLAN 60 M", "code_information": [{"code": "G0087", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 20 M", "code_information": [{"code": "G0076", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 30 M", "code_information": [{"code": "G0077", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 45 M", "code_information": [{"code": "G0078", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 60 M", "code_information": [{"code": "G0079", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 75 M", "code_information": [{"code": "G0080", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MGMT SVC BHVL HLTH COND", "code_information": [{"code": "99484", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE NOT POSS MED RSN", "code_information": [{"code": "M1147", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE SURVEY NOT COMPLETE", "code_information": [{"code": "G0917", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER DEM TRAINED", "code_information": [{"code": "G2185", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER HEALTH RISK ASSMT", "code_information": [{"code": "96161", "type": "CPT"}], "standard_charges": [{"minimum": 14.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER TRAING 1ST 30 MIN", "code_information": [{"code": "97550", "type": "CPT"}], "standard_charges": [{"minimum": 237.61, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 237.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 373.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 373.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 373.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER TRAING EA ADDL 15", "code_information": [{"code": "97551", "type": "CPT"}], "standard_charges": [{"minimum": 109.1, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [{"code": "35", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14232.4, "maximum": 24433.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14232.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20355.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22390.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24433.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [{"code": "34", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24198.78, "maximum": 41543.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24198.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34609.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38070.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41543.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "36", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11267.54, "maximum": 19343.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11267.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16115.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17726.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19343.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAROTID INTIMA ATHEROMA EVAL", "code_information": [{"code": "93895", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARPAL TUNNEL RELEASE SYSTEM ENDOSCOPIC STRATOS", "code_information": [{"code": "5500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2244.0, "discounted_cash": 785.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CARPECTOMY 25210", "code_information": [{"code": "25210", "type": "CPT"}, {"code": "1480241", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARPECTOMY ALL BONES 25215", "code_information": [{"code": "25215", "type": "CPT"}, {"code": "1480242", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARS/BD TST INFT-12MO +30MIN", "code_information": [{"code": "94781", "type": "CPT"}], "standard_charges": [{"minimum": 38.15, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARS/BD TST INFT-12MO 60 MIN", "code_information": [{"code": "94780", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARTIFORM 12 X 19MM DISC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ABS-1102-19", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12875.0, "discounted_cash": 4506.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTILAGE GRAFT COSTOCHONDRAL 20910", "code_information": [{"code": "20910", "type": "CPT"}, {"code": "17290374", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARTRIDGE CORI KNEE TENSIONER ROB10101", "code_information": [{"code": "ROB10101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1210.5, "discounted_cash": 423.68, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE I-STAT CHEM 8+", "code_information": [{"code": "9P31-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE LUQUID", "code_information": [{"code": "85-003-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.22, "discounted_cash": 61.68, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPL 60MM RELOAD LAP TROCAR ENDOPATH BLACK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GST60T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 109.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPL 60MM STAPLER RELOAD LAP RETAINING ENDOPATH LF STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPLR 60MM LINEAR CUTTER LAPARASCOPIC RELOAD TX PROXIMATE LF TI STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XR60G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STRL 19.5MM X 1.33MM X 105MM HVY DTY FALCON FOR SYS 6", "code_information": [{"code": "6625127105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 860.0, "discounted_cash": 301.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE SUT MIXED WHT CO BRAID SMARTSTITCH PERFECTPASSER MAGNUMWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OM-8178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 929.0, "discounted_cash": 325.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE TST 8 TEST DIAGNOSTIC SODIUM POTASSIUM CHLORIDE IONIZED CALCIUM UREA N", "code_information": [{"code": "3P91-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE WHT RELOAD F/ENDOCUTTER ECHEL GST60W", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "GST60W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 95.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CASCADIA GRAFT 12 X 45 X 22MM X 8DEG", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "6101-2224512LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8240.0, "discounted_cash": 2884.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CASIRI AND IMDEV REPEAT", "code_information": [{"code": "M0240", "type": "HCPCS"}], "standard_charges": [{"minimum": 1984.5, "maximum": 3118.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1984.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASIRI AND IMDEV REPEAT HM", "code_information": [{"code": "M0241", "type": "HCPCS"}], "standard_charges": [{"minimum": 3307.5, "maximum": 5197.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3307.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5197.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5197.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5197.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASIRIVI AND IMDEVI INJ", "code_information": [{"code": "M0243", "type": "HCPCS"}], "standard_charges": [{"minimum": 1984.5, "maximum": 3118.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1984.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASIRIVI AND IMDEVI INJ HM", "code_information": [{"code": "M0244", "type": "HCPCS"}], "standard_charges": [{"minimum": 3307.5, "maximum": 5197.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3307.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5197.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5197.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5197.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAT SCAN FOLLOW-UP STUDY", "code_information": [{"code": "76380", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 212.21, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 225.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATCH NT BASKET 4 WIRE ULTRA 1.8 FR", "code_information": [{"code": "NT4W18115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 12FR 2W 5CC (REPL 0165SI12)", "code_information": [{"code": "175812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 18FR30ML LATEX 3WAY LUBR 0167L18", "code_information": [{"code": "167L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 6FR 1.5ML SILICONE", "code_information": [{"code": "DYND11552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY COUDE 2 WY 30 CC 14 FR 0103L14", "code_information": [{"code": "103L14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY COUNCIL IC 2-WAY 18FR 5ML 0196SI18", "code_information": [{"code": "196SI18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY COUNCIL RD-LTX 18FR 5ML 0196L18", "code_information": [{"code": "196L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.35, "discounted_cash": 24.27, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY LF SILICON 16FR 10ML DYND11502", "code_information": [{"code": "DYND11502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY LUBRICATH STRL 12FR 5ML 0165L12", "code_information": [{"code": "165L12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY SILICONE 14FR 5CC", "code_information": [{"code": "175814", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV PROTECTIV PLUS 14GA ORANGE 306801", "code_information": [{"code": "306801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SAFETY 20G X1.25 FEP STRGHT 4252535-02", "code_information": [{"code": "4252535-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SFTY INTROCAN 24GA X 3/4", "code_information": [{"code": "4252500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH LUBR 3-WAY 30CC 0167SI24", "code_information": [{"code": "167SI24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PLACE CARDIO BRACHYTX", "code_information": [{"code": "92974", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/EMBOL", "code_information": [{"code": "C7515", "type": "HCPCS"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/STENTS", "code_information": [{"code": "C7514", "type": "HCPCS"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIALCIR W/APLASTY", "code_information": [{"code": "C7513", "type": "HCPCS"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH/APLASTY DIAL CIR W/STNT", "code_information": [{"code": "C7530", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER 30CC 2-WAY HEMATURIA BARDEX LUBRICATH", "code_information": [{"code": "2557H22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.36, "discounted_cash": 22.18, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ACCESS 10FR X 60 CM DUAL LUMEN", "code_information": [{"code": "608BX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 44.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ACCESS URETERAL DUAL LUMEN FLEXI TIP", "code_information": [{"code": "22610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BLLN 10MM 4CM DILATION URETERAL ASCEND AQ", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "AUBS-10-4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BLLN 18FR 5CC 2 WAY RIBBED", "code_information": [{"code": "165V18S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BLLN 3FR X 70CM X 4 CM URETEROSCOPY DILATING", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "78354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BLLN 6MMINFLATED 4CM DILATION URETERAL ASCEND AQ", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "AUBS-6-4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BLLN 7MM 4CM DILATION URETERAL ASCEND AQ", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "AUBS-7-4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BLLN ABLATION THERMAL SILICONE THERMACHOICE DISP", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "TC003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1689.0, "discounted_cash": 591.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER COUDE 3 WAY 30 CC 20 FR 2557H20", "code_information": [{"code": "2557H20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.36, "discounted_cash": 22.18, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER COUDE 30CC 18FR STRL", "code_information": [{"code": "100L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER CYST 10FR 5 CM 5 ML BARTHOLIN GLAND DRN LTX W/ 5CC BLLN STRL DISP", "code_information": [{"code": "564000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.56, "discounted_cash": 62.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ELECTROHEMOSTASIS 7FR 300 CM STANDARD PLUG BIPLR GOLD PROBE STRL DISP", "code_information": [{"code": "M00560070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.03, "discounted_cash": 154.01, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ELECTROHEMOSTASIS CINJECTION 6015 GOLD PROBE", "code_information": [{"code": "6015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.0, "discounted_cash": 192.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER EPI 19GA X 12IN RADIO OPAQUE ROUND DEFLECTIVE ATRAUMATIC TIP BREVI-XL", "code_information": [{"code": "155-2340", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 261.01, "discounted_cash": 91.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER EPI 21GA X 12IN RADIO OPAQUE SPRING WOUND STYLETTED W/ STYLET EPI NDL V", "code_information": [{"code": "156-2112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 265.09, "discounted_cash": 92.78, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESOPHAGEAL 6FR 10MM TO 12MM 180 CM 8 CM PYLORIC FIXED WIRE BLLN DILATOR", "code_information": [{"code": "M00558350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.0, "discounted_cash": 166.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESOPHAGEAL 6FR 12MM TO 15MM 180 CM 8 CM PYLORIC FIXED WIRE BLLN DILATOR", "code_information": [{"code": "M00558360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESOPHAGEAL 6FR 18MM TO 20MM 180 CM 8 CM PYLORIC FIXED WIRE BLLN DILATOR", "code_information": [{"code": "M00558381", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESOPHAGEAL 6FR 8MM TO 10MM 180 CM 8 CM PYLORIC FIXED WIRE BLLN DILATOR", "code_information": [{"code": "M00558340", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.0, "discounted_cash": 166.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESPH PYL 7.5FR 15-18MM 180CM 5.5CM WG BLNDIL CRE", "code_information": [{"code": "M00558430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 575.0, "discounted_cash": 201.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FEMALE EXTERNA B-DPWFX30", "code_information": [{"code": "B-DPWFX30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.69, "discounted_cash": 12.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 10FR 3ML BARDEX LUBRICATH PEDI", "code_information": [{"code": "165PL10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 12FR 5ML SIL-ELASTOMER 0165V12S", "code_information": [{"code": "165V12S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 14FR 5CC SILK COAT UROLOGIC SILICONE COATED LATEX", "code_information": [{"code": "165V14S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16 FRENCH 5 ML RED COUNCIL 2 WAY", "code_information": [{"code": "196L16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 10 ML COUDE STYLE LATEX", "code_information": [{"code": "DYND11216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.76, "discounted_cash": 5.52, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 30 ML RED COUDE TIP 2 WAY ONE EYE TIEMANN MODEL LATEX HYDROG", "code_information": [{"code": "103L16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 5 ML URETHRAL TWO WAY SILICONE HYDROGEL LUBRISIL STERILE", "code_information": [{"code": "175816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 5CC URETHRAL DRAINAGE 100 PCT SILICONE", "code_information": [{"code": "165816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 5CC URETHRAL HYDROPHILIC", "code_information": [{"code": "165L16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 5MM ELASTOMER SILICONE", "code_information": [{"code": "165V16S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 18FR 10ML COUDE 2 WAY STANDARD SPECIALTY", "code_information": [{"code": "102L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 18FR 30CC COUDE TIP 2 WAY SURG", "code_information": [{"code": "103L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 18FR 5 ML URETHRAL TWO WAY SILICONE HYDROGEL LUBRISIL STERILE", "code_information": [{"code": "175818", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 18FR 5CC BLLN 2 WAY URETHRAL", "code_information": [{"code": "165L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.16, "discounted_cash": 8.46, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 20FR 10 ML RED COUDE TIP 2 WAY STANDARD SURG LATEX", "code_information": [{"code": "102L20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 20FR 30CC THREE WAY MED ROUND TIP", "code_information": [{"code": "167L20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.43, "discounted_cash": 13.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 20FR 30ML LUBRICIOUS BARDEX LUBRICATH STRL", "code_information": [{"code": "166L20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.94, "discounted_cash": 11.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 20FR 5 ML 2 WAY COUNCIL TIP", "code_information": [{"code": "196L20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 20FR 5 ML UNCOATED SILICONE", "code_information": [{"code": "165820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 20FR 5 ML URETHRAL TWO WAY ALL SILICONE HYDROGEL LUBRISIL", "code_information": [{"code": "175820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 20FR 5 ML URETHRALINFECTION CONTROL 2 WAY COUNCIL TIP 2 OPPOSING", "code_information": [{"code": "196SI20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 20FR 5CC 2 WAY HYDROPHELIC", "code_information": [{"code": "165L20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 20FR 5ML SIL-ELASTOMER 2 WAY BARDIA", "code_information": [{"code": "165V20S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 22FR 10 ML RED COUDE TIP 2 WAY STANDARD SURG LATEX", "code_information": [{"code": "102L22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 22FR 30CC THREE WAY UROLOGIC", "code_information": [{"code": "167L22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 22FR 30ML LUBRICIOUS BARDEX LUBRICATH STRL", "code_information": [{"code": "166L22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.98, "discounted_cash": 3.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 22FR 5 ML URETHRALINFECTION CONTROL 2 WAY COUNCIL TIP 2 OPPOSIING", "code_information": [{"code": "196SI22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 22FR 5CC URETHRAL BULB SILICONE", "code_information": [{"code": "165V22S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 24 FRENCH 30 ML 3 WAY LUBRICIOUS STERILE", "code_information": [{"code": "166SI24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 24 FRENCH 30 ML 3 WAY LUBRICIOUS STRL", "code_information": [{"code": "166L24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 24FR 30 ML URETHRAL 2 WAY LUBRICIOUS BARRIER HYDROGEL LATEX", "code_information": [{"code": "366724", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 24FR 30CC THREE WAY UROLOGIC", "code_information": [{"code": "167L24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 26 FRENCH 30 ML LUBRICIOUS BARDEX LUBRICATH STRL", "code_information": [{"code": "166L26", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.98, "discounted_cash": 3.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 26FR 30CC THREE WAY UROLOGIC", "code_information": [{"code": "167L26", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 8FR 3CC 2 WAY BLLN SILICONE STRL PEDI DISP", "code_information": [{"code": "165PL08", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY COUDE 18FR 5CC 2-WAY 0168L18", "code_information": [{"code": "168L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY COUDE 22FR 5CC 2-WAY 0168L22", "code_information": [{"code": "168L22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.32, "discounted_cash": 13.41, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY COUNCIL RED-LTX 22FR 5ML 0196L22", "code_information": [{"code": "196L22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY LUBRICATH STRL 14FR 5ML 0165L14", "code_information": [{"code": "165L14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY SAFE SECURE STRL", "code_information": [{"code": "UROSECURE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER GUIDE TIP SHAPE M-110 SINUS RELIEVA FLEX DISP", "code_information": [{"code": "GC110RF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER GUIDE TIP SHAPE S-30 SINUS RELIEVA FLEX", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "GC030RF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IRRIGATION SINUS RELIEVA VORTEX 2", "code_information": [{"code": "RV02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 14GA X 1.25IN RADIOPAQUE WINGED HUB SAFETY JELCO PROTECTIV", "code_information": [{"code": "3068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 14GA X 125IN SAFETYINTROCAN", "code_information": [{"code": "4251890-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 16GA 1.7MM 220 MLAUTOGUARD LATEX FREE STERILE", "code_information": [{"code": "381454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 16GA X 5 1/4IN GRAY PERIPHERAL VENOUS FEP POLYMER ANGIOCATH", "code_information": [{"code": "382259", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.5, "discounted_cash": 18.73, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 16IN X 1.25IN RADIOPAQUE RINGED HUB", "code_information": [{"code": "306201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 18GA X 1.25IN SAFETY LF STRL", "code_information": [{"code": "306501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20GA 1.25IN RADPQ SFSHLD", "code_information": [{"code": "425253502A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20GA X 1 1/4IN PROTECTIV PLUS", "code_information": [{"code": "3066", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20GA X 1 1/4ININTRAVENOUS STRAIGHT POLY URETHANEINTROCAN SAFETY", "code_information": [{"code": "4251644-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20GA X 1IN RADIOPAQUE JELCO", "code_information": [{"code": "405720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20IN X 1.25IN RADIOPAQUE SAFETY", "code_information": [{"code": "306601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20IN X 1IN RADIOPAQUE SAFETY", "code_information": [{"code": "306701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20X1 RADIOPAQUE SAFETY 3067", "code_information": [{"code": "3067", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 22GA X 1 INCH BLUE 3060", "code_information": [{"code": "3060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 22GA X 1IN RADIOPAQUE JELCO", "code_information": [{"code": "405020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.43, "discounted_cash": 3.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 22GA X 1ININTRAVENOUS STRAIGHT POLY URETHANEINTROCAN SAFETY", "code_information": [{"code": "4251628-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.52, "discounted_cash": 2.63, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV PROTECT PLUS 24 X 3 4 3063", "code_information": [{"code": "3063", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV SAFETY 22G X1 FEP STRGHT 4252519-02", "code_information": [{"code": "4252519-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV SFTY 18GX1.25PUR STRGHT 4251687-02", "code_information": [{"code": "4251687-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV SURESITE 14G", "code_information": [{"code": "DYNSCS14114Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV SURESITE 18G", "code_information": [{"code": "DYNSCS18114Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV SURESITE 20G", "code_information": [{"code": "DYNSCS20100Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV SURESITE 22G", "code_information": [{"code": "DYNSCS22100Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV SURESITE 24G", "code_information": [{"code": "DYNSCS24340Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER LUBRISIL 2-WAY 16FR 30CC SILICONE DISP", "code_information": [{"code": "176816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER LUBRISIL 3-WAY 22FR 30CC SILICONE DISP", "code_information": [{"code": "73022L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER LUBRISIL 3-WAY 24FR 30CC SILICONE DISP", "code_information": [{"code": "73024L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER MENTOR 21GA X 1IN", "code_information": [{"code": "MC-12-21", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER MULTI LMN 7FR 16CM CDC-42703-XP1A", "code_information": [{"code": "CDC-42703-XP1A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 407.04, "discounted_cash": 142.46, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PASSER PROGRAMMER CHARGING SYSTEM", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "9771D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 49275.0, "discounted_cash": 17246.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PLUG DYND12200", "code_information": [{"code": "DYND12200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PLUG WITH DRAINAGE TUBE COVER STERILE 510 BUSSE", "code_information": [{"code": "510 BUSSE", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.84, "discounted_cash": 1.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER POLYURETHANE 6FR LOW PROFILE PORTACATH", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "21-4083-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1313.0, "discounted_cash": 459.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER POWERPORT DUO M.R.I IMPLANTABLE PORT WITH ATTACHABLE 9.5F CHRONOFLEX OPEN-ENDED DUAL-LUMEN", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "1829570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PROTECTIV PLUS IV 24 X 3/4 306301", "code_information": [{"code": "306301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PROTECTIV SAFETY IV 22GX1 BLUE", "code_information": [{"code": "306001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PUREWICK FEMALE EXTERNAL BRDPWF030F", "code_information": [{"code": "BRDPWF030F", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PURWICK FEMALE EXTERNAL PWF030F", "code_information": [{"code": "PWF030F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.53, "discounted_cash": 18.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER RUBBER 10FR RED", "code_information": [{"code": "DYND13510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SHEATH URETERAL ACCESS NAVIGATOR 11-13FR 28CM", "code_information": [{"code": "M0062502210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SINUS 3.5MM X 12MM BLLN RELIEVA", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "BC3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1610.0, "discounted_cash": 563.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SINUS BLLN 16MM LEN 7MM DIA SINUSPLASTY SEALED RELIEVA SOLO PRO", "code_information": [{"code": "BC0716SP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1539.0, "discounted_cash": 538.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SPINAL 22GAINJECTION", "code_information": [{"code": "7210320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION 10FR 20IN COILED WITHOUT CONTROL PORT STRL TRI FLOW", "code_information": [{"code": "T61", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION 10FR WITHOUT CONTROL VALVE STRL", "code_information": [{"code": "33000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION 12FR SILICONE", "code_information": [{"code": "DYND11500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION 14FR 20IN COILED WITHOUT CONTROL PORT STRL ST", "code_information": [{"code": "T60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION 8 FR", "code_information": [{"code": "T64C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION 8FR 12IN RADIOPAQUE URETHRAL ROUND RED RUBBER", "code_information": [{"code": "8887660085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION 9.6FR 1.6MM WHT REPAIR HICKMAN", "code_information": [{"code": "601630", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 430.0, "discounted_cash": 150.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION CONTROL PORT 10 FR T61C", "code_information": [{"code": "T61C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.56, "discounted_cash": 1.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION CONTROL PORT 18 FR T62C", "code_information": [{"code": "T62C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SURG 7FR 25GA 210 CM STANDARD CONNINJ LDPRB", "code_information": [{"code": "M00560150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 191.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SYSTEM SAF-T-INTIMA 20GA X 1 383336", "code_information": [{"code": "383336", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER THORACIC 32FR X 10.7MM STR SIX EYE BEVELED CONNECTOR POLYVINYL CHLORIDE", "code_information": [{"code": "88-570556", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER THORACIC STRGHT ARGYLE 32FRX20 8888570556", "code_information": [{"code": "8888570556", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.3, "discounted_cash": 12.36, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URET 4FR 70 CM SPIRAL TIP 2 DRAIN EYE POLYURETHANE STRL DISP", "code_information": [{"code": "137504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URET 5FR 70CM SPIRAL TIP 2 DRAIN EYE POLYURETHANE STRL DISP", "code_information": [{"code": "137505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL .038IN 5.8FR 15FR 75 CM 4 CM HPRS LVNINFLTR GA", "code_information": [{"code": "M0062251210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 684.0, "discounted_cash": 239.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL .038IN 5.8FR 18FR 75 CM 4 CM HPRS LVNINFLTR GA", "code_information": [{"code": "M0062251220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 684.0, "discounted_cash": 239.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL 4FR 70 CM WHISTLE TIP FLEXIMA", "code_information": [{"code": "C1758", "type": "HCPCS"}, {"code": "M0064002201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL 5FR 70 CM CONE TIP FLEXIMA", "code_information": [{"code": "M0064002111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL 5FR 70 CM OPEN END FLEXIMA", "code_information": [{"code": "M0064002011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL 5FR 70 CM WHISTLE TIP FLEXIMA", "code_information": [{"code": "C1758", "type": "HCPCS"}, {"code": "M0064002211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL 6FR 70 CM OPEN END FLEXIMA", "code_information": [{"code": "C1758", "type": "HCPCS"}, {"code": "M0064002021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 47.71, "discounted_cash": 16.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL 8FR X 65 CM CONE TIP PLASTIC STRL DISP", "code_information": [{"code": "334108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.38, "discounted_cash": 29.88, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL WHISTLE TIP 5 FR 136405", "code_information": [{"code": "136405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETH BARDX RED-RUBBER 14FR 056114", "code_information": [{"code": "56114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL .038IN 5.8FR 24FR 75 CM 4 CM HPRS LVNINFLTR GA", "code_information": [{"code": "M0062251240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 677.0, "discounted_cash": 236.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 10FR CONE TIP", "code_information": [{"code": "334110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 10FR RED ALL PURP SURG", "code_information": [{"code": "277710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 10FR RED RUBBER", "code_information": [{"code": "94100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 12FR RED ALL PURP", "code_information": [{"code": "277712", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.57, "discounted_cash": 1.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 12FR RED RUBBER BARDEX", "code_information": [{"code": "94120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 14FR RED GENERAL PURP", "code_information": [{"code": "277714", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 14FR RED RUBBER BARDEX", "code_information": [{"code": "94140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 14IN 12FR SMOOTH TIP OVAL EYES FUNNEL END RED RUBBER STRL", "code_information": [{"code": "DYND13512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 16FR 14IN RED SMOOTH TIP 2 OVAL EYE AND FUNNEL END RADIOPAQUE", "code_information": [{"code": "DYND13516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 16FR RED GENERAL PURP", "code_information": [{"code": "277716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.57, "discounted_cash": 1.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 16FR RED RUBBER", "code_information": [{"code": "94160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 18FR RED ALL PURP", "code_information": [{"code": "277718", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 4FR 70 CM OP END FLXMA", "code_information": [{"code": "M0064002001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.71, "discounted_cash": 16.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 5FR 70 CM STD POLLACK OPEN END POLYVINYLCHLORIDE ACCEPTSINSTRA", "code_information": [{"code": "21305", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 5FR SPIRAL TIP FILIFORM", "code_information": [{"code": "22105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 8FR RED ALL PURP SURG", "code_information": [{"code": "277708", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 8FR RED RUBBER BARDEX", "code_information": [{"code": "56108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL RED RUBBER 16FR/CH 5.3MM 8887660168", "code_information": [{"code": "8887660168", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL REDRUBBER STRL 14FR", "code_information": [{"code": "DYND13514", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.22, "discounted_cash": 1.83, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL REDRUBBER STRL 8FR", "code_information": [{"code": "DYND13508", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER VENOUS 10GA X 3IN PERIPHERAL ANGIOCATH", "code_information": [{"code": "382287", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.14, "discounted_cash": 20.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETERINTRATHECAL ASCENDA", "code_information": [{"code": "C1755", "type": "HCPCS"}, {"code": "8780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETERINTUBATION 19FR 56 CM X 4.7MM USE W/ LARYNGEAL MASK AIRWAYS AINTREE", "code_information": [{"code": "G10789", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.0, "discounted_cash": 59.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETERIZATION URETERAL THROUGH ESTABLISHED URETEROSTOMY 50953", "code_information": [{"code": "50953", "type": "CPT"}, {"code": "1480243", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETERIZATION URETERAL THROUGH URETEROTOMY 50972", "code_information": [{"code": "50972", "type": "CPT"}, {"code": "1480244", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETERIZE FOR URINE SPEC", "code_information": [{"code": "P9612", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.75, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATRIDGE NOVASTITCH PLUS 2 MENISCAL REPAIR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CTX-R001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1255.0, "discounted_cash": 439.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CAUTERY HIGH TEMPERATURE ESCT001H", "code_information": [{"code": "ESCT001H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.63, "discounted_cash": 12.47, "setting": "both", "billing_class": "facility"}]}, {"description": "CAUTERY LOW TEMP FINE TIP", "code_information": [{"code": "ESCT000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CAUTERY OF CERVIX CRYOCAUTERY 57511", "code_information": [{"code": "57511", "type": "CPT"}, {"code": "1480245", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAUTERY OF CERVIX ELECTRO OR THERMAL 57510", "code_information": [{"code": "57510", "type": "CPT"}, {"code": "1480246", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAUTERY OF CERVIX LASER ABLATION 57513", "code_information": [{"code": "57513", "type": "CPT"}, {"code": "1480247", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAUTERY SURG FINE TIP HIGH TEMP FOR EYES MEDI PAK", "code_information": [{"code": "22-101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CAVIWIPES 1 EXTRA LARGE DISINFECTANT", "code_information": [{"code": "13-5150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CAVOPULMONARY SHUNTING", "code_information": [{"code": "33768", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC Auto No Diff", "code_information": [{"code": "85027", "type": "CPT"}, {"code": "3153960", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 218.0, "discounted_cash": 76.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 80.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC WITHOUT PLATELET", "code_information": [{"code": "G0307", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 25.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC w/ Auto Diff", "code_information": [{"code": "85025", "type": "CPT"}, {"code": "633683", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 26.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC/DIFFWBC W/O PLATELET", "code_information": [{"code": "G0306", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 31.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBT 1ST HOUR", "code_information": [{"code": "94644", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBT EACH ADDL HOUR", "code_information": [{"code": "94645", "type": "CPT"}], "standard_charges": [{"minimum": 74.71, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CCIIV3 VAC NO PRSV 0.5 ML IM", "code_information": [{"code": "90661", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CCIIV4 VAC NO PRSV 0.5 ML IM", "code_information": [{"code": "90674", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CCIIV4 VACC ABX FREE IM", "code_information": [{"code": "90756", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CCM/BHI BY RHC/FQHC 20MIN MO", "code_information": [{"code": "G0511", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.76, "maximum": 244.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 155.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 244.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 244.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 244.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CCND1/IGH TRANSLOCATION ALYS", "code_information": [{"code": "81168", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 528.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CCP ANTIBODY", "code_information": [{"code": "86200", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CDP-SOT 6 COND W/I&R", "code_information": [{"code": "92548", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CDP-SOT 6 COND W/I&R MCT&ADT", "code_information": [{"code": "92549", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CDTB&VINCULIN IGG ANTB IA", "code_information": [{"code": "176U", "type": "CPT"}], "standard_charges": [{"minimum": 36.31, "maximum": 92.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEBPA GENE FULL SEQUENCE", "code_information": [{"code": "81218", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 373.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 616.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 970.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 970.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 970.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 348.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 348.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFAZOLIN (ANCEF) 1 GRAM VIAL", "code_information": [{"code": "MED0053", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CEFAZOLIN 500MG VIAL", "code_information": [{"code": "MED0593", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CEFAZOLIN/SW 2GRAMS/20ML SYRINGE (ANCEF)", "code_information": [{"code": "MED0054", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CEFOTAXIME (CLAFORIN) 1GM INJ", "code_information": [{"code": "MED0055", "type": "CDM"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CELL CRYOPRESERVE/STORAGE", "code_information": [{"code": "88240", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELL ENUMERATION & ID", "code_information": [{"code": "86152", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 379.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 639.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1005.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1005.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1005.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 361.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 361.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELL ENUMERATION PHYS INTERP", "code_information": [{"code": "86153", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 90.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELL FUNCTION ASSAY W/STIM", "code_information": [{"code": "86352", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 209.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 346.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 544.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 544.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 544.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 195.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 195.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELL MARKER STUDY", "code_information": [{"code": "88182", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 192.76, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 205.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELL SAVER", "code_information": [{"code": "STANDBY CELLSAVER", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1399.0, "discounted_cash": 489.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CELLERATE RX 28GM GEL", "code_information": [{"code": "C9363", "type": "HCPCS"}, {"code": "CRXG-28GMEA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CELLULITIS WITH MCC", "code_information": [{"code": "602", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8820.35, "maximum": 15142.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8820.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12615.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13876.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15142.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CELLULITIS WITHOUT MCC", "code_information": [{"code": "603", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5192.45, "maximum": 8914.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5192.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7426.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8168.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8914.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CEMENT ANTIBIOTIC 15D RIGHT BONE MEDIUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWK404RA15S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE 1 X 40 RADIOPAQUE GENTAMINCIN PALACOS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-1113-140-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 635.0, "discounted_cash": 222.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE 10CC VOID FILLER", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "800-4001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6362.0, "discounted_cash": 2226.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE 20GM FAST SET CMW 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3322020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 23.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE 40 G HV COBALT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 41.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE 40GM ANTIBIOTIC IMPREGNATED SMARTSET GHV GENTAMICIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "545035500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 503.0, "discounted_cash": 176.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE 40GM GENTAMICIN COBALT HV IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "600-15-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 339.0, "discounted_cash": 118.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE 40GM W/ GENTAMICIN COBALT HV IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 339.0, "discounted_cash": 118.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE 5CC VOID FILLER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "800-400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3182.0, "discounted_cash": 1113.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE FULL DOSE RADIOPAQUE SIMPLEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6191-1-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 170.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE FULL DOSE RADIOPAQUE TBR STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6197-9-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE FULL DOSE SIMPLEX P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6191-1-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 135.0, "discounted_cash": 47.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE HIGH VISCOSITY 1 PACK 40G 5036963", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5036963", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE HIGH VISCOSITY CANCELLOUS KPHX HV-R RADPQ STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C01A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 261.0, "discounted_cash": 91.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE INJECTIBALE HYDROSET XT 15CC 897015", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "897015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6696.0, "discounted_cash": 2343.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE PALACOS LV LOW-VISCOSITY 40GM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5036965", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 43.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE PALACOS LV+G LOW-VISCOSITY W/GENTAMICIN 40GM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5036966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 356.0, "discounted_cash": 124.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE PALACOS MV MEDIUM VISCOSITY 40GM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5051206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 43.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE PALACOS MV+G MEDIUM VISCOSITY W/GENTAMICIN 40GM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5051207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 356.0, "discounted_cash": 124.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE PALACOS R+G HIGH-VISCOSITY W/GENTAMICIN 40GM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5036964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 356.0, "discounted_cash": 124.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE R BIOMET 1X40", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110035368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 41.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE R REFOBACIN 1X40 WITH GENTAMICIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110034355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 339.0, "discounted_cash": 118.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE RADIOPAQUE TROBAMYCIN SIMPLEX P STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6197-9-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE RALLY 40G HIGH VISCOSITY ANTIBIOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71271570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE SIMPLEX HV 6194-1-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6194-1-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE SIMPLEX HV GENTAMICIN 6195-1-010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6195-1-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 339.0, "discounted_cash": 118.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE SIMPLEX HV W/ GENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6195-1-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 302.1, "discounted_cash": 105.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE VERTEBRA RADIOPAQUE VERTAPLEX HV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "406-622-015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE W/ KYPHOLON MIXER KYPHX HV R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C01B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 261.0, "discounted_cash": 91.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE W/ MIXER XPEDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CX01B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT FEMORAL SZ 5 PATELLO JOINT SYS PRECOAT LFT SIDE GENDER SOLS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-5926-015-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4899.0, "discounted_cash": 1714.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT FEMORAL SZ 5 PATELLO JOINT SYS PRECOAT RIGHT SIDE GENDER SOLS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-5926-015-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9798.0, "discounted_cash": 3429.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT PUSHER 4.2 0909-300-400", "code_information": [{"code": "909-300-400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 199.0, "discounted_cash": 69.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT PUSHER 5.0-5.8MM", "code_information": [{"code": "909-300-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 73.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT VERTEPORT MANIFOLD ASSIST 10GR", "code_information": [{"code": "605-410-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.63, "discounted_cash": 560.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENTED SZ 4 RT FEMORAL CRUCIATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1504-00-204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8405.0, "discounted_cash": 2941.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENTED SZ 5 LT FEMORAL CRUCIATE NAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "150400125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 1155.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENTED SZ 6 RT FEMORAL CRUCIATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1504-00-206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8741.0, "discounted_cash": 3059.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENTED SZ 7 LT FEMORAL CRUCIATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1504-00-107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9397.0, "discounted_cash": 3288.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENTED SZ 7 RT FEMORAL CRUCIATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1504-00-207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8405.0, "discounted_cash": 2941.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENTED SZ 9 LT FEMORAL CRUCIATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1504-00-109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTER PIECE 13MM 19-27.15MM ON FIXED END CAP ONE VARIABLE END CAP UU041-01-1927", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "UU041-01-1927", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13600.0, "discounted_cash": 4760.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DIST 8MMINVIS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71313208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CEP72 NUDT15&TPMT GENE ALYS", "code_information": [{"code": "286U", "type": "CPT"}], "standard_charges": [{"minimum": 193.15, "maximum": 1869.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1188.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1869.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1869.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1869.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 193.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 193.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHALIN FLOCULATION TEST", "code_information": [{"code": "P2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 7.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERAMENT BONE VOID FILLER 5ML", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A0210-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2380.0, "discounted_cash": 833.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERCLAGE OF CERVIX DURING PREGNANCY VAGINAL 59320", "code_information": [{"code": "59320", "type": "CPT"}, {"code": "1586536", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3437.0, "discounted_cash": 1202.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1663.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERCLAGE OF CERVIX NONOBSTETRICAL 57700", "code_information": [{"code": "57700", "type": "CPT"}, {"code": "1480248", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEREBROSPINAL FLUID SCAN", "code_information": [{"code": "78630", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1382.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2173.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2173.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2173.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 651.14, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 692.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERT NURSE MIDWIFE SS", "code_information": [{"code": "G0064", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL LYMPHADENECTOMY COMPLETE 38720", "code_information": [{"code": "38720", "type": "CPT"}, {"code": "2013587", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 6784.0, "discounted_cash": 2374.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3283.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL LYMPHADENECTOMY MOD. RADICAL NECK DISSEC. 38724", "code_information": [{"code": "38724", "type": "CPT"}, {"code": "1792990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1725.57, "maximum": 8450.0, "gross_charge": 5229.0, "discounted_cash": 1830.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1725.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL OR THROACIC FACET RADIOFREQUENCY/1ST LEVEL 64626", "code_information": [{"code": "64626", "type": "CPT"}, {"code": "1480249", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1996.0, "maximum": 8450.0, "gross_charge": 2144.0, "discounted_cash": 750.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL OR THROACIC FACET RADIOFREQUENCY/ADDITIONAL LEVEL 64627", "code_information": [{"code": "64627", "type": "CPT"}, {"code": "1480250", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1996.0, "maximum": 8450.0, "gross_charge": 2144.0, "discounted_cash": 750.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [{"code": "472", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18575.66, "maximum": 31889.79, "estimated_discounted_cash": 48619.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18575.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26567.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29223.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31889.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [{"code": "471", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30534.84, "maximum": 52420.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30534.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43671.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48038.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52420.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "473", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15444.74, "maximum": 26514.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15444.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22089.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24298.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26514.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL VISUALIZATION HARNESS", "code_information": [{"code": "PD-33-600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59510", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59515", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY ONLY", "code_information": [{"code": "59514", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [{"code": "784", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6666.36, "maximum": 11444.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6666.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9534.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10487.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11444.48, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 7600.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 7600.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [{"code": "783", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7600.0, "maximum": 19579.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11405.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16311.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17942.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19579.58, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 7600.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 7600.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "785", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5576.89, "maximum": 9574.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5576.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7976.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8773.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9574.14, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 6176.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 6176.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [{"code": "787", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6474.75, "maximum": 11115.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6474.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9260.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10186.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11115.53, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 7600.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 7600.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [{"code": "786", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7600.0, "maximum": 16650.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9698.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13871.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15258.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16650.32, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 7600.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 7600.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "788", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5398.05, "maximum": 9267.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5398.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7720.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8492.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9267.12, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 6176.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 6176.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESSJ THERAPY CATH REMOVAL", "code_information": [{"code": "37214", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CETACAINE SPRAY 5 GM", "code_information": [{"code": "MED0056", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 55.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CFTR GENE COM VARIANTS", "code_information": [{"code": "81220", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 695.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1419.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2231.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2231.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2231.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 801.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 801.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE DUP/DELET VARIANTS", "code_information": [{"code": "81222", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 543.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1109.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1744.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1744.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1744.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 626.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 626.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE FULL SEQUENCE", "code_information": [{"code": "81223", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 623.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1272.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2000.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2000.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2000.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 718.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 718.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE INTRON POLY T", "code_information": [{"code": "81224", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 210.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 430.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 676.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 676.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 676.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81221", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 247.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 389.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 389.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 389.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 139.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 139.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CGH TEST DEVELOPMENTAL DELAY", "code_information": [{"code": "S3870", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHAIR BEACH 100IN X 172IN BLUE FENESTRATED ORTHO DRP ADHSV PLYPRPLN WITHOUT COVE", "code_information": [{"code": "89066", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.0, "discounted_cash": 37.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CHAMBER WIDE EYE POLYPTRAP 1 LF NS", "code_information": [{"code": "ET1111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE G-TUBE TO G-J PERC", "code_information": [{"code": "49446", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE GASTRIC PORT OPEN", "code_information": [{"code": "43888", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF BLADDER TUBE", "code_information": [{"code": "51710", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF CYSTOSTOMY TUBE SIMPLE 51705", "code_information": [{"code": "51705", "type": "CPT"}, {"code": "42604688", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF URETER TUBE/STENT", "code_information": [{"code": "50688", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF WINDPIPE AIRWAY", "code_information": [{"code": "31502", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE STENT VIA TRANSURETH", "code_information": [{"code": "50385", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE URETER STENT PERCUT", "code_information": [{"code": "50382", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHAP SERVICES AT HOSPICE", "code_information": [{"code": "G9473", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHAPLAIN ASSESSMENT", "code_information": [{"code": "Q9001", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHAPLAIN COUNSEL GROUP", "code_information": [{"code": "Q9003", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHAPLAIN COUNSEL INDIVIDU", "code_information": [{"code": "Q9002", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHARGER 16000", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "16000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1050.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHARGER KIT LUMBAR 36000", "code_information": [{"code": "C1822", "type": "HCPCS"}, {"code": "36000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CHARGING SYSTEM 37651", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "37651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHCT FOR MAL HYPERTHERMIA", "code_information": [{"code": "89049", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEM CAUT OF GRANLTJ TISSUE", "code_information": [{"code": "17250", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE DERMAL", "code_information": [{"code": "15789", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE EPIDERM", "code_information": [{"code": "15788", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15792", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15793", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMILUMINESCENT ASSAY", "code_information": [{"code": "82397", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO ANTI-NEOPL SQ/IM", "code_information": [{"code": "96401", "type": "CPT"}], "standard_charges": [{"minimum": 266.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO BY BOTH INFUSION AND O", "code_information": [{"code": "Q0085", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO BY OTHER THAN INFUSION", "code_information": [{"code": "Q0083", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO EXTEND IV INFUS W/PUMP", "code_information": [{"code": "G0498", "type": "HCPCS"}], "standard_charges": [{"minimum": 1365.34, "maximum": 2145.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1365.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2145.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2145.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2145.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO HORMON ANTINEOPL SQ/IM", "code_information": [{"code": "96402", "type": "CPT"}], "standard_charges": [{"minimum": 266.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSE EACH ADDL HR", "code_information": [{"code": "96423", "type": "CPT"}], "standard_charges": [{"minimum": 356.02, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 356.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 559.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 559.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 559.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSION UP TO 1 HR", "code_information": [{"code": "96422", "type": "CPT"}], "standard_charges": [{"minimum": 770.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1211.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1211.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1211.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA PUSH TECNIQUE", "code_information": [{"code": "96420", "type": "CPT"}], "standard_charges": [{"minimum": 468.87, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 468.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 736.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 736.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 736.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL OVER 7", "code_information": [{"code": "96406", "type": "CPT"}], "standard_charges": [{"minimum": 208.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 208.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 327.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 327.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 327.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL UP TO 7", "code_information": [{"code": "96405", "type": "CPT"}], "standard_charges": [{"minimum": 266.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUS EACH ADDL SEQ", "code_information": [{"code": "96417", "type": "CPT"}], "standard_charges": [{"minimum": 305.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 305.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 479.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 479.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 479.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUSION 1 HR", "code_information": [{"code": "96413", "type": "CPT"}], "standard_charges": [{"minimum": 630.98, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 630.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 991.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 991.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 991.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUSION ADDL HR", "code_information": [{"code": "96415", "type": "CPT"}], "standard_charges": [{"minimum": 136.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 136.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH ADDL DRUG", "code_information": [{"code": "96411", "type": "CPT"}], "standard_charges": [{"minimum": 262.22, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 412.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 412.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 412.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH SNGL DRUG", "code_information": [{"code": "96409", "type": "CPT"}], "standard_charges": [{"minimum": 484.75, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 484.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 761.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 761.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 761.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO PROLONG INFUSE W/PUMP", "code_information": [{"code": "96416", "type": "CPT"}], "standard_charges": [{"minimum": 632.57, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 632.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 994.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 994.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 994.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENER MUSCLE LARYNX EMG", "code_information": [{"code": "64617", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 1-4 EA", "code_information": [{"code": "64643", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> EA", "code_information": [{"code": "64645", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> MUS", "code_information": [{"code": "64644", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREMITY 1-4", "code_information": [{"code": "64642", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64650", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64653", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC MIGRAINE", "code_information": [{"code": "64615", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC NECK DYSTON", "code_information": [{"code": "64616", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV SALIV GLANDS", "code_information": [{"code": "64611", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 6/>", "code_information": [{"code": "64647", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF INTERNAL ANAL SPHINCTER 46505", "code_information": [{"code": "46505", "type": "CPT"}, {"code": "1480257", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF MUSCLE(S);MUSCLE(S) INNERVATED BY FACIAL NERVE 64612", "code_information": [{"code": "64612", "type": "CPT"}, {"code": "1480259", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF MUSCLE(S);NECK MUSCLE(S) 64613", "code_information": [{"code": "1480260", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF TRUNK MUSCLES; 1-5 MUSCLES 64646", "code_information": [{"code": "64646", "type": "CPT"}, {"code": "18370603", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTAXIS ASSAY", "code_information": [{"code": "86155", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY BY INFUSION", "code_information": [{"code": "Q0084", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY DRUG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INFUSION METHOD", "code_information": [{"code": "96425", "type": "CPT"}], "standard_charges": [{"minimum": 816.91, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 816.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1283.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1283.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1283.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INJECTION", "code_information": [{"code": "96542", "type": "CPT"}], "standard_charges": [{"minimum": 189.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 189.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INTO CNS", "code_information": [{"code": "96450", "type": "CPT"}], "standard_charges": [{"minimum": 360.78, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 360.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 566.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 566.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 566.94, "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": 34668.84, "maximum": 59517.79, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34668.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49583.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54542.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59517.79, "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": 13748.8, "maximum": 23603.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13748.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19663.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21630.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23603.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "839", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9046.64, "maximum": 15530.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9046.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12938.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14232.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [{"code": "847", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8127.5, "maximum": 13952.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8127.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11624.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12786.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13952.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [{"code": "846", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16259.25, "maximum": 27913.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16259.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23254.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25579.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27913.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "848", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6279.48, "maximum": 10780.31, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6279.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8981.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9879.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10780.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTX ADMN PERTL CAV IMPL", "code_information": [{"code": "96446", "type": "CPT"}], "standard_charges": [{"minimum": 125.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 125.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEST PAIN", "code_information": [{"code": "313", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4388.28, "maximum": 7533.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4388.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6276.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6903.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7533.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEST WALL MANIPULATION", "code_information": [{"code": "94667", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEST WALL MANIPULATION", "code_information": [{"code": "94668", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHGE URTR STENT W/ DIL STRIC", "code_information": [{"code": "C7549", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIKUNGUNYA VACCINE LIVE IM", "code_information": [{"code": "90589", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [{"code": "18", "type": "MS-DRG"}], "standard_charges": [{"minimum": 227808.96, "maximum": 391091.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 227808.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 325815.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 358397.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 391091.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHIMERISM ANAL NO CELL SELEC", "code_information": [{"code": "81267", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 320.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 529.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 831.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 831.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 831.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIMERISM ANAL W/CELL SELECT", "code_information": [{"code": "81268", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 402.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 665.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1045.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1045.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1045.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 375.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 375.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIPS 30CC CANELLOUS OBS-330F", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "OBS-330F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2966.0, "discounted_cash": 1038.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CHIPS ALLOGRAFT CANCELLOUS 1-4MM 30CC OSCF2003-30", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "OSCF2003-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2554.0, "discounted_cash": 893.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CHIPS CANCELOUS 30CC 1-4MM", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "7770230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 842.6, "discounted_cash": 294.91, "setting": "both", "billing_class": "facility"}]}, {"description": "CHIROPRACT MANJ 1-2 REGIONS", "code_information": [{"code": "98940", "type": "CPT"}], "standard_charges": [{"minimum": 108.13, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIROPRACT MANJ 3-4 REGIONS", "code_information": [{"code": "98941", "type": "CPT"}], "standard_charges": [{"minimum": 108.13, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIROPRACT MANJ XTRSPINL 1/>", "code_information": [{"code": "98943", "type": "CPT"}], "standard_charges": [{"minimum": 106.5, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 167.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 167.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 167.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIROPRACTIC MANJ 5 REGIONS", "code_information": [{"code": "98942", "type": "CPT"}], "standard_charges": [{"minimum": 108.13, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIROPRACTIC SS", "code_information": [{"code": "G0065", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA ANTIBODY", "code_information": [{"code": "86631", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 47.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA CULTURE", "code_information": [{"code": "87110", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 78.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 78.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 78.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA IGM ANTIBODY", "code_information": [{"code": "86632", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA TRACHOMATIS AG IF", "code_information": [{"code": "87270", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLMYD PNEUM DNA AMP PROBE", "code_information": [{"code": "87486", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLMYD PNEUM DNA DIR PROBE", "code_information": [{"code": "87485", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLMYD PNEUM DNA QUANT", "code_information": [{"code": "87487", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH AG IA", "code_information": [{"code": "87320", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH ASSAY W/OPTIC", "code_information": [{"code": "87810", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 44.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 141.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 141.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 141.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH DNA DIR PROBE", "code_information": [{"code": "87490", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 91.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 91.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 91.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH DNA QUANT", "code_information": [{"code": "87492", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 136.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 214.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 214.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 214.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 76.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 76.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLORHEXIDINE GLUCONATE ORAL 0.12%/480ML ORAL RINSE", "code_information": [{"code": "MED0058", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CHLORHEXIDINE GLUCONATE TOPICAL 4%/118ML LIQUID (HIBICLENS)", "code_information": [{"code": "MED0057", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CHMOTX ADMN PLRL CAV THRCNTS", "code_information": [{"code": "96440", "type": "CPT"}], "standard_charges": [{"minimum": 567.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 567.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 891.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 891.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 891.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY 47600", "code_information": [{"code": "47600", "type": "CPT"}, {"code": "1480261", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1792.56, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1792.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY CHOLANGIOGRAM 47605", "code_information": [{"code": "47605", "type": "CPT"}, {"code": "1480262", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY CHOLANGIOGRAM LAPRASCOPIC 47563", "code_information": [{"code": "47563", "type": "CPT"}, {"code": "1480263", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [{"code": "415", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12358.83, "maximum": 21217.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12358.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17675.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19443.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21217.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "414", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22070.95, "maximum": 37890.34, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22070.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31566.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34722.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37890.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "416", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8651.85, "maximum": 14853.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8651.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12374.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13611.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14853.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY LAPAROSCOPIC 47562", "code_information": [{"code": "47562", "type": "CPT"}, {"code": "1480264", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY LAPAROSCOPIC WITH COMMON DUCT EXPLORATION 47564", "code_information": [{"code": "47564", "type": "CPT"}, {"code": "1480265", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY LAPRASCOPIC W/GUIDED TRANSHEPATIC CHOLANGIOGRAPHY 47560", "code_information": [{"code": "1480266", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY W/EXP. COMM. DUCT W/TRANDUODENAL SPHINTEROTOMY/PLASTY W/ OR W/O CHOLANG. 47620", "code_information": [{"code": "47620", "type": "CPT"}, {"code": "42604689", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2146.32, "maximum": 8450.0, "gross_charge": 6504.0, "discounted_cash": 2276.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2146.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [{"code": "412", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13854.03, "maximum": 23783.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13854.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19814.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21795.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23783.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [{"code": "411", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22832.54, "maximum": 39197.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22832.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32655.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35920.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39197.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "413", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10529.06, "maximum": 18075.79, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10529.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15058.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16564.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18075.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHOLERA VACCINE LIVE ORAL", "code_information": [{"code": "90625", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLINESTERASE CHALLENGE", "code_information": [{"code": "95857", "type": "CPT"}], "standard_charges": [{"minimum": 135.08, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 135.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 212.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 212.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 212.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHORD BOVIE MONOPOLAR", "code_information": [{"code": "E0510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CHORION BIOPSY", "code_information": [{"code": "59015", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHORNC GONADOTROPIN HCG IA", "code_information": [{"code": "167U", "type": "CPT"}], "standard_charges": [{"minimum": 10.82, "maximum": 10.82, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT PHYS 1ST 30", "code_information": [{"code": "99491", "type": "CPT"}], "standard_charges": [{"minimum": 370.31, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 370.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 581.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 581.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 581.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT PHYS EA ADDL", "code_information": [{"code": "99437", "type": "CPT"}], "standard_charges": [{"minimum": 239.99, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 239.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 377.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 377.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 377.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT STAF EA ADDL", "code_information": [{"code": "99439", "type": "CPT"}], "standard_charges": [{"minimum": 128.73, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 128.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 202.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 202.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 202.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT STAFF 1ST 20", "code_information": [{"code": "99490", "type": "CPT"}], "standard_charges": [{"minimum": 143.06, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 143.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMATOGRAM ASSAY SUGARS", "code_information": [{"code": "84375", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 48.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 156.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 156.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 156.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 56.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMIC GUT 4-0 1X18IN 45CM P-3 C1654N", "code_information": [{"code": "C1654N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.7, "discounted_cash": 10.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CHROMOGENIC SUBSTRATE ASSAY", "code_information": [{"code": "85130", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 47.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYS AMNIOTIC", "code_information": [{"code": "88269", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 256.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 442.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 696.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 696.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 696.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYS PLACENTA", "code_information": [{"code": "88267", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 277.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 756.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 756.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 756.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 271.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 271.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 100", "code_information": [{"code": "88249", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 267.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 441.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 694.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 694.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 694.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 249.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 249.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 15-20", "code_information": [{"code": "88262", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 192.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 503.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 503.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 503.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 20-25", "code_information": [{"code": "88245", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 267.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 441.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 694.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 694.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 694.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 249.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 249.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 20-25", "code_information": [{"code": "88264", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 192.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 368.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 579.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 579.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 579.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 208.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 208.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 45", "code_information": [{"code": "88263", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 231.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 383.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 602.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 602.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 602.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 216.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 216.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 5", "code_information": [{"code": "88261", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 330.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 674.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1060.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1060.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1060.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 380.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 380.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 50-100", "code_information": [{"code": "88248", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 267.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 441.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 694.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 694.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 694.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 249.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 249.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME BANDING STUDY", "code_information": [{"code": "88283", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 105.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 174.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 275.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 275.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 275.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 98.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 98.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME COUNT ADDITIONAL", "code_information": [{"code": "88285", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 107.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 107.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 107.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME KARYOTYPE STUDY", "code_information": [{"code": "88280", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 48.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 48.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME STUDY ADDITIONAL", "code_information": [{"code": "88289", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 53.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 138.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 138.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 138.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 49.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 49.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOTUBATION OF OVIDUCT 58350", "code_information": [{"code": "58350", "type": "CPT"}, {"code": "1480269", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [{"code": "191", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5379.2, "maximum": 9234.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5379.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7693.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8462.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9234.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [{"code": "190", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6843.98, "maximum": 11749.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6843.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9788.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10767.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11749.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC", "code_information": [{"code": "192", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4231.33, "maximum": 7264.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4231.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6051.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6656.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7264.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRONIC PAIN MGMT 30 MINS", "code_information": [{"code": "G3002", "type": "HCPCS"}], "standard_charges": [{"minimum": 344.86, "maximum": 541.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 344.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRONIC PAIN MGMT ADDL 15M", "code_information": [{"code": "G3003", "type": "HCPCS"}], "standard_charges": [{"minimum": 119.2, "maximum": 187.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 119.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIF 10 DEG -05 20-1005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-1005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CIF 10 DEG -07 20-1007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-1007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2884.0, "discounted_cash": 1009.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CILLIARY BODY DESTRUCTION;CRYOTHERAPY 66720", "code_information": [{"code": "66720", "type": "CPT"}, {"code": "1480270", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CILLIARY BODY DESTRUCTION;CYCLOPHOTOCOAGULATION TRANSSCLERAL 66710", "code_information": [{"code": "66710", "type": "CPT"}, {"code": "1480272", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CINCH KNEE MENISCAL CURVED TIP W/ LOW PROFILE PEEK IMPLANTS W/ PRETIED 2-0 FIBER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 611.0, "discounted_cash": 213.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CINE/VIDEO X-RAYS", "code_information": [{"code": "76120", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 219.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 233.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CINE/VIDEO X-RAYS ADD-ON", "code_information": [{"code": "76125", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 99.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 99.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 99.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CIPRODEX 7.5ML OTIC", "code_information": [{"code": "MED0062", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 205.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN/CILOXAN OPHTHALMIC", "code_information": [{"code": "MED0060", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN/DEXAMETHASONE (CIPRODEX) OTIC 7.5ML", "code_information": [{"code": "MED0061", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 205.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA 72IN 3LT UNILIMB W/ GAS SAMPLING LINE LF ADLT", "code_information": [{"code": "DYNJAAF6400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA ADULT LF", "code_information": [{"code": "DYNJAAF6410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA PEDI F2", "code_information": [{"code": "DYNJAPF6002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA SNGL LIMB COAXIAL ULTRAFLEX FLEX2 ADLT", "code_information": [{"code": "6753F-19021Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 40IN ANESTHESIA W/ SAMPLING ELBOW PORT AND FILTER PEDF2 PEDI", "code_information": [{"code": "PD140-6121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 40IN UNIVSL W/ SAMPLE ELBOW PORT FLEX2 LF PEDI", "code_information": [{"code": "PDP140-6121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 60IN 1L BLUE UNIVSL W/ SAMPLE ELBOW PORT AND FILTER AND 1L BAG", "code_information": [{"code": "PDB160-6121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 70IN UNIVERSAL ANESTHESIA SNGL LIMB SNGL LIMB W/ FILTER AND BA", "code_information": [{"code": "DF370-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.06, "discounted_cash": 8.07, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 70IN UNIVSL SNGL LIMB ANES W/ FILTER AND 2L BAG MASK AND SAMPL", "code_information": [{"code": "DF475V-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING UNIVSL COAXIAL FILTER W/ GAS SAMPLING LINE ELBOW PORT AND BAG", "code_information": [{"code": "PD160-6121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT GAS SAMPLING LINE 0.05\" 7066", "code_information": [{"code": "7066", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.39, "discounted_cash": 1.54, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT MODIFIED JACKSON REES", "code_information": [{"code": "DYNJAAJRS1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT PEDIATRC UNIVERSAL F2 LATEX PDP160-6121", "code_information": [{"code": "PDP160-6121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.24, "discounted_cash": 10.93, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT UNIVERSAL FLEX2 DF475-6121Z", "code_information": [{"code": "DF475-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCULAR STAR LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "G828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "286", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12995.11, "maximum": 22309.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12995.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18585.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20444.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22309.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [{"code": "287", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6783.15, "maximum": 11644.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6783.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9701.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10671.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11644.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION USING CLAMP OR RING BLOCK 54150", "code_information": [{"code": "54150", "type": "CPT"}, {"code": "1480275", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION-SURGICAL EXCISION-NEONATE 54160", "code_information": [{"code": "54160", "type": "CPT"}, {"code": "1480273", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION-SURGICAL EXCISION-OLDER THAN 28 DAYS 54161", "code_information": [{"code": "54161", "type": "CPT"}, {"code": "1480274", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "433", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6264.88, "maximum": 10755.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6264.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8960.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9856.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10755.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [{"code": "432", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11440.91, "maximum": 19641.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11440.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16362.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17999.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19641.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC", "code_information": [{"code": "434", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3775.72, "maximum": 6481.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3775.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5400.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5940.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6481.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CKMB", "code_information": [{"code": "82553", "type": "CPT"}, {"code": "1221822", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CL MULT VSD W/REM PUL BAND", "code_information": [{"code": "33677", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLAMP ADJUSTABLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "393.64", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1205.0, "discounted_cash": 421.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP ANGULAN CORRECTION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9000-ACC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP COMBINATION LG FXTNINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "390.005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1794.0, "discounted_cash": 627.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP FIXATION HOFFMAN II TITANIUM MULTI PIN STRAIGHT MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4960-2-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1199.0, "discounted_cash": 419.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP GRASPING 10MM X 31CM ENDO BABCOCK 34 X 44MM JAW 360DEG ROTATATION", "code_information": [{"code": "174001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 541.0, "discounted_cash": 189.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP NECK ARTERY", "code_information": [{"code": "61703", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLAMP PIN 5H W/ 11MM BARS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4922-2-240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2098.0, "discounted_cash": 734.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP QUICK 10.5MM TO 10.5MM JET XINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71067374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2585.0, "discounted_cash": 904.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP RING SPEED FRAME", "code_information": [{"code": "200-SFC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5639.0, "discounted_cash": 1973.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP SURG 10.5MM TO 5MM QUICK JET X", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71067372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2585.0, "discounted_cash": 904.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMPS RAIL COMPLETE 2 HOLE DNE-6000-101", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-6000-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CLARIFIX CRYOTHERAPY DEVICE", "code_information": [{"code": "CFX-0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2820.0, "discounted_cash": 987.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLARIFIX CRYOTHERAPY DEVIDE CFX-1000", "code_information": [{"code": "CFX-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3420.0, "discounted_cash": 1197.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAVICULECTOMY PARTIAL 23120", "code_information": [{"code": "23120", "type": "CPT"}, {"code": "1480276", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLAVICULECTOMY TOTAL 23125", "code_information": [{"code": "23125", "type": "CPT"}, {"code": "1480277", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLAW II 2 HOLE 15MM ORTHOLOC 3DSI 40240215", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40240215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3518.0, "discounted_cash": 1231.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAW II 4 HOLE 30MM ORTHOLOC 3DSI 40240430", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40240430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4229.0, "discounted_cash": 1480.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAW II STAR 10 DRIVER SELF RETAINING 40251100", "code_information": [{"code": "40251100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 729.0, "discounted_cash": 255.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEAN OUT MASTOID CAVITY", "code_information": [{"code": "69220", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEANER ANTI FOG 6ML BTL FOAM PAD", "code_information": [{"code": "600-AF031-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANER ANTI FOG NON IRRITATING W/ FOAM PAD MR CLR LF STRL BT DISP", "code_information": [{"code": "AF031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANER TIP ELECTROSURGICAL PENCIL LECTROBRASIVE LF STRL DISP", "code_information": [{"code": "E2401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANSER WND 20 ML GENERAL PURP POUR BOTTLE FOR USE ON ACUTE NON SURG TRAUMATIC", "code_information": [{"code": "121222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEAR EYELID GLAND W/HEAT", "code_information": [{"code": "207T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31720", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31725", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEOCIN/CLINDAMYCIN 900MG/6ML", "code_information": [{"code": "MED0250", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIN IND IMG HD TRAUMA", "code_information": [{"code": "G2187", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLIN PT NO REF", "code_information": [{"code": "G0038", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLINCH ENDOSCOPIC II 5MM 174317", "code_information": [{"code": "174317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 737.0, "discounted_cash": 257.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 150MG/ML IV SOL 2ML", "code_information": [{"code": "MED0611", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 600MG/4ML IV SOL", "code_information": [{"code": "MED0647", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 600MG/50ML D5W IV SOL", "code_information": [{"code": "MED0580", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN/CLEOCIN 2% VAG CREAM 40GM", "code_information": [{"code": "MED0063", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 223.0, "discounted_cash": 78.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINICAL SOCIAL WORK SS", "code_information": [{"code": "G0066", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLIP APPLIER LIGACLIP ENDO ROTATNG S ER420", "code_information": [{"code": "ER420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP ENDO LG 10MM PISTOL GRIP APPLIE 176625", "code_information": [{"code": "176625", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 594.0, "discounted_cash": 207.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP ENDOSCOPIC III 5MM SINGLE USE 176630", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "176630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP FXTN 10MM X 10MM X 10MM EASYCLIP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EZM10-10-10S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2507.0, "discounted_cash": 877.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP HEMOSTATIC 235 CM 2.8MM 11MM OPENING APPLIER RESOLUTION RADIOPAQUE", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "M00522610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP HEMOSTATIC 235 CM HEMOCLIPS RESOLUTION", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "2261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING 5MM ENDO W/ SUPERINTERLOCK ENDO CLIP DISP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "176620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 761.0, "discounted_cash": 266.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING LG ENDOINT HEMOCLIP LF TI STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "523170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING MED BLUE SURG GRADE TANTALUM HEMOCLIP", "code_information": [{"code": "A4649", "type": "HCPCS"}, {"code": "523100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING SM PILLING TANTALUM", "code_information": [{"code": "W523100", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATION SYS SM TUBAL FOR FEMALE CONTRACEPTION FILSHIE TI", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "AVM-851J", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 323.2, "discounted_cash": 113.12, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LOCKING LARGE AXTI 64-01", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "64-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP MANTIS 235CM M00521420", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "M00521420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP RESOLUTION BX 20 M00522612", "code_information": [{"code": "M00522612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP STIMULATING SAFE OP AIX1310-S", "code_information": [{"code": "AIX1310-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 909.22, "discounted_cash": 318.23, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP STIMULATING SAFE OP AIX1311-S", "code_information": [{"code": "AIX1311-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 909.22, "discounted_cash": 318.23, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP SUTURE ENDO ABS 2-0/3-0/4-0 VICRYL XC200", "code_information": [{"code": "XC200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP WECK HORIZON TI LG 24 CLIPS/POUCH 004204", "code_information": [{"code": "4204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP WECK HORIZON TI MED 24 CLIPS/POUCH 002204", "code_information": [{"code": "2204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP WECK HORIZON TI SMALL 24 CLIPS/POUCH 001204", "code_information": [{"code": "1204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS EXTRA LIGATING TITANUM LIGACLIP MD LT200", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "LT200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS EXTRA LIGATING TITANUM LIGACLIP SM LT100", "code_information": [{"code": "LT100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOBETASOL TOP 0.05% CREAM 30 GM", "code_information": [{"code": "MED0821", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE 100 MCG/ML INTRATHECAL SOL 10 ML", "code_information": [{"code": "MED0687", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSE BLADDER-UTERUS FISTULA", "code_information": [{"code": "51920", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE BRONCHIAL FISTULA", "code_information": [{"code": "32815", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE CHEST AFTER DRAINAGE", "code_information": [{"code": "32810", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE KIDNEY-SKIN FISTULA", "code_information": [{"code": "50520", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MASTOID FISTULA", "code_information": [{"code": "69700", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD", "code_information": [{"code": "33675", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD W/RESECTION", "code_information": [{"code": "33676", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50525", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50526", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68760", "type": "CPT"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68761", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR SYSTEM FISTULA", "code_information": [{"code": "68770", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION ACROMIOCLAVICULAR DISLOCATION W/O MANIPULATION 23540", "code_information": [{"code": "23540", "type": "CPT"}, {"code": "1480278", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION ARTICULAR FRACTURE 26740", "code_information": [{"code": "26740", "type": "CPT"}, {"code": "1480279", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION CARPAL BONE W/ MANIPULATION 26742", "code_information": [{"code": "26742", "type": "CPT"}, {"code": "1480280", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION CARPAL SCAPHOID FRACTRUE W/MANIPULATION 25624", "code_information": [{"code": "25624", "type": "CPT"}, {"code": "1480281", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION CARPAL SCAPHOID FRACTRUE W/O MANIPULATION 25622", "code_information": [{"code": "25622", "type": "CPT"}, {"code": "1480282", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION CLAVICULAR FRACTURE W/O MANIPULATION 23500", "code_information": [{"code": "23500", "type": "CPT"}, {"code": "1480283", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION DISTAL EXTENSOR TENDON W/ OR W/O PINNING 26432", "code_information": [{"code": "26432", "type": "CPT"}, {"code": "1480284", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION DISTAL FEMUR EPIPHYSEAL SEPARATION 27516", "code_information": [{"code": "27516", "type": "CPT"}, {"code": "1480287", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION DISTAL FIBULA W/MANIPULATION 27510", "code_information": [{"code": "27510", "type": "CPT"}, {"code": "1480289", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION DISTAL PHALANGEAL FX W/MANIPULATION 27755", "code_information": [{"code": "27755", "type": "CPT"}, {"code": "1480290", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION DISTAL PHALANGEAL FX W/O MANIPULATION 26750", "code_information": [{"code": "26750", "type": "CPT"}, {"code": "1480291", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION DISTAL RADIOULNAR FX W/MANIPULATION 25675", "code_information": [{"code": "25675", "type": "CPT"}, {"code": "1480292", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION DISTAL RADIOULNAR FX W/O MANIPULATION", "code_information": [{"code": "25680", "type": "CPT"}, {"code": "1480293", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION DISTAL TIBIA 27824", "code_information": [{"code": "27824", "type": "CPT"}, {"code": "1480294", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION DISTAL TIBIA WITH MANIPULATION 27825", "code_information": [{"code": "27825", "type": "CPT"}, {"code": "11710549", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "gross_charge": 1643.0, "discounted_cash": 575.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 795.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION ELBOW FRACTURE MONTEGGIA FX 24620", "code_information": [{"code": "24620", "type": "CPT"}, {"code": "1480295", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION ELBOW W/ANESTHESIA 24605", "code_information": [{"code": "24605", "type": "CPT"}, {"code": "1480296", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION FEMUR W/MANIPULATION 27502", "code_information": [{"code": "27502", "type": "CPT"}, {"code": "1480297", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION FEMUR W/O MANIPULATION 27500", "code_information": [{"code": "27500", "type": "CPT"}, {"code": "1480298", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION FIBULA W/O MANIPULATION 27780", "code_information": [{"code": "27780", "type": "CPT"}, {"code": "1480299", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION GREATER HUMERAL TUBEROSITY W/MANIPULATION 23625", "code_information": [{"code": "23625", "type": "CPT"}, {"code": "1480300", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION HUMERAL SHAFT W/MANIPULATION 24505", "code_information": [{"code": "24505", "type": "CPT"}, {"code": "1480301", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION HUMERAL SHAFT W/O MANIPULATION 24500", "code_information": [{"code": "24500", "type": "CPT"}, {"code": "1480302", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION INTERPHALANGEAL DISLOCATION FINGER W/ANESTHESIA 26775", "code_information": [{"code": "26775", "type": "CPT"}, {"code": "1480303", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION INTERPHALANGEAL DISLOCATIONFINGER W/O ANESTHESIA 26770", "code_information": [{"code": "26770", "type": "CPT"}, {"code": "1480304", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION LUNATE DISLOCATION W/MANIPUATION 25690", "code_information": [{"code": "25690", "type": "CPT"}, {"code": "1480305", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION MANDIBLE FX W/INTERDENTAL FIXATION 21453", "code_information": [{"code": "21453", "type": "CPT"}, {"code": "1480306", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION MANDIBLE W/MANIPULATION 21451", "code_information": [{"code": "21451", "type": "CPT"}, {"code": "1480307", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION METACARPAL FX W/MANIPULATION 26605", "code_information": [{"code": "26605", "type": "CPT"}, {"code": "1480308", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION METACARPOPHALANGEAL DISLOCATION W/ANES. 26705", "code_information": [{"code": "26705", "type": "CPT"}, {"code": "1480309", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION NASAL FRACTURE W OR W/O STABILIZATION 21337", "code_information": [{"code": "21337", "type": "CPT"}, {"code": "1480310", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION OF DISTAL RADIUS FRACTURE W/MANIPULATION 25605", "code_information": [{"code": "25605", "type": "CPT"}, {"code": "1480314", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION OF DISTAL RADIUS FRACTURE W/O MANIPULATION 25600", "code_information": [{"code": "25600", "type": "CPT"}, {"code": "1480315", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION PHALANGEAL SHAFT FX W/MANIPULATION 26725", "code_information": [{"code": "26725", "type": "CPT"}, {"code": "1480317", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION PHALANGEAL SHAFT FX W/O MANIPULATION 26720", "code_information": [{"code": "26720", "type": "CPT"}, {"code": "1480316", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION POST HIP ARTHROPLASTY W/ ANESTHESIA 27266", "code_information": [{"code": "27266", "type": "CPT"}, {"code": "1480318", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION PROXIMAL FIBULA W/MANIPULATION 27781", "code_information": [{"code": "27781", "type": "CPT"}, {"code": "1480319", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION RADIAL & ULNA SHAFT W/ MANIPULATION 25565", "code_information": [{"code": "25565", "type": "CPT"}, {"code": "1480320", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION RADIAL HEAD OR NECK W/MANIPULATION 24655", "code_information": [{"code": "24655", "type": "CPT"}, {"code": "1480321", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION RADIAL HEAD OR NECK W/O MANIPULATION 24650", "code_information": [{"code": "24650", "type": "CPT"}, {"code": "1480322", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION RADIUS W/MANIPULATION 25505", "code_information": [{"code": "25505", "type": "CPT"}, {"code": "1480323", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION RADIUS W/O MANIPULATION 25500", "code_information": [{"code": "25500", "type": "CPT"}, {"code": "1480324", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION SHOULDER DISLOCATION W/ANESTHESIA 23655", "code_information": [{"code": "23655", "type": "CPT"}, {"code": "1480325", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION SHOULDER DISLOCATION W/O ANESTHESIA 23650", "code_information": [{"code": "23650", "type": "CPT"}, {"code": "1480326", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION SUPRACONDYLAR HUMERAL FRACTURE W/MANIPULATION 24535", "code_information": [{"code": "24535", "type": "CPT"}, {"code": "1480327", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION TIBIA W/MANIPULATION 27752", "code_information": [{"code": "27752", "type": "CPT"}, {"code": "1480328", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION TIBIAL PLATEAU W/MANIPULATION/TRACTION 27532", "code_information": [{"code": "27532", "type": "CPT"}, {"code": "1480329", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION TIBIAL PLATEAU W/O MANIPULATION 27530", "code_information": [{"code": "27530", "type": "CPT"}, {"code": "1480330", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION ULNA PROXIMAL W/O MANIPULATION 24670", "code_information": [{"code": "24670", "type": "CPT"}, {"code": "1480331", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION ULNAR SHAFT W/MANIPULATION 25535", "code_information": [{"code": "25535", "type": "CPT"}, {"code": "1480332", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION ULNAR SHAFT W/O MANIPULATION 25530", "code_information": [{"code": "25530", "type": "CPT"}, {"code": "1480333", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION ULNAR STYLOID FRACTURE 25650", "code_information": [{"code": "25650", "type": "CPT"}, {"code": "1480334", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT CARPOMETACARPAL DISLOC. OTHER THAN THUMB W/MANIPULATION EA JT. REQ. ANES. 26675", "code_information": [{"code": "26675", "type": "CPT"}, {"code": "2189124", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT DISTAL FIBULA W/O MANIPULATION 27786", "code_information": [{"code": "27786", "type": "CPT"}, {"code": "1480336", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT FRACTURE PHALANX/PHALANGES OTHER THAN GREAT TOE W/MANIPULATION 28515", "code_information": [{"code": "28515", "type": "CPT"}, {"code": "13495688", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1347.0, "discounted_cash": 471.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 651.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT NASAL FRACTURE W/O STABILIZATION 21315", "code_information": [{"code": "21315", "type": "CPT"}, {"code": "1480312", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION 21320", "code_information": [{"code": "21320", "type": "CPT"}, {"code": "1480313", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF BIMALLEOLAR ANKLE FX W/MANIPULATION 27810", "code_information": [{"code": "27810", "type": "CPT"}, {"code": "8480476", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF CARPAL BONE FRACTURE W/MANIPULATION EA. BONE 25635", "code_information": [{"code": "25635", "type": "CPT"}, {"code": "12315336", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF CARPAL BONE FRACTURE; WITHOUT MANIPULATION; EA BONE 25630", "code_information": [{"code": "25630", "type": "CPT"}, {"code": "42663783", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1330.0, "discounted_cash": 465.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 643.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF DISTAL PHALANGEAL FX FINGER OR THUMB W/MANIPULATION 26755", "code_information": [{"code": "26755", "type": "CPT"}, {"code": "1941660", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1330.0, "discounted_cash": 465.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 643.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF FRACTURE ORBIT W/ MANIPULATION 21401", "code_information": [{"code": "21401", "type": "CPT"}, {"code": "1481720", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF INTERCONDYLAR SPINE AND/OR TUBEROSITY FRACTURE OF KNEE 27538", "code_information": [{"code": "27538", "type": "CPT"}, {"code": "44640902", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION REQ. ANES. 28665", "code_information": [{"code": "28665", "type": "CPT"}, {"code": "2189131", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE W/O MANIPULATION 27760", "code_information": [{"code": "27760", "type": "CPT"}, {"code": "15476555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 127.33, "maximum": 8450.0, "gross_charge": 263.08, "discounted_cash": 92.08, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 127.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF METACARPAL FX SINGLE W/O MANIPULATION EA. BONE 26600", "code_information": [{"code": "26600", "type": "CPT"}, {"code": "9033732", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF METATARSAL FX W/MANIPULATION EACH 28475", "code_information": [{"code": "28475", "type": "CPT"}, {"code": "8822133", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1892.0, "discounted_cash": 662.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 915.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF PROXIMAL HUMERUS W/MANIPULATION 23605", "code_information": [{"code": "23605", "type": "CPT"}, {"code": "4327140", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.92, "maximum": 8450.0, "gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF TRIMALLEOLAR FX W/ OR W/O MANIPULATION 27818", "code_information": [{"code": "27818", "type": "CPT"}, {"code": "9017537", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "gross_charge": 1844.0, "discounted_cash": 645.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 892.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF ULNAR FRACTURE PROXIMAL END W/MANIPULATION 24675", "code_information": [{"code": "24675", "type": "CPT"}, {"code": "42609640", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "gross_charge": 1893.0, "discounted_cash": 662.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 916.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX NOSE/JAW FX", "code_information": [{"code": "21345", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX VERT FX W/MANJ", "code_information": [{"code": "22315", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX VERT FX W/O MANJ", "code_information": [{"code": "22310", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM AG IA", "code_information": [{"code": "87324", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM TOXIN A W/OPTIC", "code_information": [{"code": "87803", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE DEVICE PMI PUNCTURE DISP", "code_information": [{"code": "PMITCSG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSURE DEVICE V-LOC 90 3-0 VLOCM0134", "code_information": [{"code": "VLOCM0134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSURE ENTEROSTOMY W/RESECTION AND COLORECTAL ANASTOMOSIS 44626", "code_information": [{"code": "44626", "type": "CPT"}, {"code": "1480341", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.67, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF ANAL FISTULA WITH RECTAL ADVANCEMENT FLAP 46288", "code_information": [{"code": "46288", "type": "CPT"}, {"code": "18959511", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2342.07, "maximum": 8450.0, "gross_charge": 4839.0, "discounted_cash": 1693.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2342.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF EYELID BY SUTURE", "code_information": [{"code": "67875", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1794.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF RECTOVAGINAL FISTULA WITH COLOSTOMY 57307", "code_information": [{"code": "57307", "type": "CPT"}, {"code": "1480350", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF RECTOVAGINAL FISTULA;ABDOMINAL APPROACH 57305", "code_information": [{"code": "57305", "type": "CPT"}, {"code": "1480351", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF RECTOVAGINAL FISTULA;TRANSPERINEAL APPROACH 57308", "code_information": [{"code": "57308", "type": "CPT"}, {"code": "1480352", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF RECTOVAGINAL FISTULA;VAGINAL OR TRANSANAL APPROACH 57300", "code_information": [{"code": "57300", "type": "CPT"}, {"code": "1480353", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SALIVARY FISTULA", "code_information": [{"code": "42600", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF URETHROVAGINAL FISTULA 57310", "code_information": [{"code": "57310", "type": "CPT"}, {"code": "1480354", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF URETHROVAGINAL FISTULA WITH BULBOCAVERNOSUS TRANSPLANT 57311", "code_information": [{"code": "57311", "type": "CPT"}, {"code": "1480355", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33600", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33602", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VESICOVAGINAL FISTULA;TRANSVESICAL AND VAGINAL APPROACH 57330", "code_information": [{"code": "57330", "type": "CPT"}, {"code": "1480356", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VESICOVAGINAL FISTULA;VAGINAL APPROACH 57320", "code_information": [{"code": "57320", "type": "CPT"}, {"code": "1480357", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF WINDPIPE LESION", "code_information": [{"code": "31820", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE SKIN PRINEO DERMABOND 22CM CLR222US", "code_information": [{"code": "CLR222US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 219.63, "discounted_cash": 76.87, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSURE SKIN PRINEO DERMABOND 42CM CLR422US", "code_information": [{"code": "CLR422US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 305.0, "discounted_cash": 106.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSURE SYSTEM CARTER-THOMASON SNGL USE CTI-512N", "code_information": [{"code": "CTI-512N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 215.0, "discounted_cash": 75.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSURE URETER/BOWEL FISTULA", "code_information": [{"code": "50930", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE URETER/SKIN FISTULA", "code_information": [{"code": "50920", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE WOUND 1/2IN X 4IN SUT STIP PLUS LF", "code_information": [{"code": "TP-1103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSURE WOUND 1IN X 5IN SUT STRIP PLUS", "code_information": [{"code": "TP-1105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSURE WOUND DEHISCENCE WITH PACKING 12021", "code_information": [{"code": "12021", "type": "CPT"}, {"code": "1480359", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE WOUND DEHISCENCE-SUPERFICIAL 12020", "code_information": [{"code": "12020", "type": "CPT"}, {"code": "1480358", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURES:DERMABOND PRINEO SKIN CLOSURE SYSTEM 60CM CLR602US", "code_information": [{"code": "CLR602US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 358.0, "discounted_cash": 125.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOT FACTOR FLETCHER FACT", "code_information": [{"code": "85292", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR II PROTHROM SPEC", "code_information": [{"code": "85210", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR IX PTC/CHRSTMAS", "code_information": [{"code": "85250", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 76.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 76.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 76.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VII PROCONVERTIN", "code_information": [{"code": "85230", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII AHG 1 STAGE", "code_information": [{"code": "85240", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII MULTIMETRIC", "code_information": [{"code": "85247", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 35.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII RELTD ANTGN", "code_information": [{"code": "85244", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 81.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 81.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 81.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII VW ANTIGEN", "code_information": [{"code": "85246", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 35.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII VW RISTOCTN", "code_information": [{"code": "85245", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 35.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR WGHT KININOGEN", "code_information": [{"code": "85293", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR X STUART-POWER", "code_information": [{"code": "85260", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XI PTA", "code_information": [{"code": "85270", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XII HAGEMAN", "code_information": [{"code": "85280", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XIII FIBRIN SCRN", "code_information": [{"code": "85291", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 36.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 36.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XIII FIBRIN STAB", "code_information": [{"code": "85290", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT INHIBIT PROT C ANTIGEN", "code_information": [{"code": "85302", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT INHIBIT PROT S FREE", "code_information": [{"code": "85306", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT INHIBIT PROT S TOTAL", "code_information": [{"code": "85305", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOTH SKIN PREPARATION 7.5IN X 7.5IN 2 PCT ALCOHOL FREE PRE OPERATIVE CHLORHEXID", "code_information": [{"code": "SGE9705", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.78, "discounted_cash": 3.07, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOTTING ASSAY WHOLE BLOOD", "code_information": [{"code": "85396", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOTTING FUNCT ACTIVITY", "code_information": [{"code": "85397", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 38.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 78.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 44.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 44.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27197", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27198", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX ACROMCLAV DISLC W/MNPJ", "code_information": [{"code": "23545", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/MNPJ", "code_information": [{"code": "23505", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX MED ANKLE FX W/MNPJ", "code_information": [{"code": "27762", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX", "code_information": [{"code": "27767", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX W/MNPJ", "code_information": [{"code": "27768", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SCAP FX W/MNPJ +-TRACTJ", "code_information": [{"code": "23575", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DISLC NECK FX MNPJ", "code_information": [{"code": "23675", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC FX GR HMRL TBR", "code_information": [{"code": "23665", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/MNPJ", "code_information": [{"code": "23525", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX", "code_information": [{"code": "27267", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX W/MNPJ", "code_information": [{"code": "27268", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH 10-20MIN", "code_information": [{"code": "G9869", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH <10MIN", "code_information": [{"code": "G9868", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH >20MIN", "code_information": [{"code": "G9870", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMMI MOD HOME VISIT", "code_information": [{"code": "G9490", "type": "HCPCS"}], "standard_charges": [{"minimum": 197.08, "maximum": 309.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 197.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 309.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 309.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 309.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR E/N/E/L ADDL 5CM/<", "code_information": [{"code": "13153", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "13133", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L 1.1-2.5 CM", "code_information": [{"code": "13120", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L ADDL 5 CM/>", "code_information": [{"code": "13122", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR TRUNK ADDL 5CM/<", "code_information": [{"code": "13102", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPRTV DNA ALYS MLT SNPS", "code_information": [{"code": "79U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH DX IMG ANT SEGMT", "code_information": [{"code": "92132", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH IMG OPTIC NERVE", "code_information": [{"code": "92133", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMS 2728 COMPLETED", "code_information": [{"code": "M1265", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV ANTIBODY", "code_information": [{"code": "86644", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV ANTIBODY IGM", "code_information": [{"code": "86645", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV IG IV", "code_information": [{"code": "90291", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNBP GENE DETC ABNOR ALLELE", "code_information": [{"code": "81187", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNS DNA AMP PROBE TYPE 12-25", "code_information": [{"code": "87483", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 643.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1062.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNSLT BEFORE SCREEN COLONOSC", "code_information": [{"code": "S0285", "type": "HCPCS"}], "standard_charges": [{"minimum": 146.24, "maximum": 229.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 146.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 229.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 229.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 229.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNVRT NEPH CATH W/ DIL STRIC", "code_information": [{"code": "C7547", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CO GNOTYP AQP1 EXON 1", "code_information": [{"code": "181U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 266.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CO/MEMBANE DIFFUSE CAPACITY", "code_information": [{"code": "94729", "type": "CPT"}], "standard_charges": [{"minimum": 206.61, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 206.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 324.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 324.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 324.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CO2 CANN SSOFT ADLT 14O2 14CO2 M 100 HCS4566BS", "code_information": [{"code": "HCS4566BS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COAGULATION DISORDERS", "code_information": [{"code": "813", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9398.84, "maximum": 16135.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9398.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13442.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14786.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16135.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME LEE & WHITE", "code_information": [{"code": "85345", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME OTR METHOD", "code_information": [{"code": "85348", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COAGULATOR HARMONIC 5MM X 31 CM BALL TIP", "code_information": [{"code": "HBC05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 576.0, "discounted_cash": 201.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COAGULATOR SUCTION 10FR 6IN ELECTROSURGICAL", "code_information": [{"code": "E3310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COAGULATOR SUCTION 10FRFT SWITCH VALLEYLAB", "code_information": [{"code": "E2505-10FR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.08, "discounted_cash": 14.03, "setting": "both", "billing_class": "facility"}]}, {"description": "COBLATION WAND TURBINATOR", "code_information": [{"code": "EICA-6895-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COBLATOR II ENT 70 XTR", "code_information": [{"code": "EIC5874-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 637.0, "discounted_cash": 222.95, "setting": "both", "billing_class": "facility"}]}, {"description": "COCAINE 4% TOPICAL SOLUTION 4ML", "code_information": [{"code": "MED0244", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 429.0, "discounted_cash": 150.15, "setting": "both", "billing_class": "facility"}]}, {"description": "COCCIDIOIDES ANTIBODY", "code_information": [{"code": "86635", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 45.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 45.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 45.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCCIDIOIDOMYCOSIS SKIN TEST", "code_information": [{"code": "86490", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCCYGECTOMY 27080", "code_information": [{"code": "27080", "type": "CPT"}, {"code": "1480360", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCHLEAR DEVICE IMPLANTATION 69930", "code_information": [{"code": "69930", "type": "CPT"}, {"code": "1480361", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18935.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCHLEAR IMPLT F/UP EXAM 7/>", "code_information": [{"code": "92603", "type": "CPT"}], "standard_charges": [{"minimum": 551.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 551.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 866.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 866.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 866.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCHLEAR IMPLT F/UP EXAM <7", "code_information": [{"code": "92601", "type": "CPT"}], "standard_charges": [{"minimum": 567.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 567.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 891.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 891.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 891.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCM BY RHC/FQHC 60 MIN MO", "code_information": [{"code": "G0512", "type": "HCPCS"}], "standard_charges": [{"minimum": 273.38, "maximum": 429.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 273.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 429.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 429.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 429.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCR HD NECK 28MM 720500028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "720500028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 737.0, "discounted_cash": 257.95, "setting": "both", "billing_class": "facility"}]}, {"description": "COFFEE K-CUP ORGANIC SUMATRAN RESERVE DARK ROAST EXTRA BOLD", "code_information": [{"code": "4060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COGNITIVE TEST BY HC PRO", "code_information": [{"code": "96125", "type": "CPT"}], "standard_charges": [{"minimum": 495.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 495.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COIL RETRIEVAL 3FR 115 CM 10MM SPECIMEN UROLOGICAL NITINOL STONE CONE", "code_information": [{"code": "M0063903100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COL CHROMOTOGRAPHY QUAL/QUAN", "code_information": [{"code": "82542", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLAG SINGLE USE INSTRUMENT SET P06 S0002", "code_information": [{"code": "P06 S0002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2650.0, "discounted_cash": 927.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COLD AGGLUTININ SCREEN", "code_information": [{"code": "86156", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLD AGGLUTININ TITER", "code_information": [{"code": "86157", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLD PACK LARGE 6X9", "code_information": [{"code": "11440-900", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COLD PACK XSMALL 5X5.5 BULK", "code_information": [{"code": "103B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COLD SNARES Diamond Thin Wire 129-0671 10 7 230 2.8", "code_information": [{"code": "CS50011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.19, "discounted_cash": 12.32, "setting": "both", "billing_class": "facility"}]}, {"description": "COLD SNARES Diamond Thin Wire 129-0672 15 7 230 2.8", "code_information": [{"code": "CS50021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COLD SNARES Oval Thin Wire 129-0160 10 7 230 2.8", "code_information": [{"code": "CS50031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COLD SNARES Oval Thin Wire 129-0161 15 7 230 2.8", "code_information": [{"code": "CS50041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COLECTOMY PARTIAL W/ANASTOMOSIS 44140", "code_information": [{"code": "44140", "type": "CPT"}, {"code": "1480368", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLECTOMY W/ILEOANAL ANAST", "code_information": [{"code": "44157", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLECTOMY W/NEO-RECTUM POUCH", "code_information": [{"code": "44158", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLGN CRS-LINK CRN&PACHYMTRY", "code_information": [{"code": "402T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLGN CRS-LINK CRN&PACHYMTRY", "code_information": [{"code": "418U", "type": "CPT"}], "standard_charges": [{"minimum": 181.97, "maximum": 1017.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1017.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1017.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLINK MIDFOOT FOR 3.0 AND 3.5MM SCREWS C02 S0001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C02 S0001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 790.0, "discounted_cash": 276.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAGEN CELLERATE 1G POWDER SURG ACTIVATED", "code_information": [{"code": "WCI-01-SACRXP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1261.0, "discounted_cash": 441.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAGEN CROSSLINKS", "code_information": [{"code": "82523", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGEN MENISCUS IMPLANT", "code_information": [{"code": "G0428", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLATERAL LIGAMENT PRIMARY REPAIR ANKLE 27695", "code_information": [{"code": "27695", "type": "CPT"}, {"code": "1480377", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLATERAL LIGAMENT PRIMARY REPAIR ANKLE BOTH LIGAMENTS 27696", "code_information": [{"code": "27696", "type": "CPT"}, {"code": "1480378", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLATERAL LIGAMENT SECONDARY REPAIR ANKLE BOTH LIGAMENTS 27698", "code_information": [{"code": "27698", "type": "CPT"}, {"code": "1480379", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECT BLOOD FROM PICC", "code_information": [{"code": "36592", "type": "CPT"}], "standard_charges": [{"minimum": 278.03, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECT SWEAT FOR TEST", "code_information": [{"code": "89230", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECTION SET DISPOSABLE W/HANDLE", "code_information": [{"code": "22310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.77, "discounted_cash": 18.12, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLECTION: Venous Draw", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "1006106", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.55, "maximum": 8450.0, "gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECTION: Venous Draw", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "1006126", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.55, "maximum": 8450.0, "gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECTION: Venous Draw Charge", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "45419337", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.55, "maximum": 8450.0, "gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLJ & INTERPJ DATA EA 30 D", "code_information": [{"code": "99091", "type": "CPT"}], "standard_charges": [{"minimum": 257.46, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 257.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 404.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 404.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 404.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLJ CAPILLARY BLOOD SPEC", "code_information": [{"code": "36416", "type": "CPT"}], "standard_charges": [{"minimum": 2.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLODION 100 ML", "code_information": [{"code": "MED0064", "type": "CDM"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COLON CA SCRN;BLD-BSD BIOMRK", "code_information": [{"code": "G0327", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 4.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON CANCER SCREEN NOT HIGH RISK G0121", "code_information": [{"code": "G0121", "type": "HCPCS"}, {"code": "1582414", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 3827.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON MOTILITY 6 HR STUDY", "code_information": [{"code": "91117", "type": "CPT"}], "standard_charges": [{"minimum": 629.35, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 629.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 988.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 988.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 988.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FLEX W/ABLATION OF TUMOR/POLYP OR OTHER LESION 45388", "code_information": [{"code": "45388", "type": "CPT"}, {"code": "39099786", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 562.45, "maximum": 8450.0, "gross_charge": 1162.09, "discounted_cash": 406.73, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 562.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FLEX W/BAND LIGATION 45398", "code_information": [{"code": "45398", "type": "CPT"}, {"code": "39297723", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 646.14, "maximum": 8450.0, "gross_charge": 1335.0, "discounted_cash": 467.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 646.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FLEX W/ENDOSCOPIC MUCOSAL RESECTION 45390", "code_information": [{"code": "45390", "type": "CPT"}, {"code": "39297606", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 646.14, "maximum": 8450.0, "gross_charge": 1335.0, "discounted_cash": 467.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 646.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FLEXIBLE; DIAGNOSTIC; INCL. COLLECTION OF SPECIMENS 45378", "code_information": [{"code": "45378", "type": "CPT"}, {"code": "1480383", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FLEXIBLE; WITH BIOPSY; SINGLE OR MULTIPLE 45380", "code_information": [{"code": "45380", "type": "CPT"}, {"code": "1480381", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FLEXIBLE; WITH CONTROL OF BLEEDING; ANY METHOD 45382", "code_information": [{"code": "45382", "type": "CPT"}, {"code": "1480382", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION 45381", "code_information": [{"code": "45381", "type": "CPT"}, {"code": "1954773", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FLEXIBLE; WITH REMOVAL OF FOREIGN BODY 45379", "code_information": [{"code": "45379", "type": "CPT"}, {"code": "1480386", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FLEXIBLE; WITH REMOVAL OF TUMOR/POLYP/LESION BY HOT BIOPSY FORCEPS 45384", "code_information": [{"code": "45384", "type": "CPT"}, {"code": "1480387", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FLEXIBLE; WITH REMOVAL OF TUMOR/POLYP/LESION BY SNARE TECHNIQUE 45385", "code_information": [{"code": "45385", "type": "CPT"}, {"code": "1480388", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY STOMA FOREIGN BODY REMOVAL 44390", "code_information": [{"code": "44390", "type": "CPT"}, {"code": "1480391", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY STOMA W/BIOPSY 44389", "code_information": [{"code": "44389", "type": "CPT"}, {"code": "1480392", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY STOMA W/BIOPSY USING ABLATION 44393", "code_information": [{"code": "1480395", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COLONOSCOPY STOMA W/BIOPSY USING SNARE 44394", "code_information": [{"code": "44394", "type": "CPT"}, {"code": "1480394", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY STOMA W/CONTROL OF BLEEDING 44391", "code_information": [{"code": "44391", "type": "CPT"}, {"code": "1480390", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY STOMA W/REMOVAL OF TUMOR/POLYP/LESION BY HOT BIOPSY FORCEPS 44392", "code_information": [{"code": "44392", "type": "CPT"}, {"code": "1480393", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY STOMA; INCL. COLLECTION OF SPECIMENS 44388", "code_information": [{"code": "44388", "type": "CPT"}, {"code": "1480389", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ABLATION OF TUMORS NOT AMENDABLE TO HOT BIOPSY/SNARE/BI-POLAR 45383", "code_information": [{"code": "1480399", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/BALLOON DILAT", "code_information": [{"code": "45386", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "44408", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "45393", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DILATION", "code_information": [{"code": "44405", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPE US", "code_information": [{"code": "45391", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPIC FNB", "code_information": [{"code": "45392", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/INJECTION", "code_information": [{"code": "44404", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/NDL ASPIR/BX", "code_information": [{"code": "44407", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "44403", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "44402", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "45389", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ULTRASOUND", "code_information": [{"code": "44406", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH ABLATION", "code_information": [{"code": "44401", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLORECTAL CA SCREEN DOC REV", "code_information": [{"code": "M1277", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLORECTAL CANCER SCREEN COLONOSCOPY IND. W/HIGH RISK G0105", "code_information": [{"code": "G0105", "type": "HCPCS"}, {"code": "1807635", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 3827.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLORECTAL CANCER SCREENING FLEXIBLE SIGMOIDOSCOPY G0104", "code_information": [{"code": "G0104", "type": "HCPCS"}, {"code": "4040507", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 194.56, "maximum": 2881.0, "gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 194.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY", "code_information": [{"code": "44320", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY WITH BIOPSIES", "code_information": [{"code": "44322", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOCENTESIS 57020", "code_information": [{"code": "57020", "type": "CPT"}, {"code": "1480403", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOCLEISIS (LE FORT TYPE) 57120", "code_information": [{"code": "57120", "type": "CPT"}, {"code": "1480404", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOPERINEORRHAPHY 57210", "code_information": [{"code": "57210", "type": "CPT"}, {"code": "1480405", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY INTRAPERITONEAL", "code_information": [{"code": "57283", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY VAGINAL EXTRA-PERITONEAL APPROACH 57282", "code_information": [{"code": "57282", "type": "CPT"}, {"code": "1480407", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY, MIN/INV, EX-PERIT", "code_information": [{"code": "C9778", "type": "HCPCS"}], "standard_charges": [{"minimum": 2743.0, "maximum": 6125.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPORRHAPHY 57200", "code_information": [{"code": "57200", "type": "CPT"}, {"code": "1480409", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOSCOPY OF CERVIX 57452", "code_information": [{"code": "57452", "type": "CPT"}, {"code": "1480410", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOSCOPY OF CERVIX WITH BIOPSY 57455", "code_information": [{"code": "57455", "type": "CPT"}, {"code": "1480411", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOSCOPY OF CERVIX WITH BIOPSY AND ENDOCERVICAL CURETTAGE 57454", "code_information": [{"code": "57454", "type": "CPT"}, {"code": "1480412", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOSCOPY OF CERVIX WITH ENDOCERVICAL CURETTAGE 57456", "code_information": [{"code": "57456", "type": "CPT"}, {"code": "1480413", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOSCOPY OF CERVIX WITH LOOP ELECTRODE BIOPSY 57460", "code_information": [{"code": "57460", "type": "CPT"}, {"code": "1480414", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOSCOPY OF CERVIX WITH LOOP ELECTRODE CONIZATION 57461", "code_information": [{"code": "57461", "type": "CPT"}, {"code": "1480415", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOSCOPY OF THE VULVA 56820", "code_information": [{"code": "56820", "type": "CPT"}, {"code": "1480416", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOSCOPY OF THE VULVA;WITH BIOPSY 56821", "code_information": [{"code": "56821", "type": "CPT"}, {"code": "1480417", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOSCOPY OF VAGINA AND CERVIX 57420", "code_information": [{"code": "57420", "type": "CPT"}, {"code": "1480418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOSCOPY OF VAGINA AND CERVIX W/ BIOPSY 57421", "code_information": [{"code": "57421", "type": "CPT"}, {"code": "1480419", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOTOMY;WITH DRAINAGE OF PELVIC ABSCESS 57010", "code_information": [{"code": "57010", "type": "CPT"}, {"code": "1480420", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOTOMY;WITH EXPLORATION 57000", "code_information": [{"code": "57000", "type": "CPT"}, {"code": "1480421", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COM CARE", "code_information": [{"code": "G9930", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMBO THRPY OF >= 2 PROPHLY", "code_information": [{"code": "G9956", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMM HLTH INTG SVS ADD 30 M", "code_information": [{"code": "G0022", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.41, "maximum": 244.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 155.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMM HLTH INTG SVS SDOH 60MN", "code_information": [{"code": "G0019", "type": "HCPCS"}], "standard_charges": [{"minimum": 374.54, "maximum": 588.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 374.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMM SVCS BY RHC/FQHC 5 MIN", "code_information": [{"code": "G0071", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.85, "maximum": 79.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMMUNICATOR WITH HANDSET TH90Q01", "code_information": [{"code": "TH90Q01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4096.0, "discounted_cash": 1433.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COMMUNITY/WORK REINTEGRATION", "code_information": [{"code": "97537", "type": "CPT"}], "standard_charges": [{"minimum": 147.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMP ASSES CARE PLAN CCM SVC", "code_information": [{"code": "G0506", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.02, "maximum": 322.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 205.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 322.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 322.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 322.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMP GENET TEST HYP CARDIOMY", "code_information": [{"code": "S3865", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPATIBILITY TEST ANTIGLOB", "code_information": [{"code": "86922", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPATIBILITY TEST ELECTRIC", "code_information": [{"code": "86923", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPATIBILITY TEST INCUBATE", "code_information": [{"code": "86921", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPL RPLCMT PICC RS&I", "code_information": [{"code": "36584", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT ANTIGEN", "code_information": [{"code": "86160", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT FIXATION EACH", "code_information": [{"code": "86171", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT TOTAL (CH50)", "code_information": [{"code": "86162", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 81.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 81.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 81.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT/FUNCTION ACTIVITY", "code_information": [{"code": "86161", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETION PNEUMONECTOMY", "code_information": [{"code": "32488", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEX E/M VISIT ADD ON", "code_information": [{"code": "G2211", "type": "HCPCS"}], "standard_charges": [{"minimum": 77.88, "maximum": 122.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 77.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 122.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 122.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 122.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [{"code": "381", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6443.72, "maximum": 11062.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6443.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9215.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10137.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11062.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "380", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11476.19, "maximum": 19701.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11476.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16413.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18054.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19701.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITHOUT CC/MCC", "code_information": [{"code": "382", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4675.39, "maximum": 8026.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4675.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6686.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7355.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8026.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [{"code": "920", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6232.64, "maximum": 10699.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6232.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8914.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9805.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10699.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [{"code": "919", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11217.66, "maximum": 19257.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11217.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16043.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17648.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19257.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITHOUT CC/MCC", "code_information": [{"code": "921", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4245.33, "maximum": 7288.17, "estimated_discounted_cash": 11574.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4245.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6071.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6678.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7288.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPONENT ARTICULAR 12MM 2.0MM X 3MM OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9122-2030-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4722.0, "discounted_cash": 1652.7, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT ARTICULAR 15MM 2.5MM X 4.5MM OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9M52-2545-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3124.0, "discounted_cash": 1093.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT BEARING MED 3MM MENISCAL LFT OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1947.0, "discounted_cash": 681.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT BEARING MED 3MM MENISCAL RIGHT OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1947.0, "discounted_cash": 681.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT BEARING MED 4MM MENISCAL LFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1947.0, "discounted_cash": 681.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT BEARING MED 4MM MENISCAL RIGHT OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1947.0, "discounted_cash": 681.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL 11MM X 135MM REDUCTION POROUS NO COLLAR BI METRIC ECHO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14408.0, "discounted_cash": 5042.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL 13MM STANDARD POROUSINTEGRAL IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "X170313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3502.0, "discounted_cash": 1225.7, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL 13MM X 155MM POROUS COATED SYNERGY TI IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9695.0, "discounted_cash": 3393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL 7.0MM X 3.0MM X 1.0MM OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "U202-0731-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13953.0, "discounted_cash": 4883.55, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL CEMENTED NUMBER 4 RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5510-F-402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13630.0, "discounted_cash": 4770.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL FREEDOM SZ F LEFT PFCRLF00-PK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PFCRLF00-PK", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL LG TWIN PEG PARTIAL KNEE OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "161470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL MED TWIN PEG PARTIAL KNEE OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "161469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL PS BEADED SZ6 LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5516-F-601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4952.0, "discounted_cash": 1733.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL PS TRIATHLON SZ 5 RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5516-F-502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL RIGHT MEDIAL LFT LAT OXINIUM JOURNEY UNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71422355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6144.0, "discounted_cash": 2150.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 1-2 15MM HIGH FLEX XLPE LEGION PS IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3688.0, "discounted_cash": 1290.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 15 165MM SYNERGY POROUS COATED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9234.0, "discounted_cash": 3231.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 16 SYNERGY POROUS COATED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9234.0, "discounted_cash": 3231.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 2 LFT CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 2.5 NON POROUS RIGHT CR PFC SIGMA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "960018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6312.0, "discounted_cash": 2209.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 25 POST STABILIZED LFT LEGION OXINUM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71421215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7672.0, "discounted_cash": 2685.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 3 CARBURIZED RIGHT COBALT CHROME LEGION PS IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5932.0, "discounted_cash": 2076.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 3 CEMENTED LFT MEDIAL IBALANCE UKA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-501-UFLC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 3 CRUCIATE RETAINING LFT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 3 LFT POST STABELIZED OXINIUM LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7377.0, "discounted_cash": 2581.95, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 3 NON AUGMENTED RIGHT GENESIS III IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71927193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4820.0, "discounted_cash": 1687.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 3 RIGHT CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5510-F-302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3069.0, "discounted_cash": 1074.15, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 3 RIGHT LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15543.0, "discounted_cash": 5440.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 3 RIGHT OXINIUM CRCUIATE RETAINING LEGION OXINIUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6986.0, "discounted_cash": 2445.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 3 RIGHT POST STABELIZED OXINIUM LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7672.0, "discounted_cash": 2685.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 3-4 15MM HIGH FLEX XLPE LEGEND PS IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3688.0, "discounted_cash": 1290.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 LFT CRUCIATE RETAINING OXINIUM LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7265.0, "discounted_cash": 2542.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 LFT NON POROUS LEGION PS IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5935.0, "discounted_cash": 2077.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 LFT POST", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5515-F-401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2980.0, "discounted_cash": 1043.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 LFT POST STABILIZED SIGMA IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "196040400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6596.0, "discounted_cash": 2308.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 NON POROUS CRUCIATE RETAINING LFT LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5935.0, "discounted_cash": 2077.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 NON POROUS POST STABILIZED RIGHT LEGION IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71423234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5932.0, "discounted_cash": 2076.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 POST STABILIZED LFT LEGION OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8247.0, "discounted_cash": 2886.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 POST STABILIZED RIGHT LEGION OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7672.0, "discounted_cash": 2685.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 RIGHT CRUCIATE RETAINING LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5935.0, "discounted_cash": 2077.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 RIGHT LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12399.0, "discounted_cash": 4339.65, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 RIGHT TROCHLEA SIGMA HP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "102404400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6574.0, "discounted_cash": 2300.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 4 TRIATHLON TS RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5512-F-402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13970.0, "discounted_cash": 4889.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 5 CARBURIZED COBALT CHROME LEGION PS IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5932.0, "discounted_cash": 2076.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 5 CRUCIATE RETAINING RIGHT LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7265.0, "discounted_cash": 2542.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 5 LFT CONSTRAINED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12575.0, "discounted_cash": 4401.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 5 LFT CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5510-F-501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2980.0, "discounted_cash": 1043.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 5 LFT CRUCIATE RETAINING OXINIUM LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7265.0, "discounted_cash": 2542.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 5 LFT POST STABILIZED CEMENTED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5515-F-501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3801.0, "discounted_cash": 1330.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 5 NON POROUS CRUCIATE RETAINING LFT LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5707.0, "discounted_cash": 1997.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 5 POST STABILIZED LFT NARROW IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1504-10-125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8405.0, "discounted_cash": 2941.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 5 RIGHT CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 5 RIGHT POST STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5515-F-502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5083.0, "discounted_cash": 1779.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 5-6 9MM HIGH FLEX XLPE LEGION PS IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3546.0, "discounted_cash": 1241.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 6 CRUCIATE RETAINING LFT LEGION OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8918.0, "discounted_cash": 3121.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 6 CRUCIATE RETAINING RIGHT LEGION OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7265.0, "discounted_cash": 2542.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 6 LFT LEGION PS IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6229.0, "discounted_cash": 2180.15, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 6 LFT POST STABILIZED LEGION OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3872.0, "discounted_cash": 1355.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 6 LFT TRIATHLON FEMUR CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5510-F-601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4952.0, "discounted_cash": 1733.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 6 NON POROUS CRUCIATE RETAINING LFT LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5935.0, "discounted_cash": 2077.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 6 RIGHT CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 6 RIGHT CRUCIATE RETAINING RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5510-F-602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2980.0, "discounted_cash": 1043.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 6 RIGHT POST STABILIZED LEGION OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7672.0, "discounted_cash": 2685.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 7 CRUCIATE RETAINING LFT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5510-F-701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2365.0, "discounted_cash": 827.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 7 CRUCIATE RETAINING LFT LEGION OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7265.0, "discounted_cash": 2542.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 7 CRUCIATE RETAINING RIGHT LEGION OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7265.0, "discounted_cash": 2542.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 7 LFT POST STABELIZED OXINIUM LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7377.0, "discounted_cash": 2581.95, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 7 POST STABILIZED RIGHT LEGION OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7672.0, "discounted_cash": 2685.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 7 RIGHT PERSONA PS STANDARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5006-062-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 8 LFT PERSONA CR STANDARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5026-064-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4818.0, "discounted_cash": 1686.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 8 LFT POST STABELIZED OXINIUM LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7672.0, "discounted_cash": 2685.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 8 RIGHT CRUCIATE RETAINING OXINIUM LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6986.0, "discounted_cash": 2445.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 8 RIGHT PERSONA CR STANDARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5026-064-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4818.0, "discounted_cash": 1686.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ 9 110MM CEMENTED STEM SYNERGY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71316009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5421.0, "discounted_cash": 1897.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMORAL SZ16 SYN POR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8878.0, "discounted_cash": 3107.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMRL SZ 4 UNICOMPARTMENTAL KNEE SYS LM RL JOURNEY UNI OXIUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71422344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6144.0, "discounted_cash": 2150.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEMRL SZ 5-6 13MM HIGH FLEXIBLE CRUCIATE RETAINING XLPE LEGION CR IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4141.0, "discounted_cash": 1449.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT GLND 15D SM AUG CORTILOC SHLDR RT DWK403RA15S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWK403RA15S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT GLND 25D MED AUG CORTILOC SHLDR LT DWK404LA25S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWK404LA25S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT HEAD 12/14 36MM +4MM FEMORAL COBALT CHROME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71303604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2701.0, "discounted_cash": 945.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT HIGH FLEX SZ 7 - 8 13MM POST STABELISED CROSS LINKED POLYETHYLENE LEGI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3688.0, "discounted_cash": 1290.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT HIGH FLEX SZ 7 -8 15MM POST STABELISED CROSS LINKED POLYETHYLENE LEGIO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3688.0, "discounted_cash": 1290.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT KNEE 12MM SZ 7-12 GH CRUCIATE RETAINING ARTICULAR SURFACE VIVACIT E IM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5120-006-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2791.0, "discounted_cash": 976.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT KNEE 16MM SZ 3-9 CD CRUCIATE RETAINING ARTICULAR SURFACE RT VITAMIN E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5220-004-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2791.0, "discounted_cash": 976.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT KNEE 16MM SZ 6-9 EF POST STABILIZED ARTICULAR SURFACE RT VITAMIN E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5224-007-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT METATARSAL SZ 3 19.6MM X 15.3MM DECOMPRESSION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "MD103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9630.0, "discounted_cash": 3370.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT PATELLA 32 X 36 X 10MM SZ A32 TRIALTHLON TRITANIUM ASYMMETRIC METAL BACKED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5552-L-320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT PATELLA 32MM X 3.5MM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71432636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1551.0, "discounted_cash": 542.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT PATELLA 35 X 39 X 10MM SZ A32 TRIALTHLON TRITANIUM ASYMMETRIC METAL BACKED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5552-L-350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT PATELLA 35MM MEDIALIZED DOME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1518-20-035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1928.0, "discounted_cash": 674.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT PATELLA 38MM MEDIALIZED DOME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1518-20-038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1928.0, "discounted_cash": 674.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT PATELLA 7.5MM X 26MM RESURFACING ANT CUT FIRST GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71932634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1551.0, "discounted_cash": 542.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT PHALANGEAL DF-P FIXATION HEMICAP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9P15-S180-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1866.0, "discounted_cash": 653.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT RADIAL HEAD SZ 4 15MM X 24MM ELBOW IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "RHA-H4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4361.0, "discounted_cash": 1526.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT RADIAL SZ2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "RHA-H2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4361.0, "discounted_cash": 1526.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBA BASE TRITANIUM SZ 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5536-B-400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 937.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBA BASE TRITANIUM SZ 6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5536-B-600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 937.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBA BASE TRITANIUM SZ 7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5536-B-700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 937.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBIAL SZ2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5536-B-200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 937.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBIAL TRIATHLON SZ 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5536-B-300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2600.0, "discounted_cash": 910.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL BASE RIGHT MEDIAL LFT LAT JOURNEY UNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71422434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2473.0, "discounted_cash": 865.55, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ 1 RIGHT CEMENTED GNS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4146.0, "discounted_cash": 1451.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ 2 LFT CEMENTED GNS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420162", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3987.0, "discounted_cash": 1395.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ 3 BASE FIXED BEARING IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1506-00-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ 4 BASE FIXED BEARING IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1506-00-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ 4 BASE RIGHT LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8448.0, "discounted_cash": 2956.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ 5 LFT GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420168", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3779.0, "discounted_cash": 1322.65, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ 6 BASE FIXED BEARING IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1506-00-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5142.0, "discounted_cash": 1799.7, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ 7 BASE FIXED BEARING IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1506-00-007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5142.0, "discounted_cash": 1799.7, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ 8 LFT CEMENTED GNS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3599.0, "discounted_cash": 1259.65, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ 8 RIGHT GNSII", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3599.0, "discounted_cash": 1259.65, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ B ALPHA LFT MEDIAL OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "154720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ C ALPHA RIGHT MEDIAL OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "154723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3445.0, "discounted_cash": 1205.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TIBL SZ D ALPHA LFT MEDIAL OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "154724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT TOE MED HEMI GREAT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "375-0003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4161.0, "discounted_cash": 1456.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 2 VEINS", "code_information": [{"code": "35682", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 3/> SEGMT", "code_information": [{"code": "35683", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT PROS&VEIN", "code_information": [{"code": "35681", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPOSITE GRAFT INCLUDING PRIMARY CLOSURE 15760", "code_information": [{"code": "15760", "type": "CPT"}, {"code": "1480424", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPOSITE MESH ULTRA PRO ADVANCED MESH 15X15CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UPA31515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPR SRS PROX BDY - SM 48MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "211215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4738.0, "discounted_cash": 1658.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPRE AUDIOMETRY EVALUATION", "code_information": [{"code": "212T", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 958.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL ABLTJ ATR FIB", "code_information": [{"code": "93656", "type": "CPT"}], "standard_charges": [{"minimum": 2347.0, "maximum": 141616.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 90119.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 141616.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 141616.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 141616.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL TX SVT", "code_information": [{"code": "93653", "type": "CPT"}], "standard_charges": [{"minimum": 2347.0, "maximum": 141616.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 90119.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 141616.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 141616.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 141616.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL TX VT", "code_information": [{"code": "93654", "type": "CPT"}], "standard_charges": [{"minimum": 2347.0, "maximum": 141616.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 90119.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 141616.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 141616.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 141616.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE FUL BDY 3D MTN ALYS", "code_information": [{"code": "693T", "type": "CPT"}], "standard_charges": [{"minimum": 1531.69, "maximum": 2407.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1531.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2407.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2407.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2407.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE OPH EXAM EST PT 1/>", "code_information": [{"code": "92014", "type": "CPT"}], "standard_charges": [{"minimum": 511.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE OPH EXAM NEW PT 1/>", "code_information": [{"code": "92004", "type": "CPT"}], "standard_charges": [{"minimum": 511.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPREHENSIVE HEARING TEST", "code_information": [{"code": "92557", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRESSION SYSTEM DYNAMIC EASY FUSE FFSP1530", "code_information": [{"code": "FFSP1530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 923.0, "discounted_cash": 323.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPRESSION WIRE LONG 48MM ALPS", "code_information": [{"code": "8242-99-105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.0, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPUTER ASSISTED MUSCULOSKELETAL SURGICAL NAVIGATIONAL ORTHO PROCEDURE W/FLUORO 0054T", "code_information": [{"code": "54T", "type": "CPT"}, {"code": "45027709", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "gross_charge": 349.0, "discounted_cash": 122.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 168.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPUTER ASSISTED MUSCULOSKELETAL SURGICAL NAVIGATIONAL ORTHO PROCEDURE W/IMAGE GUIDE CT/MRI 0055T", "code_information": [{"code": "55T", "type": "CPT"}, {"code": "22241110", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 3800.36, "gross_charge": 7852.0, "discounted_cash": 2748.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3800.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPUTER ASSISTED SURGICAL NAVIGATION 20985", "code_information": [{"code": "20985", "type": "CPT"}, {"code": "1480016", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2182.0, "discounted_cash": 763.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1056.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMT GENE", "code_information": [{"code": "32U", "type": "CPT"}], "standard_charges": [{"minimum": 251.72, "maximum": 700.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 445.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCAVE REAMER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "310-01-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONCUSSION WITH CC", "code_information": [{"code": "89", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6469.27, "maximum": 11106.13, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6469.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9252.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10177.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11106.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITH MCC", "code_information": [{"code": "88", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8851.98, "maximum": 15196.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8851.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12660.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13926.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15196.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITHOUT CC/MCC", "code_information": [{"code": "90", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5198.53, "maximum": 8924.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5198.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7435.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8178.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8924.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONDITIONING PLAY AUDIOMETRY", "code_information": [{"code": "92582", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONDYLECTOMY TEMPOROMANDIBULAR JOINT 21050", "code_information": [{"code": "21050", "type": "CPT"}, {"code": "1480425", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONE TIBIAL SZ A SYMMETRIC AUGMENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5549-A-110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6374.0, "discounted_cash": 2230.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CONFORMER OCULAR #1 SMALL NATURAL-IRIS 24X20X9MM EYE SOCKET PREVENT CLOSURE STERILE BLUE", "code_information": [{"code": "89120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 723.0, "discounted_cash": 253.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CONFORMER OCULAR VENTED MEDIUM 9779", "code_information": [{"code": "9779", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONFORMER OCULAR VENTED SMALL 9778", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "9778", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 44.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CONFORMING GAUZE BANDAGE 1INX75IN, STER", "code_information": [{"code": "C-CB1S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CONGO RED BLOOD TEST", "code_information": [{"code": "P2029", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 7.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONIZATION OF CERVIX COLD KNIFE OR LASER 57520", "code_information": [{"code": "57520", "type": "CPT"}, {"code": "1480426", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONIZATION OF CERVIX LOOP ELECTRODE EXCISION 57522", "code_information": [{"code": "57522", "type": "CPT"}, {"code": "1480427", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJUNCTIVAL FLAP;TOTAL 68362", "code_information": [{"code": "68362", "type": "CPT"}, {"code": "1480428", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJUNCTIVOPLASTY;RECON CUL-DE-SAC W/CONJUNCTIVAL GRAFT OR EXTEN.REARRANGEMENT 68326", "code_information": [{"code": "68326", "type": "CPT"}, {"code": "1480429", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJUNCTIVOPLASTY;RECON OF CUL-DE-SAC W/BUCCAL MUCOUS MEMBRANE GRAFT 68328", "code_information": [{"code": "68328", "type": "CPT"}, {"code": "1480430", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJUNCTIVOPLASTY;WITH BUCCAL MUCOUS MEMBRANE GRAFT 68325", "code_information": [{"code": "68325", "type": "CPT"}, {"code": "1480431", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJUNCTIVOPLASTY;WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT 68320", "code_information": [{"code": "68320", "type": "CPT"}, {"code": "1480432", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "546", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7348.26, "maximum": 12615.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7348.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10509.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11560.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12615.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "545", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15226.36, "maximum": 26139.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15226.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21776.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23954.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26139.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "547", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5070.79, "maximum": 8705.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5070.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7252.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7977.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8705.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTOR 28-34MM HH OS-2820", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS-2820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR AUX WATER PORT DISP", "code_information": [{"code": "100241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR CROSS XIA 3 53 X 73MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48236053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR FLEXIBLE", "code_information": [{"code": "101067", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR H TO H 22MM - 28MM OS-2810", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS-2810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR MAXPLUS TRUSWAB IV CLEAR", "code_information": [{"code": "MP1000-C", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR PRECISION 35CM M-1", "code_information": [{"code": "SC-9004-35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2143.0, "discounted_cash": 750.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR SAMPLING GAS STRAIGHT", "code_information": [{"code": "225-3524-804", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR SUCTION Y SIXIN ONE RESPIRATORY VENTILATION LF STRL", "code_information": [{"code": "DYND50519", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CONSLTJ COMPRE RVW REC REPRT", "code_information": [{"code": "88325", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSLTJ&REPRT MATRL PREP SLD", "code_information": [{"code": "88323", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 46.77, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 49.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSLTJ&REPRT SLD PREP ELSWR", "code_information": [{"code": "88321", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRICTOR ROPE + 3.7MM DRILL BIT DLF 002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DLF 002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2955.0, "discounted_cash": 1034.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CONSTRUCT BLADDER OPENING", "code_information": [{"code": "51980", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50820", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50825", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT VAGINA WITH GRAFT", "code_information": [{"code": "57292", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46730", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46735", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46740", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF INTERMARGINAL ADHESIONS MEDIAN TARSORRHAPHY OR CANTHORRHAPHY 67880", "code_information": [{"code": "67880", "type": "CPT"}, {"code": "1480433", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF VAGINA", "code_information": [{"code": "57291", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSULTATION WITH FAMILY", "code_information": [{"code": "90887", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR ANALYSIS I&R", "code_information": [{"code": "95251", "type": "CPT"}], "standard_charges": [{"minimum": 160.52, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 160.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 252.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 252.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 252.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR PHYS/QHP EQP", "code_information": [{"code": "95250", "type": "CPT"}], "standard_charges": [{"minimum": 511.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR PT PROV EQP", "code_information": [{"code": "95249", "type": "CPT"}], "standard_charges": [{"minimum": 247.93, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 247.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 389.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 389.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 389.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITG APHAKIA 1", "code_information": [{"code": "92311", "type": "CPT"}], "standard_charges": [{"minimum": 1603.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1603.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITG APHAKIA OU", "code_information": [{"code": "92312", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITTING FOR TX", "code_information": [{"code": "92071", "type": "CPT"}], "standard_charges": [{"minimum": 151.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 151.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 237.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 237.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 237.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITTING OU", "code_information": [{"code": "92310", "type": "CPT"}], "standard_charges": [{"minimum": 268.61, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 268.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 422.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 422.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 422.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS HASSAN-TORNAMBE SUPER VIEW FLAT", "code_information": [{"code": "40417", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTAINER PATHOLOGY 8OZ W/ LID", "code_information": [{"code": "DYND34255", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTAINER SPEC 4OZ STRL FLUID PATH PP POLYSTYRENE W/ LABEL AND SCREW LID LF", "code_information": [{"code": "DYND30330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTAINER SPECIMEN 4OZ SCREW TOP CAP STRL DISP", "code_information": [{"code": "13594-130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTAINER TLIF 2 KIT MACESS MAS CONSOL 3500016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3500016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5948.0, "discounted_cash": 2081.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTAINER WASTE CHEMOTHERAPY 2 GAL Y 8982", "code_information": [{"code": "8982", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTINUOUS INTRAOP NEUROPHYSIOLOGY MONITORING IN THE O.R. REQ. PERSONAL ATTEND. EA 15 MIN 95940", "code_information": [{"code": "95940", "type": "CPT"}, {"code": "2958404", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"minimum": 147.82, "maximum": 8450.0, "gross_charge": 1875.0, "discounted_cash": 656.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTOUR CRANIAL BONE LESION", "code_information": [{"code": "21181", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM ABDOMINL AORTA", "code_information": [{"code": "75625", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 141.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 150.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM THORACIC AORTA", "code_information": [{"code": "75600", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 362.55, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 385.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM THORACIC AORTA", "code_information": [{"code": "75605", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 31575.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7463.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20085.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 163.17, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 173.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY BLADDER", "code_information": [{"code": "74430", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 63.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 67.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY GALLBLADDER", "code_information": [{"code": "74290", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 163.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 174.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF ANKLE", "code_information": [{"code": "73615", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 234.73, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 249.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70010", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70015", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 259.66, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 275.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF ELBOW", "code_information": [{"code": "73085", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 174.45, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 185.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF KNEE JOINT", "code_information": [{"code": "73580", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 186.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 198.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL 360 SYSTEM ANATOMIC BIPLANAR FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "sk12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.0, "discounted_cash": 2660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTROL HEMORRHAGE ANTERIOR SIMPLE ANY METHOD 30901", "code_information": [{"code": "30901", "type": "CPT"}, {"code": "1857264", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL KIT FREELINK REMOTE SC-5572-1", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "SC-5572-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTROL NASAL ANTERIOR COMPLEX ANY METHOD 30903", "code_information": [{"code": "30903", "type": "CPT"}, {"code": "9467894", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42970", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42971", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42972", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30905", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL OROPHARYNGEAL HEMORRHAGE PRIMARY OR SEC. W/SEC. SURGICAL INTERVENTION 42962", "code_information": [{"code": "42962", "type": "CPT"}, {"code": "7942258", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL OROPHRYNGEAL HEMORRHAGE PRIMARY OR SECONDARY SIMPLE 42960", "code_information": [{"code": "42960", "type": "CPT"}, {"code": "9017536", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1114.0, "discounted_cash": 389.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 539.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL REMOTE PRECISION SPECTRA", "code_information": [{"code": "SC-5232", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42961", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONVERSION EXT BIL DRG CATH", "code_information": [{"code": "47535", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONVERT NEPHROSTOMY CATHETER", "code_information": [{"code": "50434", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONVERTOR ARTHROSCOPY SPECIMEN 65652-123", "code_information": [{"code": "65652-123", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CONVEX 23MM P04 N0044", "code_information": [{"code": "P04 N0044", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 672.5, "discounted_cash": 235.38, "setting": "both", "billing_class": "facility"}]}, {"description": "COOL QUANT SENSORY TEST", "code_information": [{"code": "108T", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 381.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS TEST DIRECT", "code_information": [{"code": "86880", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS TEST INDIRECT QUAL", "code_information": [{"code": "86885", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS TEST INDIRECT TITER", "code_information": [{"code": "86886", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPY NUMBER SEQUENCE ALYS", "code_information": [{"code": "156U", "type": "CPT"}], "standard_charges": [{"minimum": 2505.6, "maximum": 4651.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4651.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4651.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4651.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2505.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2505.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7516", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ILIC/FEM ANGIO", "code_information": [{"code": "C7517", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO/VENT W/DRUG ADMIN", "code_information": [{"code": "C7558", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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": 3565.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ARTERY DISEASE MRNA", "code_information": [{"code": "81493", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1312.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2677.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4210.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4210.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4210.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1512.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1512.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ FLOW RESRV", "code_information": [{"code": "C7519", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7518", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ILIC/FEM ANG", "code_information": [{"code": "C7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORD BIPOLAR MOLDED CONNECTOR DISP", "code_information": [{"code": "E0512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD ELECTROCAUTERY 10FT BIPOLAR STRL DISP", "code_information": [{"code": "60-5102-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD ELECTROSURGICAL 10FT MONOPOLAR FOOTSWITCH STRL PEDI DISP", "code_information": [{"code": "E0503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD FORCEPS 12FT BIPOLARFT SWITCHING STRL", "code_information": [{"code": "E0509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CORDOTOMY WITH SECTION OF BOTH SPINOTHALAMIC TRACTS 1 STAGE;THORACIC 63197", "code_information": [{"code": "63197", "type": "CPT"}, {"code": "1480438", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORE NDL BX LNG/MED PERQ", "code_information": [{"code": "32408", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORE REV 10MM FREEZE DRIED BONE VOID FILLER", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "400130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2398.0, "discounted_cash": 839.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CORE REV 12MM FREEZE DRIED BONE VOID FILLER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "400132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2398.0, "discounted_cash": 839.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CORF SKILLED NURSING SERVICE", "code_information": [{"code": "G0128", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.97, "maximum": 54.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORING REAMER, 8 MM, W/COLLARED PIN, STERILE", "code_information": [{"code": "AR-1222S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CORKSCREW 5.5MM BC FT SUTURETAPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1927BCT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 769.64, "discounted_cash": 269.37, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNEA WHOLE LEBT-BCM LT 15-0846-200", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "15-0846-200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 6077.0, "discounted_cash": 2126.95, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORNEA WHOLE PRE-CUT FOR ALK", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "V0003000", "type": "CDM"}, {"code": "810", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 7468.0, "discounted_cash": 2613.8, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORNEA WHOLE PRE-CUT FOR DMEK", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "V0089000", "type": "CDM"}, {"code": "810", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 10455.0, "discounted_cash": 3659.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORNEAL HYSTERESIS DETER", "code_information": [{"code": "92145", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORNEAL SMEAR", "code_information": [{"code": "65430", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL TISSUE TRANSPLANT", "code_information": [{"code": "65767", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ART/GRFT ANGIO S&I", "code_information": [{"code": "93455", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY ANGIO S&I", "code_information": [{"code": "93454", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY BYPASS/REOP", "code_information": [{"code": "33530", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY CORRECTION", "code_information": [{"code": "33502", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33503", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33504", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [{"code": "233", "type": "MS-DRG"}], "standard_charges": [{"minimum": 48191.35, "maximum": 82732.58, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48191.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68924.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75816.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 82732.58, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [{"code": "234", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32458.89, "maximum": 55723.85, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32458.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46423.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51065.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55723.85, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [{"code": "231", "type": "MS-DRG"}], "standard_charges": [{"minimum": 53018.82, "maximum": 91020.14, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53018.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75828.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83411.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 91020.14, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [{"code": "232", "type": "MS-DRG"}], "standard_charges": [{"minimum": 36216.97, "maximum": 62175.53, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36216.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51798.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56977.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62175.53, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "235", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37131.24, "maximum": 63745.12, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37131.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53105.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58416.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63745.12, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [{"code": "236", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24922.05, "maximum": 42784.97, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24922.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 35643.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39208.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 42784.97, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONERS AUTOPSY (NECROPSY)", "code_information": [{"code": "88045", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 82.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 82.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONOIDECTOMY 21070", "code_information": [{"code": "21070", "type": "CPT"}, {"code": "1480441", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPECTOMY EXCISION OF INTRASPINAL LESION SINGLE SEGMENT;EXTRADURAL CERVICAL 63300", "code_information": [{"code": "63300", "type": "CPT"}, {"code": "1480443", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPECTOMY EXCISION OF INTRASPINAL LESION SINGLE SEGMENT;INTRADURAL CERVICAL 63304", "code_information": [{"code": "63304", "type": "CPT"}, {"code": "1480444", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPECTOMY/EXC INTRASPINAL LES;SINGLE SEG;EXT DURAL LUM/SACRAL W/PERITONEAL 63303", "code_information": [{"code": "63303", "type": "CPT"}, {"code": "1480445", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPECTOMY/EXC.INTRASPINAL LES;SINGLE SEG;EXT DURAL THORACIC W/TRANSTHORACIC 63301", "code_information": [{"code": "63301", "type": "CPT"}, {"code": "1480446", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPECTOMY/EXC.INTRASPINAL LES;SINGLE SEG;EXT.DURAL THORACIC W/THORACOLUMB. 63302", "code_information": [{"code": "63302", "type": "CPT"}, {"code": "1480447", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPECTOMY/EXC.INTRASPINAL LES;SINGLE SEG;INTRADURAL LUM/SACRAL W/RETROPERITONEAL 63307", "code_information": [{"code": "63307", "type": "CPT"}, {"code": "1480448", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPECTOMY/EXC.INTRASPINAL LES;SINGLE SEG;INTRADURAL THORACIC W/THOROCOLUMBAR 63306", "code_information": [{"code": "63306", "type": "CPT"}, {"code": "1480442", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPECTOMY/EXC.INTRASPINAL LES;SINGLE SEG;INTRADURAL THORACIC W/TRANSTHORACIC 63305", "code_information": [{"code": "63305", "type": "CPT"}, {"code": "1480449", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT INVERTED NIPPLE(S)", "code_information": [{"code": "19355", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT MALROTATION OF BOWEL", "code_information": [{"code": "44055", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45540", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45541", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR 6.0 CM/<", "code_information": [{"code": "11920", "type": "CPT"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR EA 20.0CM", "code_information": [{"code": "11922", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT SKN COLOR 6.1-20.0CM", "code_information": [{"code": "11921", "type": "CPT"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION CHORDEE OR REPAIR HYPOSPADIAS FIRST STAGE 54304", "code_information": [{"code": "54304", "type": "CPT"}, {"code": "1481907", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION CLAW FINGER 26499", "code_information": [{"code": "26499", "type": "CPT"}, {"code": "1480450", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION HALLUX VALGUS W/SESAMOIDECTOMY ANY METHOD 28295", "code_information": [{"code": "28295", "type": "CPT"}, {"code": "44660517", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1556.54, "maximum": 8450.0, "gross_charge": 3216.0, "discounted_cash": 1125.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1556.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION HAMMER TOE 28285", "code_information": [{"code": "28285", "type": "CPT"}, {"code": "1481863", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65772", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65775", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF BLADDER DEFECT", "code_information": [{"code": "51940", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF LAGOPHTHALMOS WITH IMPLANTATION OF UPPER EYELID LID LOAD 67912", "code_information": [{"code": "67912", "type": "CPT"}, {"code": "1480451", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF LID RETRACTION 67911", "code_information": [{"code": "67911", "type": "CPT"}, {"code": "1480452", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL FREE", "code_information": [{"code": "82530", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISPORIN BACITRACIN/HYDROCORTISONE/NEOMYCIN/POLYMYXIN B OPHTHALMIC OINTMENT 3.5 GM", "code_information": [{"code": "MED0065", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CORTISPORIN OTIC 1% 10ML", "code_information": [{"code": "MED0066", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CORUS SPINAL SYSTEM DX-22-300", "code_information": [{"code": "DX-22-300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3947.0, "discounted_cash": 1381.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNSEL IMMUNE <21  5-15 M", "code_information": [{"code": "G0315", "type": "HCPCS"}], "standard_charges": [{"minimum": 111.26, "maximum": 174.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COUNSEL IMMUNE <21 16-30 M", "code_information": [{"code": "G0314", "type": "HCPCS"}], "standard_charges": [{"minimum": 111.26, "maximum": 174.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COUNTER NDL FORTY CAPACITY MAGNET FOAM BLOCK PLSTC W/ BLADE REMOVER DEVON STRL", "code_information": [{"code": "31142386", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTER NDL TEN COUNT SNGL MAGNET TYPE NDL SPONGE COUNTER FOAM BLOCK W/ MAGNET L", "code_information": [{"code": "DYNJNC10F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.46, "discounted_cash": 1.21, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTER NDL XL FOAM BLOCK 40 COUNT SHARP BLADE REMOVAL W/ SNGL BLACK MAGNET DEVO", "code_information": [{"code": "31142311", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTER NEEDLE FOAM/ MAGNET 40CNT", "code_information": [{"code": "DYNJNC40F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTER SINK 2.0/ 2.5 CHI-5023", "code_information": [{"code": "CHI-5023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 672.5, "discounted_cash": 235.38, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTER SINK, 1.4COUNTERSINK SCREW FOR 2 MM AND 2.4 MM CANNULATED SCREWS", "code_information": [{"code": "210-24-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERBORE 3 IN 1", "code_information": [{"code": "P51-904-1001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 1.1MM", "code_information": [{"code": "2622-11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1270.0, "discounted_cash": 444.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 2.0MM HEADLESS", "code_information": [{"code": "P20-915-2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 859.0, "discounted_cash": 300.65, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 2.0MM X 2.5MM HEADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSN20001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 2.3MM STRYKER HAND PLATE SYS", "code_information": [{"code": "60-80123", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 431.0, "discounted_cash": 150.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 2.5 HEADED SCREW T009000040", "code_information": [{"code": "T009000040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 2.5/2.7 HEADED", "code_information": [{"code": "P20-910-2500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 817.0, "discounted_cash": 285.95, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 3.0 MM", "code_information": [{"code": "A-3938", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.83, "discounted_cash": 289.04, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 3.0/3.5/4.0/4.5 CANNULATED", "code_information": [{"code": "CCS 059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 3.0/4.0MM P06 N0711", "code_information": [{"code": "P06 N0711", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 3.0MM HCS HSINK-3.0", "code_information": [{"code": "HSINK-3.0", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 3.0MM HEADED MINI MONSTER SCREW", "code_information": [{"code": "P20-915-3000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 3.0MM HEADLESS CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSN20004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 3.0MM-3.5MM HEADED CANNULATED", "code_information": [{"code": "MSN20003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 3.5/4.0 CORTEX CANNULATED", "code_information": [{"code": "310.98", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1354.0, "discounted_cash": 473.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 4.0 GOLD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD-070-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 4.0/5.0 LAG P06N0511", "code_information": [{"code": "P06N0511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 4.0MM CANNULATED DART FIRE", "code_information": [{"code": "DSDS1040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 459.0, "discounted_cash": 160.65, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 4.0MM CS56", "code_information": [{"code": "CS56", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 954.95, "discounted_cash": 334.23, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 4.0MM-4.5MM HEADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSN20005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 131.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 4.5MM JONES FRACTURE JF-C45", "code_information": [{"code": "JF-C45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 5.0 HEADED 05900044-NS", "code_information": [{"code": "5900044-NS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 823.0, "discounted_cash": 288.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 5.5MM CS75", "code_information": [{"code": "CS75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1291.2, "discounted_cash": 451.92, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 6.5MM LARGE", "code_information": [{"code": "IW230532", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 854.0, "discounted_cash": 298.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 6MM SOLID 58870002", "code_information": [{"code": "58870002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 417.89, "discounted_cash": 146.26, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 7.0 CANNULATED", "code_information": [{"code": "215-70-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1150.0, "discounted_cash": 402.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK AO END 1.7MM", "code_information": [{"code": "60-80317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 621.0, "discounted_cash": 217.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK AUTOFIX CANNULATED 2.0/2.5MM", "code_information": [{"code": "907-1003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 719.0, "discounted_cash": 251.65, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK BONE 5.5MM MONSTER SCREWS", "code_information": [{"code": "P20-910-5500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 576.0, "discounted_cash": 201.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK BONE 7.0MM MONSTER SCREWS", "code_information": [{"code": "P20-910-7000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 236.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANN 2.0/2.4", "code_information": [{"code": "CCS-035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANN 3.0/3.5/4.0/4.5", "code_information": [{"code": "CCS-059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANN 4.5MM 210-45-002", "code_information": [{"code": "210-45-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 712.85, "discounted_cash": 249.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED", "code_information": [{"code": "316-0031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1103.0, "discounted_cash": 386.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 1.8MM", "code_information": [{"code": "503004355", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 503.0, "discounted_cash": 176.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 2.3MM", "code_information": [{"code": "503004356", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 503.0, "discounted_cash": 176.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 2.5 HEADLESS MSN20002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSN20002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 2.8MM AO COUPLING ASNIS STRL DISP", "code_information": [{"code": "45-20007S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 3.8MM AO COUPLING ASNIS STRL", "code_information": [{"code": "45-30007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 225.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 3MM TO 4MM DIA", "code_information": [{"code": "316-0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1053.0, "discounted_cash": 368.55, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 6.5MM X 8MM AO FITTING SURGINSTR ASNIS III", "code_information": [{"code": "702621", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED AO FITTING 4.0MM", "code_information": [{"code": "705260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 837.0, "discounted_cash": 292.95, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED AO FITTING 5.0MM", "code_information": [{"code": "705261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 870.0, "discounted_cash": 304.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED AO FITTING 7.0MM", "code_information": [{"code": "705262", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 887.0, "discounted_cash": 310.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED BIODRIVE MICRO BLUE RING FOR 2.3MM SCREW", "code_information": [{"code": "FR230B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 928.0, "discounted_cash": 324.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED FOR 3.5 MM AND 4 MM CANNULATED SCREW", "code_information": [{"code": "310.86", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1090.0, "discounted_cash": 381.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED FOR 4.5MM CANNULATED SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "310.85", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED LG SQC", "code_information": [{"code": "3-4000-14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED MONSTER DISP 3.5MM", "code_information": [{"code": "P20-910-3500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED MONSTER DISP 4.0MM", "code_information": [{"code": "P20-910-4000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED MONSTER DISP 4.5MM", "code_information": [{"code": "P20-910-4500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED SM SMALL A/O COUNTERSINK CANNULATED SCREW SYS", "code_information": [{"code": "3-4000-13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED ZT642-14", "code_information": [{"code": "ZT642-14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 941.5, "discounted_cash": 329.53, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK FOR 5.0MM HEADED SCREW CANNULATED JACOBS QC OS900044-NS", "code_information": [{"code": "OS900044-NS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 823.0, "discounted_cash": 288.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK GRIDLOCK ANKLE", "code_information": [{"code": "320-35-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK HEADED 3.0MM OS900042-NS", "code_information": [{"code": "OS900042-NS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1341.0, "discounted_cash": 469.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK INION IFS-9031", "code_information": [{"code": "IFS-9031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK MANUAL", "code_information": [{"code": "320-0024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK QC T30 SCREWS ZT632-14", "code_information": [{"code": "ZT632-14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SCREW 2MM 2.4MM CANNULATED QUICK RELEASEINSTR", "code_information": [{"code": "316-0211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1316.0, "discounted_cash": 460.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SCREW 3MM 4MM CANNULATED QUICK RELEASEINSTR", "code_information": [{"code": "316-0201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1275.0, "discounted_cash": 446.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SCREW CANN 5.5MM", "code_information": [{"code": "215-55-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SELFSTOPPING 3.0MM MINI-MONSTER HEAD", "code_information": [{"code": "P20-910-3000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 395.0, "discounted_cash": 138.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK STRYKR END 53MM SCREW 1.7MM", "code_information": [{"code": "60-80117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.0, "discounted_cash": 148.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SURG 5.5MMINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MDS-070-55", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 173.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SURG 7MM BLUEINSTR", "code_information": [{"code": "MSD-070-70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SURG 7MMINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSS-073-70", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SURG FOR 3.5 MM CORTEX AND 4 MM CANCELLOUS BONE SCREW", "code_information": [{"code": "310.89", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 849.0, "discounted_cash": 297.15, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK VILEX LONG Z632-11", "code_information": [{"code": "Z632-11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK VILEX STANDARD Z622-11", "code_information": [{"code": "Z622-11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1270.0, "discounted_cash": 444.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLER OFFSET 2MM LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2075.0, "discounted_cash": 726.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLER OFFSET 4MM LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2075.0, "discounted_cash": 726.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLER OFFSET POSITIVE 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71424227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2948.0, "discounted_cash": 1031.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLING SURG ROD TO ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4922-1-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1842.0, "discounted_cash": 644.7, "setting": "both", "billing_class": "facility"}]}, {"description": "COUTERSINK 2.7/3.5MM", "code_information": [{"code": "45-80040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 806.0, "discounted_cash": 282.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COUTERSINK 4.0 C556", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 710.0, "discounted_cash": 248.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER ALLEN WILSON FRAME SKINCARE", "code_information": [{"code": "A-70810-A3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER CASSETTE 21IN X 36IN X RAY PROCEDURE DRP PLASTIC", "code_information": [{"code": "8720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER COMFORT CASE OF FIVE DISP", "code_information": [{"code": "A-70260-A3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 197.0, "discounted_cash": 68.95, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE SUTURE", "code_information": [{"code": "65779", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVER FOOTSWITCH UNIVERSAL LIEBEL-FLARSHEIM", "code_information": [{"code": "337125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER FUSIONMAX DISPOSABLE 33501-DC", "code_information": [{"code": "33501-DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 154.25, "discounted_cash": 53.99, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER HANDLE LIGHT FLEXIBLE SOFT LF STRL", "code_information": [{"code": "DYNJLHS1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER LIGHTHANDLE STERILE BLUE LB53", "code_information": [{"code": "LB53", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PLASTIC MAYO STAND 22/CS BXT8339", "code_information": [{"code": "BXT8339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER SHOE SMS DURA-FIT ANTI-SKID 4852", "code_information": [{"code": "4852", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER SHOE SMS DURA-FIT X-LG 4854", "code_information": [{"code": "4854", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER STAND 24IN X 53IN BLUE MAYO LF STRL", "code_information": [{"code": "DYNJP2500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.83, "discounted_cash": 1.69, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER STAND MAYO 23PLACTIC FOB 30 CS", "code_information": [{"code": "8337", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.78, "discounted_cash": 1.67, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TABLE 44IN X 90IN SURG REINFORCED LF STRL DISP", "code_information": [{"code": "DYNJP2311", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "COVERALL ELAST CUFF ANKLE WHITE XXL 2202CV", "code_information": [{"code": "2202CV", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COVID TEST SELF-ADMN/COLLECT", "code_information": [{"code": "K1034", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.6, "maximum": 48.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVID-19 CONVALESCENT PLASMA", "code_information": [{"code": "C9507", "type": "HCPCS"}], "standard_charges": [{"minimum": 3309.71, "maximum": 5200.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3309.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5200.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5200.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5200.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVID-19 LAB TEST NON-CDC", "code_information": [{"code": "U0002", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.88, "maximum": 205.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 73.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 73.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVIDIEN SPACEMAKER PLUS DISSECTOR SYSTEM WITH 5MM CONVERTER 10MM - 12MM", "code_information": [{"code": "SMSBTRND", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1328.0, "discounted_cash": 464.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CPK-MB Isoenzyme", "code_information": [{"code": "82552", "type": "CPT"}, {"code": "633713", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE 1ST 60 MIN", "code_information": [{"code": "99487", "type": "CPT"}], "standard_charges": [{"minimum": 233.64, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 233.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 367.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 367.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 367.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE EA ADDL 30", "code_information": [{"code": "99489", "type": "CPT"}], "standard_charges": [{"minimum": 117.61, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 117.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 184.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 184.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 184.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPTR OPHTH DX IMG POST SEGMT", "code_information": [{"code": "92134", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPTRIZED CORNEAL TOPOGRAPHY", "code_information": [{"code": "92025", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRADLE POSITIONER 3IN X 5IN X 24IN ARM FOAM LATEX", "code_information": [{"code": "NON081344", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.16, "discounted_cash": 4.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [{"code": "73", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8837.99, "maximum": 15172.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8837.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12640.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13904.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15172.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [{"code": "74", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6198.58, "maximum": 10641.42, "estimated_discounted_cash": 12222.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6198.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8865.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9751.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10641.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY BONE FLAP CRANI.TRANSTEMP.FOR EXC.CEREBELLO TUMOR W/MPD/POST. 61526", "code_information": [{"code": "61526", "type": "CPT"}, {"code": "1480453", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY BONE FLAP CRANI.TRANSTEMP.FOR EXCISION OF CEREBELLO.ANGLE TUMOR", "code_information": [{"code": "61518", "type": "CPT"}, {"code": "1480454", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1046.43, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1046.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY FOR EXCISION OF CEREBELLOPONTINE ANGLE TUMOR 61520", "code_information": [{"code": "61520", "type": "CPT"}, {"code": "1480455", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY FOR EXCISION OF MIDLINE TUMOR AT BASE OF SKULL 61521", "code_information": [{"code": "61521", "type": "CPT"}, {"code": "1480456", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY FOR EXCISION OR FENESTRATION OF CYST 61516", "code_information": [{"code": "61516", "type": "CPT"}, {"code": "1480457", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY FOR RECONTOURING WITH MULTIPLE OSTEOTOMIES AND BONE AUTOGRAFTS 61559", "code_information": [{"code": "61559", "type": "CPT"}, {"code": "1480458", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY OR CRANIOTOMY WITH LOBECTOMY 61323", "code_information": [{"code": "61323", "type": "CPT"}, {"code": "1480459", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY SUBOCCIPITAL WITH CERVICAL LAMINECTOMY 61343", "code_information": [{"code": "61343", "type": "CPT"}, {"code": "1480460", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY TREP.BONE FLAP CRANI.FOR EXCISION BRAIN ABSCESS SUPRATENTORIAL 61514", "code_information": [{"code": "61514", "type": "CPT"}, {"code": "1480461", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY TREP.BONE FLAP CRANI.FOR EXCISION BRAIN TUMOR SUPRATENTORIAL 61512", "code_information": [{"code": "61512", "type": "CPT"}, {"code": "1480462", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY TREP.BONE FLAP CRANI.FOR EXCISION OF MENINGIOMA SUPRATENTORIAL 61519", "code_information": [{"code": "61519", "type": "CPT"}, {"code": "1480463", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIECTOMY;WITH EXCISION OF TUMOR 61500", "code_information": [{"code": "61500", "type": "CPT"}, {"code": "1480464", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 9735.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61580", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61581", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA;EXTRADURAL 61582", "code_information": [{"code": "61582", "type": "CPT"}, {"code": "1480465", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA;INTRADURAL 61583", "code_information": [{"code": "61583", "type": "CPT"}, {"code": "1480466", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOPLASTY FOR SKULL DEFECT WITH REPARATIVE BRAIN SURGERY 62145", "code_information": [{"code": "62145", "type": "CPT"}, {"code": "1480467", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOPLASTY FOR SKULL DEFECT;LARGER THAN 5 CM DIAMETER 62141", "code_information": [{"code": "62141", "type": "CPT"}, {"code": "1480468", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOPLASTY FOR SKULL DEFECT;UP TO 5 CM DIAMETER 62140", "code_information": [{"code": "62140", "type": "CPT"}, {"code": "1480469", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOPLASTY WITH AUTOGRAFT;LARGER THAN 5 CM DIAMETER 62147", "code_information": [{"code": "62147", "type": "CPT"}, {"code": "1480470", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOPLASTY WITH AUTOGRAFT;UP TO 5 CM DIAMETER 62146", "code_information": [{"code": "62146", "type": "CPT"}, {"code": "1480471", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "26", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18626.15, "maximum": 31976.47, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18626.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26639.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29303.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31976.47, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "25", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27357.68, "maximum": 46966.35, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27357.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39127.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43040.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46966.35, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "27", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15294.49, "maximum": 26256.83, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15294.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21874.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24061.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26256.83, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY DECOMPRESSIVE FOR TREATMENT OF INTRACRANIAL HYPERTENSION 61322", "code_information": [{"code": "61322", "type": "CPT"}, {"code": "1480472", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY DRAINAGE OF INTRACRANIAL ABSCESS;INFRATENTORIAL 61522", "code_information": [{"code": "61522", "type": "CPT"}, {"code": "1480473", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY EXPLORATORY;INFRATENTORIAL 61305", "code_information": [{"code": "61305", "type": "CPT"}, {"code": "1480475", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY EXPLORATORY;SUPRATENTORIAL 61304", "code_information": [{"code": "61304", "type": "CPT"}, {"code": "1480476", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR CRANIOSYNOSTOSIS;BIFRONTAL BONE FLAP 61557", "code_information": [{"code": "61557", "type": "CPT"}, {"code": "1480477", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR CRANIOSYNOSTOSIS;FRONTAL OR PARIETAL BONE FLAP 61556", "code_information": [{"code": "61556", "type": "CPT"}, {"code": "1480478", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR EVACUATION OF HEMATOMA INFRATENTORIAL 61314", "code_information": [{"code": "61314", "type": "CPT"}, {"code": "1480479", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR EVACUATION OF HEMATOMA INTRACEREBELLAR 61315", "code_information": [{"code": "61315", "type": "CPT"}, {"code": "1480480", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR EVACUATION OF HEMATOMA SUPRATENTORIAL 61312", "code_information": [{"code": "61312", "type": "CPT"}, {"code": "1480481", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR EXCISION OF CEREBRAL EPILEPTOGENIC FOCUS 61536", "code_information": [{"code": "61536", "type": "CPT"}, {"code": "1480482", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR EXCISION OF COAGULATION OF CHOROID PLEXUS 61544", "code_information": [{"code": "61544", "type": "CPT"}, {"code": "1480483", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR EXCISION OF CRANIOPHARYNGIOMA 61545", "code_information": [{"code": "61545", "type": "CPT"}, {"code": "1480484", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR EXCISION OF EPILEPTOGENIC FOCUS WITHOUT 61534", "code_information": [{"code": "61534", "type": "CPT"}, {"code": "1480485", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "955", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38257.81, "maximum": 65679.16, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38257.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54716.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60188.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 65679.16, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR SUBDURAL IMPLANTATION OF ELECTRODE ARRAY 61533", "code_information": [{"code": "61533", "type": "CPT"}, {"code": "1480488", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR TOTAL HEMISPHERECTOMY 61542", "code_information": [{"code": "1480489", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR TRANSECTION OF CORPUS CALLOSUM 61541", "code_information": [{"code": "61541", "type": "CPT"}, {"code": "1480490", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "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": 34502.17, "maximum": 59231.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34502.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49345.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54280.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59231.65, "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": 23960.94, "maximum": 41134.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23960.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34269.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37696.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41134.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY;WITH EXCISION OF FOREIGN BODY FROM BRAIN 61334", "code_information": [{"code": "1480491", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CRANIOTOMY;WITH TREATMENT OF PENETRATING WOUND OF BRAIN 61571", "code_information": [{"code": "61571", "type": "CPT"}, {"code": "1480492", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRC NO DOC NO RSN", "code_information": [{"code": "M1315", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRCLG STRAIGHT PASSER SM DISPOSABLE AR-7825", "code_information": [{"code": "AR-7825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 656.09, "discounted_cash": 229.63, "setting": "both", "billing_class": "facility"}]}, {"description": "CRD C HRT DS 9 GEN 12 VRNTS", "code_information": [{"code": "416U", "type": "CPT"}], "standard_charges": [{"minimum": 600.17, "maximum": 600.17, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD C HRT DS 9 GEN 12 VRNTS", "code_information": [{"code": "417U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 1713.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CAD ALYS 3 PRTN 3 PARAM", "code_information": [{"code": "308U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 562.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CERAMIDES LIQ CHROM PLSM", "code_information": [{"code": "119U", "type": "CPT"}], "standard_charges": [{"minimum": 61.43, "maximum": 120.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 120.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 120.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CV DS ALY 4 PRTN PLM ALG", "code_information": [{"code": "309U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 562.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD HRT TRNSPL MRNA 1283 GEN", "code_information": [{"code": "87U", "type": "CPT"}], "standard_charges": [{"minimum": 4549.56, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4549.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4549.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE EARDRUM OPENING", "code_information": [{"code": "69433", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE NEW TUBAL OPENING", "code_information": [{"code": "58770", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE PASSAGE TO KIDNEY", "code_information": [{"code": "52334", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68745", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68750", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATINE ISOFORMS", "code_information": [{"code": "82554", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 47.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE CLEARANCE TEST", "code_information": [{"code": "82575", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATION OF LESION BY STEROTACTICPERCUTANEOUS NEURO.AGENT TRIGEMINAL MEDULLAR 61791", "code_information": [{"code": "61791", "type": "CPT"}, {"code": "1480493", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATION OF SHUNT;VENTRICULO-PERITONEAL 62223", "code_information": [{"code": "62223", "type": "CPT"}, {"code": "1480496", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRH STIMULATION PANEL", "code_information": [{"code": "80412", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1002.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2044.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3214.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3214.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3214.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1154.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1154.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRICOTRACHEAL RESECTION", "code_information": [{"code": "31592", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRISIS PSYCHOTHERAPY 60M", "code_information": [{"code": "G0017", "type": "HCPCS"}], "standard_charges": [{"minimum": 833.89, "maximum": 1310.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 833.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1310.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1310.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1310.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRIT CARE TELEHEA CONSULT 50", "code_information": [{"code": "G0509", "type": "HCPCS"}], "standard_charges": [{"minimum": 885.26, "maximum": 1391.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 885.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1391.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1391.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1391.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRIT CARE TELEHEA CONSULT 60", "code_information": [{"code": "G0508", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.7, "maximum": 1473.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 937.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1473.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1473.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1473.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRITICAL CARE ADDL 30 MIN", "code_information": [{"code": "99292", "type": "CPT"}], "standard_charges": [{"minimum": 1680.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2643.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2643.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2643.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRITICAL CARE FIRST HOUR", "code_information": [{"code": "99291", "type": "CPT"}], "standard_charges": [{"minimum": 1680.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2643.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2643.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2643.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROM GNOTYP CD55 EXONS 1-10", "code_information": [{"code": "182U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 433.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSS CONNECTOR 43-54 XIA 3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48236043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSS LINK ADJUSTABLE FOR RODSMEDIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX.TL.1050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSS-OVER VEIN GRAFT", "code_information": [{"code": "34520", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSS-PLATE COMPRESSION T8 LEFT METATARSAL PHALLANGEAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4744.0, "discounted_cash": 1660.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CRTX SCREW 18MM S-T PERILOCK 3.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73824018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUCIATE RETAINING FEMORAL TRIATHLON SIZE #7 RIGHT CR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCH AXILLARY ADULT 62-70 300LB CA901AD", "code_information": [{"code": "CA901AD", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCH AXILLARY CHILD 48-52 300LB", "code_information": [{"code": "CA901CH", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCH AXILLARY TALL 70-78 300LB CA901TL", "code_information": [{"code": "CA901TL", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCH AXILLARY YOUTH SZ 52-62 300LB CA901YTH", "code_information": [{"code": "CA901YTH", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCHES ADULT 61-69IN BARIATRIC 650LB PUSH BUTTON ADJUSTABLE", "code_information": [{"code": "IPR-AXI-0022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 32.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CRYO FIB COMP PATH REDU EACH", "code_information": [{"code": "P9026", "type": "HCPCS"}], "standard_charges": [{"minimum": 203.62, "maximum": 320.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 203.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 320.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 320.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 320.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYO UNIT W/ PROSTATE PROCEDURE PROBE PACK 6 CRYO-207-V", "code_information": [{"code": "C2618", "type": "HCPCS"}, {"code": "CRYO-207-V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CRYOABLATE PROSTATE", "code_information": [{"code": "55873", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE RENAL MASS OPEN", "code_information": [{"code": "50250", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOABLATION RENAL MASS LAPAROSCOPIC 50542", "code_information": [{"code": "50542", "type": "CPT"}, {"code": "1480499", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 14796.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION EMBRYO(S)", "code_information": [{"code": "89258", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION OOCYTE(S)", "code_information": [{"code": "89337", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION SPERM", "code_information": [{"code": "89259", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE STEM CELLS", "code_information": [{"code": "38207", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE TESTICULAR TISS", "code_information": [{"code": "89335", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOSURG ABLATE FA EACH", "code_information": [{"code": "19105", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY ANAL LESION(S)", "code_information": [{"code": "46916", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOTHERAPY OF SKIN", "code_information": [{"code": "17340", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS ANTIBODY", "code_information": [{"code": "86641", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS NEOFORM AG IA", "code_information": [{"code": "87327", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM AG IA", "code_information": [{"code": "87328", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM AG IF", "code_information": [{"code": "87272", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF LEAKAGE IMAGING", "code_information": [{"code": "78650", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1129.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1775.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1775.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1775.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 526.53, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 560.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT EVALUATION", "code_information": [{"code": "78645", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1351.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2124.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2124.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2124.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 636.67, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 677.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT REPROGRAM", "code_information": [{"code": "62252", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF VENTRICULOGRAPHY", "code_information": [{"code": "78635", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1400.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2201.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2201.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2201.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 659.18, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 701.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSIT LOWRISK SURG PTS PREOP", "code_information": [{"code": "G8961", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSIT ON PT ANY REAS 30 DAYS", "code_information": [{"code": "G8962", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB FULL GENE ANALYSIS", "code_information": [{"code": "232U", "type": "CPT"}], "standard_charges": [{"minimum": 395.76, "maximum": 1102.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB GENE DETC ABNOR ALLELE", "code_information": [{"code": "81188", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB GENE FULL GENE SEQUENCE", "code_information": [{"code": "81189", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81190", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 472.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABD & PELV W/CONTRAST", "code_information": [{"code": "74177", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 531.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 564.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABDOMEN W/DYE", "code_information": [{"code": "74160", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 420.43, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 446.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABDOMEN W/O & W/DYE", "code_information": [{"code": "74170", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 476.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 506.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO ABD&PELV W/O&W/DYE", "code_information": [{"code": "74174", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1269.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1995.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1995.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1995.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 680.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 724.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO ABDOM W/O & W/DYE", "code_information": [{"code": "74175", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 542.62, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 577.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO ABDOMINAL ARTERIES", "code_information": [{"code": "75635", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 737.16, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 783.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO HRT W/3D IMAGE", "code_information": [{"code": "75574", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 881.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 520.11, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 553.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO LWR EXTR W/O&W/DYE", "code_information": [{"code": "73706", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 576.36, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 613.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO UPR EXTRM W/O&W/DYE", "code_information": [{"code": "73206", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 524.13, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 557.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIOGRAPH PELV W/O&W/DYE", "code_information": [{"code": "72191", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 541.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 576.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIOGRAPHY CHEST", "code_information": [{"code": "71275", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 483.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 514.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIOGRAPHY HEAD", "code_information": [{"code": "70496", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 479.11, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 509.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIOGRAPHY NECK", "code_information": [{"code": "70498", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 478.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 508.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Abd and Pelvis w/ + w/o Con 74178", "code_information": [{"code": "74178", "type": "CPT"}, {"code": "1171864", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5671.0, "discounted_cash": 1984.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2327.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2327.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2871.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2106.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 599.69, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 637.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Abd and Pelvis w/o Contrast 74176", "code_information": [{"code": "74176", "type": "CPT"}, {"code": "1171868", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2013.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2013.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2483.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1822.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 252.4, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Abdomen w/o Contrast 74150", "code_information": [{"code": "74150", "type": "CPT"}, {"code": "625600", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5671.0, "discounted_cash": 1984.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2327.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2327.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2871.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2106.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 199.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 211.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BONE DENSITY AXIAL", "code_information": [{"code": "77078", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 272.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 428.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 428.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 428.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 213.03, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 226.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C+", "code_information": [{"code": "637T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 2528.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2528.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2528.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2528.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C-", "code_information": [{"code": "636T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 1580.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1005.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C-/C+", "code_information": [{"code": "638T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 2528.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2528.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2528.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2528.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C+", "code_information": [{"code": "634T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 1226.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 780.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1226.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1226.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1226.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C-", "code_information": [{"code": "633T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 748.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 476.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 748.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 748.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 748.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C-/C+", "code_information": [{"code": "635T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 1226.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 780.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1226.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1226.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1226.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT CHEST SPINE W/DYE", "code_information": [{"code": "72129", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 278.15, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 295.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT CHEST SPINE W/O & W/DYE", "code_information": [{"code": "72130", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 342.45, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 364.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT CHEST SPINE W/O DYE", "code_information": [{"code": "72128", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 204.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 217.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT COLONOGRAPHY DX", "code_information": [{"code": "74261", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 731.53, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 777.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT COLONOGRAPHY DX W/DYE", "code_information": [{"code": "74262", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 844.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 897.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT COLONOGRAPHY SCREENING", "code_information": [{"code": "74263", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2847.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4476.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4476.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4476.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1469.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1560.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT GUIDE FOR TISSUE ABLATION", "code_information": [{"code": "77013", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 859.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1351.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1351.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1351.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT HEAD/BRAIN W/O & W/DYE", "code_information": [{"code": "70470", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 280.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 298.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT HRT C+ STRUX CGEN HRT DS", "code_information": [{"code": "75573", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 881.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 461.41, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 491.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT HRT W/3D IMAGE", "code_information": [{"code": "75572", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 795.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1250.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1250.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1250.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 361.73, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 385.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT HRT W/O DYE W/CA TEST", "code_information": [{"code": "75571", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 180.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 191.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Head or Brain w/ Contrast 70460", "code_information": [{"code": "70460", "type": "CPT"}, {"code": "629962", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2860.0, "discounted_cash": 1001.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1174.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1174.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1448.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1062.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 250.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Head or Brain w/o Contrast 70450", "code_information": [{"code": "70450", "type": "CPT"}, {"code": "629966", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 3142.0, "discounted_cash": 1099.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1289.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1289.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1590.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1166.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 164.8, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 175.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT LOWER EXTREMITY W/DYE", "code_information": [{"code": "73701", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 276.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 294.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT LOWER EXTREMITY W/O DYE", "code_information": [{"code": "73700", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 204.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 217.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT LUCIA IOL LENS 19.0 D CT LUCIA 19.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CT LUCIA 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CT LUMBAR SPINE W/O & W/DYE", "code_information": [{"code": "72133", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 338.43, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 359.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT LUMBAR SPINE W/O DYE", "code_information": [{"code": "72131", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 204.19, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 217.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT LWR EXTREMITY W/O&W/DYE", "code_information": [{"code": "73702", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 340.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 362.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT MAXILLOFACIAL W/DYE", "code_information": [{"code": "70487", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 244.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 260.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT MAXILLOFACIAL W/O & W/DYE", "code_information": [{"code": "70488", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 307.08, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 326.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT MAXILLOFACIAL W/O DYE", "code_information": [{"code": "70486", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 216.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 229.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT NECK SPINE W/DYE", "code_information": [{"code": "72126", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 274.91, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 292.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT NECK SPINE W/O & W/DYE", "code_information": [{"code": "72127", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 337.64, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 359.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ORBIT/EAR/FOSSA W/DYE", "code_information": [{"code": "70481", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 313.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 333.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ORBIT/EAR/FOSSA W/O DYE", "code_information": [{"code": "70480", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 243.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 259.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ORBIT/EAR/FOSSA W/O&W/DYE", "code_information": [{"code": "70482", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 370.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 394.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT PELVIS W/DYE", "code_information": [{"code": "72193", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 423.64, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 450.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT PELVIS W/O & W/DYE", "code_information": [{"code": "72194", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 475.11, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 504.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT PERFUSION W/CONTRAST CBF", "code_information": [{"code": "42T", "type": "CPT"}], "standard_charges": [{"minimum": 428.26, "maximum": 673.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 428.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 673.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 673.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 673.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Pelvis w/o Contrast 72192", "code_information": [{"code": "72192", "type": "CPT"}, {"code": "630114", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 3818.0, "discounted_cash": 1336.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1567.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1567.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1933.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1418.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 202.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 215.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT SCAN F/BIOMCHN CT ALYS", "code_information": [{"code": "558T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 548.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT SCAN FOR LOCALIZATION", "code_information": [{"code": "77011", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 737.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1158.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1158.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1158.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 378.64, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 402.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT SCAN FOR NEEDLE BIOPSY", "code_information": [{"code": "77012", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 341.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 537.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 537.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 537.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 138.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 147.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT SCAN FOR THERAPY GUIDE", "code_information": [{"code": "77014", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 337.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 529.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 529.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 529.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 178.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 189.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT SFT TSUE NCK W/O & W/DYE", "code_information": [{"code": "70492", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 357.73, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 380.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT SOFT TISSUE NECK W/DYE", "code_information": [{"code": "70491", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 294.22, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 313.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT SOFT TISSUE NECK W/O DYE", "code_information": [{"code": "70490", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 221.87, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Spine Cervical w/o Contrast 72125", "code_information": [{"code": "72125", "type": "CPT"}, {"code": "629610", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5348.0, "discounted_cash": 1871.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2195.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2195.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2707.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1986.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 218.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Spine Cervical w/o Contrast 72125", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1117.0, "discounted_cash": 390.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CT Spine Lumbar w/ Contrast 72132", "code_information": [{"code": "72132", "type": "CPT"}, {"code": "630052", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 382.0, "discounted_cash": 133.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 156.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 156.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 193.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 141.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 276.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 294.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT THORAX DX C+", "code_information": [{"code": "71260", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 276.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 294.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT THORAX DX C-", "code_information": [{"code": "71250", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 203.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 216.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT THORAX LUNG CANCER SCR C-", "code_information": [{"code": "71271", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 451.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 710.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 710.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 710.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 214.63, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 228.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Thorax w/ + w/o Contrast 71270", "code_information": [{"code": "71270", "type": "CPT"}, {"code": "629698", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4330.0, "discounted_cash": 1515.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1777.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1777.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2192.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1608.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 338.43, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 359.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT UPPER EXTREMITY W/DYE", "code_information": [{"code": "73201", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 357.73, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 380.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT UPPER EXTREMITY W/O DYE", "code_information": [{"code": "73200", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 280.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 298.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT UPPR EXTREMITY W/O&W/DYE", "code_information": [{"code": "73202", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 465.43, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 495.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT/CTA/MRI/A CHST FOLL REC", "code_information": [{"code": "G9554", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT/CTA/MRI/A NO FOLLUP IMAG", "code_information": [{"code": "G9556", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT/CTA/MRI/A NO THYR <1.0CM", "code_information": [{"code": "G9557", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CTHTR IV SFTY 16GX1.25\" PUR STRAIGHT 4251709-02", "code_information": [{"code": "4251709-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CTHTR IV SFTY 24GX.75 FEP STRAIGHT 4252500-02", "code_information": [{"code": "4252500-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF 34IN SPSB STER DISP W PLC 60707510600", "code_information": [{"code": "60707510600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF ADULT LONG 2-TUBE NAVY 002756", "code_information": [{"code": "2756", "type": "CDM"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE 12CM-19CM GREEN WHITE TWO TUBE MATED SOFT CUF PEDI DISP", "code_information": [{"code": "2451", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE 23CM TO 33 CM NAVY WHITE LONG 2 TB SOFT LATEX FREE ADULT", "code_information": [{"code": "2454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE 23CM TO 33CM NAVY WHITE", "code_information": [{"code": "2453", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE 31CM-40CM LRG ROSE WHITE TWO PORT MATED SOFT CUF ADULT", "code_information": [{"code": "2455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE MINI GRN 2 TUBE MATED SUBMIN CONNECTOR CHILD DURA-CUF", "code_information": [{"code": "2751", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF PROSTHESIS URINARY+B14918", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "72404132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12603.0, "discounted_cash": 4411.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET 12IN 1 PORT 1 BLADDER PUMP LN CONN DISP", "code_information": [{"code": "60707510200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET 18IN CYLINDRICAL SNGL PORT DUAL BLADDER ATS 1200", "code_information": [{"code": "60708510200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET 18IN SNGL PORT SNGL BLADDER STRL", "code_information": [{"code": "60707510300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.37, "discounted_cash": 17.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET 30IN 1 PORT 1 BLADDER PUMP LN CONN DISP", "code_information": [{"code": "60707510500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.35, "discounted_cash": 17.62, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET 34IN 1 PORT 1 BLADDER PUMP LN CONN DISP", "code_information": [{"code": "60-7075-106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.08, "discounted_cash": 18.93, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET 42IN 1 PORT 1 BLADDER PUMP LN CONN DISP", "code_information": [{"code": "60707510700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TRNQT 24IN X 4IN DUAL PORT SNGL BLADDER W/ OUT SLEEVE STRL DISP", "code_information": [{"code": "60707510400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TRNQT 34IN X 4IN 2 PORT SNGL BLADDER SLF CHECK CALIBRATION REPROCESS WITHOU", "code_information": [{"code": "60-7070-106R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CUL TYP ID BLD PTHGN 6+ TRGT", "code_information": [{"code": "87154", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 556.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 874.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 874.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 874.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 314.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 314.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT EPIDERM GRFT F/N/HFG +%", "code_information": [{"code": "15157", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRAFT T/A/L +%", "code_information": [{"code": "15152", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT F/N/HFG ADD", "code_information": [{"code": "15156", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/A/L ADDL", "code_information": [{"code": "15151", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/ARM/LEG", "code_information": [{"code": "15150", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89250", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89251", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE AEROBIC IDENTIFY", "code_information": [{"code": "87077", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE AEROBIC QUANT OTHER", "code_information": [{"code": "87071", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE BACTERIA ANAEROBIC", "code_information": [{"code": "87073", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE BACTERIAL URINE", "code_information": [{"code": "P7001", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 63.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE OF SPECIMEN BY KIT", "code_information": [{"code": "87084", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 108.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 108.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 108.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPE IMMUNOFLUORESC", "code_information": [{"code": "87140", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPE IMMUNOLOGIC", "code_information": [{"code": "87147", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPE PULSE FIELD GEL", "code_information": [{"code": "87152", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPING ADDED METHOD", "code_information": [{"code": "87158", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPING GLC/HPLC", "code_information": [{"code": "87143", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP ACTBLR 58MM BHR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74122158", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9234.0, "discounted_cash": 3231.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CUP CERVICAL V-CARE SM 32MM", "code_information": [{"code": "60-6085-200A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CUP HUMERAL 38MM +6MM STANDARD POLYETHYLENE DELTA XTEND", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "130738206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUP REVERS 42 UNIVERSAL NEUTRAL CAP COATED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9502-42CPC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5253.0, "discounted_cash": 1838.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CUP REVERS HUMERAL OFF SET 39+2MM LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9502-39LCPC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5253.0, "discounted_cash": 1838.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CUR FUNCT ASSES; NO CARE PLN", "code_information": [{"code": "G8543", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUR MEDS NOT DOCUMENT", "code_information": [{"code": "G8428", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST CLAVICLE OR SCAPULA 23140", "code_information": [{"code": "23140", "type": "CPT"}, {"code": "1480501", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST CLAVICLE OR SCAPULA W/ALLOGRAFT 23146", "code_information": [{"code": "23146", "type": "CPT"}, {"code": "1480502", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST CLAVICLE OR SCAPULA W/AUTOGRAFT 23145", "code_information": [{"code": "23145", "type": "CPT"}, {"code": "1480503", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST FINGER 26210", "code_information": [{"code": "26210", "type": "CPT"}, {"code": "1480504", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST FINGER W/AUTOGRAFT 26215", "code_information": [{"code": "26215", "type": "CPT"}, {"code": "1480505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST HIP 27065", "code_information": [{"code": "27065", "type": "CPT"}, {"code": "1480506", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST HUMERUS WITH ALLOGRAFT 24116", "code_information": [{"code": "24116", "type": "CPT"}, {"code": "1480507", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST HUMERUS WITH AUTOGRAFT 24115", "code_information": [{"code": "24115", "type": "CPT"}, {"code": "1480508", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST METACARPAL 26200", "code_information": [{"code": "26200", "type": "CPT"}, {"code": "1480509", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST METACARPAL W/AUTOGRAFT 26205", "code_information": [{"code": "26205", "type": "CPT"}, {"code": "1480510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST OR BENIGN TUMOR HUMERUS 24110", "code_information": [{"code": "24110", "type": "CPT"}, {"code": "1480511", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST RADIUS ULNA W/ALLOGRAFT 24126", "code_information": [{"code": "24126", "type": "CPT"}, {"code": "1480512", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST RADIUS/ULNA 24120", "code_information": [{"code": "24120", "type": "CPT"}, {"code": "1480513", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST RADIUS/ULNA W/AUTOGRAFT 24125", "code_information": [{"code": "24125", "type": "CPT"}, {"code": "1480514", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST WITH ALLOGRAFT TALUS OR CALCANEOUS 28103", "code_information": [{"code": "28103", "type": "CPT"}, {"code": "1480515", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST WITH AUTOGRAFT TALUS OR CALCANEOUS 28102", "code_information": [{"code": "28102", "type": "CPT"}, {"code": "1480516", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE BONE CYST/BENIGN TUMOR TALUS OR CALCANEOUS 28100", "code_information": [{"code": "28100", "type": "CPT"}, {"code": "1480517", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE OR EXCISION BONE CYST WITH ALLOGRAFT TIBIA OR FIBULA 27638", "code_information": [{"code": "27638", "type": "CPT"}, {"code": "1480518", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE OR EXCISION OF BONE CYST TIBIA OR FIBULA 27635", "code_information": [{"code": "27635", "type": "CPT"}, {"code": "1480519", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGEOR EXCISION BONE CYST WITH AUTOGRAFT TIBIA OR FIBULA 27637", "code_information": [{"code": "27637", "type": "CPT"}, {"code": "1480520", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTE 10MM RIGID CURVED 022110", "code_information": [{"code": "22110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.5, "discounted_cash": 8.23, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE 11G", "code_information": [{"code": "306-621-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1229.0, "discounted_cash": 430.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE 11MM RIGID CURVED 022111", "code_information": [{"code": "22111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE ADENOID 2 DISP", "code_information": [{"code": "1423002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 44.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE PIPETTE 23.97 CM SNGL USE DOUBLE O RING LF STRL", "code_information": [{"code": "MX140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE RIGID CURVED 6MM 022106", "code_information": [{"code": "22106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE RIGID CURVED 8MM 022108", "code_information": [{"code": "22108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE SURG SZ 2 LASIK ADENOID REPROCESSINSTR DISP", "code_information": [{"code": "14-23002R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 44.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE VAC 12MM PLS CANN CRV RND TIP SMRG THNWL STRL DISP", "code_information": [{"code": "21555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE VACUUM 10MM CANNULATED CURVED ROUND OPEN TIP RIGID DISP", "code_information": [{"code": "21553", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE VCM 9MM CANNULATED RIGID CURVED ROUND TIP ASPIRATION BERKELEY DISP", "code_information": [{"code": "21552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CURRENT SMOKER", "code_information": [{"code": "G9642", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURRETTAGE POSTPARTUM 59160", "code_information": [{"code": "59160", "type": "CPT"}, {"code": "1764939", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURVED ROD 3.5MM X 50MM LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-002-03-3550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CUSTOM HAND BAG 8IN X 4IN X 15IN", "code_information": [{"code": "32-1361", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.55, "discounted_cash": 3.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER 45MM RELOAD GREY ECHELON ECR45M", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "ECR45M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER ENDO 60MM ECHELON FLEX ENDOPATH POWER FLEX SHAFT", "code_information": [{"code": "PSEE60A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1027.0, "discounted_cash": 359.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER HIGH SPEED 23G 8000CPM", "code_information": [{"code": "8268.VIT23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER HIGH SPEED 25G 8000CPM", "code_information": [{"code": "8268.VIT25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER HIGH SPEED 27G 8000CPM", "code_information": [{"code": "8268.VIT27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER LINEAR 100MM TISSUE RETAINING DIST END SAFETY LOCKOUT PROXIMATE LF", "code_information": [{"code": "TLC10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 162.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER LINEAR 55MM TISSUE RETAINING DIST END SAFETY LOCKOUT PROXIMATE LF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLC55", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 134.2, "discounted_cash": 46.97, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER LINEAR 75MM SAFETY LOCKOUT TLC75", "code_information": [{"code": "TLC75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.25, "discounted_cash": 83.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER LINEAR CUTTER 45MM WHT ENDOSCPC TR45W", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "TR45W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 73.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER LINEAR POWERED ECHO FLEX 34 MM 34 CM SHAFT", "code_information": [{"code": "PSE45A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 860.0, "discounted_cash": 301.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER LINEAR PROXIMATE 75MM LONG TCT75", "code_information": [{"code": "TCT75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 393.0, "discounted_cash": 137.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER TOMCAT 4MM REPROCESS FORMULA", "code_information": [{"code": "375-545-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER:ETHICON-ECHELON RELOAD CUTTER VASCULAR35", "code_information": [{"code": "VASECR35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 417.0, "discounted_cash": 145.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CV DS ACS BLD ALG 5 YR SCORE", "code_information": [{"code": "415U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 562.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV DS PLASMA ALYS PRTN BMRK", "code_information": [{"code": "19M", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV DS QUAN ADVSRM/PLSM LPRTN", "code_information": [{"code": "377U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 68.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 68.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CVA STROKE DX TX TRANSF FAC", "code_information": [{"code": "G9766", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CVAC SYSTEM KIDNEY STONE REMOVAL CVC127020-1", "code_information": [{"code": "C1747", "type": "HCPCS"}, {"code": "CVC127020-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7654.05, "discounted_cash": 2678.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CVD RISK ASSESS NOT PERF", "code_information": [{"code": "M1257", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CVD RISK ASSESS PERF", "code_information": [{"code": "M1258", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYCLOPENTOLATE HCL 2 mg", "code_information": [{"code": "MED0067", "type": "CDM"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CYP1A2 GENE", "code_information": [{"code": "31U", "type": "CPT"}], "standard_charges": [{"minimum": 251.72, "maximum": 700.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 445.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2C19 GENE COM VARIANTS", "code_information": [{"code": "81225", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 364.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 742.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1168.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1168.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1168.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 419.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 419.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2C9 GENE COM VARIANTS", "code_information": [{"code": "81227", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 445.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 3' GENE DUP/MLT", "code_information": [{"code": "76U", "type": "CPT"}], "standard_charges": [{"minimum": 649.31, "maximum": 1808.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 5' GENE DUP/MLT", "code_information": [{"code": "75U", "type": "CPT"}], "standard_charges": [{"minimum": 649.31, "maximum": 1808.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 FULL GENE SEQUENCE", "code_information": [{"code": "71U", "type": "CPT"}], "standard_charges": [{"minimum": 768.44, "maximum": 1208.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 768.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN COM&SLCT RAR VRNT", "code_information": [{"code": "70U", "type": "CPT"}], "standard_charges": [{"minimum": 973.97, "maximum": 2712.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1724.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2712.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2712.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2712.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 973.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 973.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN CYP2D6-2D7 HYBRID", "code_information": [{"code": "72U", "type": "CPT"}], "standard_charges": [{"minimum": 649.31, "maximum": 1808.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN CYP2D7-2D6 HYBRID", "code_information": [{"code": "73U", "type": "CPT"}], "standard_charges": [{"minimum": 649.31, "maximum": 1808.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GENE COM VARIANTS", "code_information": [{"code": "81226", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 563.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 NONDUPLICATED GENE", "code_information": [{"code": "74U", "type": "CPT"}], "standard_charges": [{"minimum": 649.31, "maximum": 1808.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP3A4 GENE COMMON VARIANTS", "code_information": [{"code": "81230", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 445.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP3A5 GENE COMMON VARIANTS", "code_information": [{"code": "81231", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 445.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYS REN LES OR ADREN", "code_information": [{"code": "G9547", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTATIN C", "code_information": [{"code": "82610", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTITOME IRRIGATING 27GA ANGLED REVERSE CUTTING OPHTHALMIC STRLINSTR DISP", "code_information": [{"code": "8065425820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.65, "discounted_cash": 6.88, "setting": "both", "billing_class": "facility"}]}, {"description": "CYSTO W/ BX(S) W/ BLUE LIGHT", "code_information": [{"code": "C7550", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO W/PRST8 COMMISSUROTOMY", "code_information": [{"code": "619T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO W/RENAL STRICTURE TX", "code_information": [{"code": "52343", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO W/TEMP PROS IMPLANT", "code_information": [{"code": "C9769", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 4382.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO/LITHO/VACUUM ASPIRATION OF KIDNEY C9761", "code_information": [{"code": "C9761", "type": "HCPCS"}, {"code": "46355443", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 18082.0, "gross_charge": 6990.0, "discounted_cash": 2446.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 16287.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 14288.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3383.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/UP", "code_information": [{"code": "51727", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP", "code_information": [{"code": "51728", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP&UP", "code_information": [{"code": "51729", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTORRHAPHY-SUTURE OF BLADDER WOUND/INJURY/RUPTURE-SIMPLE 51860", "code_information": [{"code": "51860", "type": "CPT"}, {"code": "1481833", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & DUCT CATHETER", "code_information": [{"code": "52010", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND RADIOTRACER", "code_information": [{"code": "52250", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52277", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52283", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52300", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY BLADDER WASHINGS 51700", "code_information": [{"code": "51700", "type": "CPT"}, {"code": "1480532", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY CYSTOMETROGRAM-COMPLEX 51726", "code_information": [{"code": "51726", "type": "CPT"}, {"code": "1480533", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY CYSTOMETROGRAM-SIMPLE 51725", "code_information": [{"code": "51725", "type": "CPT"}, {"code": "1480534", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY IMPLANT STENT", "code_information": [{"code": "52282", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY INJECT MATERIAL", "code_information": [{"code": "52327", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY INJECTION COLLAGEN 51715", "code_information": [{"code": "51715", "type": "CPT"}, {"code": "1480535", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY PROSTATIC IMP 1-3", "code_information": [{"code": "C9739", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY STONE REMOVAL", "code_information": [{"code": "52325", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSTOMY CYSTOTOMY W/DRAINAGE 51040", "code_information": [{"code": "51040", "type": "CPT"}, {"code": "1480539", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/CONGEN REPR", "code_information": [{"code": "52400", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/RENAL STRICT", "code_information": [{"code": "52346", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO CUT EJACUL DUCT", "code_information": [{"code": "52402", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY 52000", "code_information": [{"code": "52000", "type": "CPT"}, {"code": "1480541", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 18082.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 16287.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 14288.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY BLADDER DISTENSION W/GENERAL ANESTHESIA 52260", "code_information": [{"code": "52260", "type": "CPT"}, {"code": "1480542", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY BLADDER DISTENSION W/LOCAL ANESTHESIA 52265", "code_information": [{"code": "52265", "type": "CPT"}, {"code": "1480543", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1475.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1475.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY BLADDER DIVERTICULECTOMY 52305", "code_information": [{"code": "52305", "type": "CPT"}, {"code": "1480544", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY CATHETERIZATION URETERAL 52005", "code_information": [{"code": "52005", "type": "CPT"}, {"code": "1480545", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 18082.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 16287.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 14288.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY DILATION URETEROPELVIC JUNCTION 52342", "code_information": [{"code": "52342", "type": "CPT"}, {"code": "1480546", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY DIRECT VISUAL INTERNAL URETHROTOMY 52276", "code_information": [{"code": "52276", "type": "CPT"}, {"code": "1480547", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY EVACUATION CLOTS 52001", "code_information": [{"code": "52001", "type": "CPT"}, {"code": "1480548", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY FOR TREATMENT FOR URETHRAL STRICTURE; MALE 52284", "code_information": [{"code": "52284", "type": "CPT"}, {"code": "46339479", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5955.0, "discounted_cash": 2084.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2882.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY FOR TREATMENT OF FEMAL URETHRAL SYNDROME 52285", "code_information": [{"code": "52285", "type": "CPT"}, {"code": "2034641", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 690.18, "maximum": 8450.0, "gross_charge": 1426.0, "discounted_cash": 499.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 690.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY LITHOLAPAXY-COMPLEX 52318", "code_information": [{"code": "52318", "type": "CPT"}, {"code": "1480549", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY LITHOLAPAXY-SIMPLE 52317", "code_information": [{"code": "52317", "type": "CPT"}, {"code": "1480550", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY STONE EXTRACTION 52320", "code_information": [{"code": "52320", "type": "CPT"}, {"code": "1480552", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY URETERAL DILATATION 52341", "code_information": [{"code": "52341", "type": "CPT"}, {"code": "1480553", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY URETERAL STENT INSERTION 52332", "code_information": [{"code": "52332", "type": "CPT"}, {"code": "1480554", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 18082.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 16287.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 14288.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/ FULGERATION AND/OR RESECTION BLADDER TUMORS-LARGE 52240", "code_information": [{"code": "52240", "type": "CPT"}, {"code": "1482039", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/ FULGERATION AND/OR RESECTION BLADDER TUMORS-MEDIUM 52235", "code_information": [{"code": "52235", "type": "CPT"}, {"code": "1482040", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/ FULGERATION AND/OR RESECTION BLADDER TUMORS-SMALL 52234", "code_information": [{"code": "52234", "type": "CPT"}, {"code": "1482041", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/BIOPSY BLADDER 52204", "code_information": [{"code": "52204", "type": "CPT"}, {"code": "1480555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/BLADDER FULGURATION-COMPLEX 52214", "code_information": [{"code": "52214", "type": "CPT"}, {"code": "1480556", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/BLADDER FULGURATION-MINOR LESIONS 52224", "code_information": [{"code": "52224", "type": "CPT"}, {"code": "1480557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/BRUSH BIOPSY URETER 52007", "code_information": [{"code": "52007", "type": "CPT"}, {"code": "1480558", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/DILATION OF URETHERAL STRICTURE 52281", "code_information": [{"code": "52281", "type": "CPT"}, {"code": "1480559", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/FB/CALCULUS/STENT REMOVAL-COMPLEX 52315", "code_information": [{"code": "52315", "type": "CPT"}, {"code": "1480560", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/FB/CALCULUS/STENT REMOVAL-SIMPLE 52310", "code_information": [{"code": "52310", "type": "CPT"}, {"code": "1480561", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/INSERTION OF PERM. ADJ. TRANSPROSTATIC IMPLANT EA. ADD. IMPLANT 52442", "code_information": [{"code": "52442", "type": "CPT"}, {"code": "39314134", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 801.02, "maximum": 8450.0, "gross_charge": 1655.0, "discounted_cash": 579.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 801.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/INSERTION OF PERM. ADJ. TRANSPROSTATIC IMPLANT SINGLE 52441", "code_information": [{"code": "52441", "type": "CPT"}, {"code": "39314132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1227.9, "maximum": 8450.0, "gross_charge": 2537.0, "discounted_cash": 887.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1227.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/INSERTION OF TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS C9740", "code_information": [{"code": "C9740", "type": "HCPCS"}, {"code": "42603691", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9906.51, "gross_charge": 20468.0, "discounted_cash": 7163.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 9906.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/INTERNAL URETHOTOMY-FEMALE 52270", "code_information": [{"code": "52270", "type": "CPT"}, {"code": "1480562", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/INTERNAL URETHOTOMY-MALE 52275", "code_information": [{"code": "52275", "type": "CPT"}, {"code": "1480563", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/MANIPULATION OF STONE W/O REMOVAL 52330", "code_information": [{"code": "52330", "type": "CPT"}, {"code": "1480564", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/MEATOTOMY UNILATERAL OR BILATERAL 52290", "code_information": [{"code": "52290", "type": "CPT"}, {"code": "1480565", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/URETEROSCOPY AND/OR PYELOSCOPY W/LITHOTRIPSY 52353", "code_information": [{"code": "52353", "type": "CPT"}, {"code": "1480536", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 18082.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 16287.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 14288.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 5624.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 5624.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11235.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11235.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/URETEROSCOPY AND/OR PYELOSCOPY W/RES. URETERAL/RENAL PELVIC TUMOR 52355", "code_information": [{"code": "52355", "type": "CPT"}, {"code": "1954776", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/URETEROSCOPY FOR STRICTURE 52344", "code_information": [{"code": "52344", "type": "CPT"}, {"code": "1480569", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/URETEROSCOPY FOR STRICTURE AT URETEROPELVIC JUNCTION 52345", "code_information": [{"code": "52345", "type": "CPT"}, {"code": "1480570", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/URETEROSCOPY-BIOPSY/FULGRATION LESION 52354", "code_information": [{"code": "52354", "type": "CPT"}, {"code": "1480566", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/URETEROSCOPY-DIAGNOSTIC 52351", "code_information": [{"code": "52351", "type": "CPT"}, {"code": "1480567", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/URETEROSCOPY-MANIPULATION/REMOVAL OF CALCULUS 52352", "code_information": [{"code": "52352", "type": "CPT"}, {"code": "1480568", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/URETEROSCOPY/PYELOSCOPY INC. LITHOTRIPSY AND STENT INSERTION 52356", "code_information": [{"code": "52356", "type": "CPT"}, {"code": "18370559", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 18082.0, "gross_charge": 6507.0, "discounted_cash": 2277.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 16287.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 14288.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3149.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY WITH INJECTION FOR CHEMODENERVATION OF THE BLADDER 52287", "code_information": [{"code": "52287", "type": "CPT"}, {"code": "18959541", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY WITH RESECTION OR FULGURATION OF ORTHOTOPIC URETEROCELE; UNI OR BIL 52301", "code_information": [{"code": "52301", "type": "CPT"}, {"code": "38264180", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1703.19, "maximum": 8450.0, "gross_charge": 3519.0, "discounted_cash": 1231.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1703.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY WITH TRANSURETHRAL PROSTATE VAPORIZATION WITH LASER 52648", "code_information": [{"code": "52648", "type": "CPT"}, {"code": "1480571", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY WITH TRANSURETHRAL PROSTATECTOMY 52601", "code_information": [{"code": "52601", "type": "CPT"}, {"code": "1480572", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTURETH BLU LI CYST FL IMG", "code_information": [{"code": "C7554", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTO/MOLECULAR REPORT", "code_information": [{"code": "88291", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 135.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 135.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 135.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 47.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 47.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOG ALYS CHRML ABNR CGH", "code_information": [{"code": "81228", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2295.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3609.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3609.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3609.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOG ALYS CHRML ABNR LW-PS", "code_information": [{"code": "81349", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 785.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1235.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1235.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1235.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1670.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1670.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOG ALYS CHRML ABNR SNPCGH", "code_information": [{"code": "81229", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4651.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4651.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4651.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1670.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1670.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOG CONST ALYS INTERROG", "code_information": [{"code": "209U", "type": "CPT"}], "standard_charges": [{"minimum": 1133.5, "maximum": 3609.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2295.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3609.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3609.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3609.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1133.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1133.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 10-30", "code_information": [{"code": "88273", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 49.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 88.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 139.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 139.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 139.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 100-300", "code_information": [{"code": "88275", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 63.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 205.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 205.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 205.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 25-99", "code_information": [{"code": "88274", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 53.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 3-5", "code_information": [{"code": "88272", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 50.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 103.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 163.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 163.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 163.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 58.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 58.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS DNA PROBE", "code_information": [{"code": "88271", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 85.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 85.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 85.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOGENOMIC NEO MICRORA ALYS", "code_information": [{"code": "81277", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4651.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4651.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4651.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1670.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1670.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOLOGY BRUSHES Cytology Brush 133-5541 2mm 180cm 2.8", "code_information": [{"code": "CY49021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CYTOLOGY BRUSHES Cytology Brush 133-5542 3mm 240cm 2.8", "code_information": [{"code": "CY49051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CYTOMEG DNA AMP PROBE", "code_information": [{"code": "87496", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOMEG DNA DIR PROBE", "code_information": [{"code": "87495", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 120.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 120.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 120.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 43.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 43.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOMEG DNA QUANT", "code_information": [{"code": "87497", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS AG IA", "code_information": [{"code": "87332", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS DFA", "code_information": [{"code": "87271", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO FLUID REDO", "code_information": [{"code": "88175", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 40.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 67.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 106.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 106.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 106.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO IN FLUID", "code_information": [{"code": "88174", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 101.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 101.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 101.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO REDO", "code_information": [{"code": "88152", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 70.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 110.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 110.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 110.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO RESCREEN", "code_information": [{"code": "88148", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTOMATED", "code_information": [{"code": "88147", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 63.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 128.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 202.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 202.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 202.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V INDEX ADD-ON", "code_information": [{"code": "88155", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V INTERPRET", "code_information": [{"code": "88141", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V MANUAL", "code_information": [{"code": "88150", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V REDO", "code_information": [{"code": "88153", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 34.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V THIN LAYER", "code_information": [{"code": "88142", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 81.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 81.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 81.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V THIN LAYER REDO", "code_information": [{"code": "88143", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH FL NONGYN FILTER", "code_information": [{"code": "88106", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 82.09, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 87.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH SMEAR OTHER SOURCE", "code_information": [{"code": "88162", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 146.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 156.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V AUTO REDO", "code_information": [{"code": "88166", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V MANUAL", "code_information": [{"code": "88164", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V REDO", "code_information": [{"code": "88165", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 52.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 107.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 60.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 60.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V SELECT", "code_information": [{"code": "88167", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOTOXIC ANTIBODY SCREENING", "code_information": [{"code": "86807", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 98.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 200.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 315.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 315.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 315.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 113.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 113.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOTOXIC ANTIBODY SCREENING", "code_information": [{"code": "86808", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 75.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 119.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 119.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 119.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTP DX EVAL FNA 1ST EA SITE", "code_information": [{"code": "88172", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 34.29, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 36.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTP FNA EVAL EA ADDL", "code_information": [{"code": "88177", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 13.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 14.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTP URINE 3-5 PROBES CMPTR", "code_information": [{"code": "88121", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 558.6, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 593.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTP URNE 3-5 PROBES EA SPEC", "code_information": [{"code": "88120", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 783.62, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 832.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Calcitonin Level", "code_information": [{"code": "82308", "type": "CPT"}, {"code": "633686", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 188.0, "discounted_cash": 65.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 69.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 107.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 107.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 107.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Calcium", "code_information": [{"code": "82310", "type": "CPT"}, {"code": "1099834", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Calcium Level Ionized", "code_information": [{"code": "82330", "type": "CPT"}, {"code": "633689", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 36.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cancer Antigen 125", "code_information": [{"code": "86304", "type": "CPT"}, {"code": "633692", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.96, "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": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Carbamazepine Level", "code_information": [{"code": "80156", "type": "CPT"}, {"code": "633694", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 46.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Carbonic anhydrase VI (CA VI), parotid specific/secretory protein (PSP) and salivary protein (SP1) IgG, IgM, and IgA antibodies, enzyme-linked immunosorbent assay (ELISA), semiqualitative, blood, reported as predictive evidence of early Sj\u00f6gren's syndrome", "code_information": [{"code": "472U", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Carbonic anhydrase VI, parotid specific/secretory protein and salivary protein 1 (SP1), IgG, IgM, and IgA antibodies, chemiluminescence, semiqualitative, blood", "code_information": [{"code": "522U", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With MCC", "code_information": [{"code": "222", "type": "MS-DRG"}], "standard_charges": [{"minimum": 48365.93, "maximum": 83032.29, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48365.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69173.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 76091.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83032.29, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without MCC", "code_information": [{"code": "223", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35272.88, "maximum": 60554.78, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35272.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50447.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55492.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60554.78, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With MCC", "code_information": [{"code": "224", "type": "MS-DRG"}], "standard_charges": [{"minimum": 45738.69, "maximum": 78521.96, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45738.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 65416.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71957.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 78521.96, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": 34173.08, "maximum": 58666.69, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34173.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48874.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53762.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58666.69, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant Without Cardiac Catheterization With MCC", "code_information": [{"code": "226", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39934.9, "maximum": 91337.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 91337.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 91337.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 72173.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39934.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57115.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62827.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68558.29, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant Without Cardiac Catheterization Without MCC", "code_information": [{"code": "227", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31705.2, "maximum": 91337.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 91337.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 91337.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 72173.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31705.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 45345.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49879.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54429.96, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiac Output Measurements", "code_information": [{"code": "93561", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}], "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": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cardiology (coronary heart disease [CHD]), DNA, analysis of 10 single-nucleotide polymorphisms (SNPs) (rs710987 [LINC010019], rs1333048 [CDKN2B-AS1], rs12129789 [KCND3], rs942317 [KTN1-AS1], rs1441433 [PPP3CA], rs2869675 [PREX1], rs4639796 [ZBTB41], rs437", "code_information": [{"code": "440U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cardiology (coronary heart disease [CHD]), DNA, analysis of 5 single-nucleotide polymorphisms (SNPs) (rs11716050 [LOC105376934], rs6560711 [WDR37], rs3735222 [SCIN/LOC107986769], rs6820447 [intergenic], and rs9638144 [ESYT2]) and 3 DNA methylation markers", "code_information": [{"code": "439U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cardiology, Cardiac Catheterization Laboratory", "code_information": [{"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 3700.0, "maximum": 3714.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3700.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3714.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Cardiology, General", "code_information": [{"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 3714.0, "maximum": 3714.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3714.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Cardiovascular disease (HDL reverse cholesterol transport), cholesterol efflux capacity, LC-MS/MS, quantitative measurement of 5 distinct HDL-bound apolipoproteins (apolipoproteins A1, C1, C2, C3, and C4), serum, algorithm reported as prediction of corona", "code_information": [{"code": "541U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Caregiver training in behavior management/modification for caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; initial 30 m", "code_information": [{"code": "G0539", "type": "HCPCS"}], "standard_charges": [{"minimum": 206.21, "maximum": 324.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 206.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 324.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 324.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 324.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Caregiver training in behavior management/modification for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face", "code_information": [{"code": "G0540", "type": "HCPCS"}], "standard_charges": [{"minimum": 110.6, "maximum": 173.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infe", "code_information": [{"code": "G0541", "type": "HCPCS"}], "standard_charges": [{"minimum": 206.21, "maximum": 324.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 206.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 324.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 324.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 324.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infe", "code_information": [{"code": "G0542", "type": "HCPCS"}], "standard_charges": [{"minimum": 110.6, "maximum": 173.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Carrier screening for severe inherited conditions (eg, cystic fibrosis, spinal muscular atrophy, beta hemoglobinopathies [including sickle cell disease], alpha thalassemia), regardless of race or self-identified ancestry, genomic sequence analysis panel, ", "code_information": [{"code": "449U", "type": "CPT"}], "standard_charges": [{"minimum": 6243.83, "maximum": 9818.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6243.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Catheter Based Enlargement Of Opening Between Two Upper Heart Chambers", "code_information": [{"code": "92993", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) fo", "code_information": [{"code": "C7562", "type": "HCPCS"}], "standard_charges": [{"minimum": 4218.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Catheterization with removal of temporary device for ischemic remodeling (ie, pressure necrosis) of bladder neck and prostate", "code_information": [{"code": "53866", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cell Count w/ Diff Body Fluid", "code_information": [{"code": "89051", "type": "CPT"}, {"code": "633699", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cerebrospinal Fluid Culture", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "633886", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 111.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Chikungunya virus vaccine, recombinant, for intramuscular use", "code_information": [{"code": "90593", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous", "code_information": [{"code": "38228", "type": "CPT"}], "standard_charges": [{"minimum": 1462.75, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1462.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2298.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2298.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2298.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day", "code_information": [{"code": "38225", "type": "CPT"}], "standard_charges": [{"minimum": 433.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 433.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 681.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 681.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 681.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for transportation (eg, cryopreservation, storage)", "code_information": [{"code": "38226", "type": "CPT"}], "standard_charges": [{"minimum": 174.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 174.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 274.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 274.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 274.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR-T cells for administration", "code_information": [{"code": "38227", "type": "CPT"}], "standard_charges": [{"minimum": 176.36, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 176.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 277.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 277.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 277.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cholesterol Low Density Lipids", "code_information": [{"code": "83721", "type": "CPT"}, {"code": "633704", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 28.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 42.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 42.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 42.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cholesterol Total", "code_information": [{"code": "82465", "type": "CPT"}, {"code": "633705", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 111.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Clinic Dental Clinic", "code_information": [{"code": "512", "type": "RC"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 85.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 85.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Clinic General", "code_information": [{"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 85.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 85.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Clinic Pediatric Clinic", "code_information": [{"code": "515", "type": "RC"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 85.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 85.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Clinic Psychiatric Clinic", "code_information": [{"code": "513", "type": "RC"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 85.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 85.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Clinic, Chronic Pain Center", "code_information": [{"code": "511", "type": "RC"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 85.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 85.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Clinic, Obstetrics/Gynecology (Ob/Gyn)", "code_information": [{"code": "514", "type": "RC"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 85.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 85.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Clinical Pathology Consultation", "code_information": [{"code": "80500", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Colonoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for colonic stricture, including fluoroscopic guidance, when performed", "code_information": [{"code": "885T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Combined Anterior And Posterior Spinal Fusion With CC", "code_information": [{"code": "454", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37064.33, "maximum": 63630.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37064.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53009.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58310.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63630.24, "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": 55890.6, "maximum": 95950.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55890.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 79935.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 87929.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 95950.28, "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": 29084.65, "maximum": 49931.12, "estimated_discounted_cash": 50777.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29084.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 41597.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 45757.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49931.12, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Complete ophthalmologic care MIPS value pathway", "code_information": [{"code": "M1420", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "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": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "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": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Comprehensive Metabolic Panel", "code_information": [{"code": "80053", "type": "CPT"}, {"code": "633709", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 32.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 42.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 42.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 42.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Comprehensive, Clinical Pathology Consultation", "code_information": [{"code": "80502", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat) Scan, Other", "code_information": [{"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 793.0, "maximum": 1996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 793.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1091.0, "methodology": "other"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1996.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1091.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1327.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1134.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat)Scan, Body Scan", "code_information": [{"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 793.0, "maximum": 1996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 793.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1091.0, "methodology": "other"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1996.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1091.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1327.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1134.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat)Scan, General", "code_information": [{"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 793.0, "maximum": 1996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 793.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1091.0, "methodology": "other"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1996.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1091.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1327.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1134.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat)Scan, Head Scan", "code_information": [{"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 793.0, "maximum": 1996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 793.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1091.0, "methodology": "other"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1996.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1091.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1327.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1134.0, "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": 1360.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1360.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2139.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2139.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2139.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Concurrent optical and magnetic stimulation (COMS) therapy, wound assessment and dressing care; each additional application, total wound(s) surface area less than or equal to 50 sq cm (List separately in addition to code for primary procedure)", "code_information": [{"code": "907T", "type": "CPT"}], "standard_charges": [{"minimum": 1409.04, "maximum": 2214.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1409.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Concurrent optical and magnetic stimulation (COMS) therapy, wound assessment and dressing care; first application, total wound(s) surface area less than or equal to 50 sq cm", "code_information": [{"code": "906T", "type": "CPT"}], "standard_charges": [{"minimum": 876.27, "maximum": 1376.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 876.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1376.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1376.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1376.99, "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": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Continuous interop neurphysiology monitoring; G0453", "code_information": [{"code": "G0453", "type": "HCPCS"}, {"code": "36550181", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 85.48, "maximum": 2204.0, "gross_charge": 2297.0, "discounted_cash": 803.95, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, whic", "code_information": [{"code": "G0534", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.41, "maximum": 244.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 155.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Coronary Care Unit General", "code_information": [{"code": "210", "type": "RC"}], "standard_charges": [{"minimum": 5143.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Coronary Care Unit Heart Transplant", "code_information": [{"code": "213", "type": "RC"}], "standard_charges": [{"minimum": 5143.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Coronary Care Unit Myocardial Infarction", "code_information": [{"code": "211", "type": "RC"}], "standard_charges": [{"minimum": 5143.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Coronary Care Unit Other", "code_information": [{"code": "219", "type": "RC"}], "standard_charges": [{"minimum": 5143.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Coronary Care Unit Pulmonary Care", "code_information": [{"code": "212", "type": "RC"}], "standard_charges": [{"minimum": 5143.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Creatine Kinase", "code_information": [{"code": "82550", "type": "CPT"}, {"code": "633712", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 19.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Creatinine", "code_information": [{"code": "82565", "type": "CPT"}, {"code": "633606", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cross AHG", "code_information": [{"code": "86920", "type": "CPT"}, {"code": "1099830", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cryotherapy of the oral cavity using temperature regulated fluid cooling system, including placement of an oral device, monitoring of patient tolerance to treatment, and removal of the oral device", "code_information": [{"code": "881T", "type": "CPT"}], "standard_charges": [{"minimum": 1674.17, "maximum": 2630.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1674.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Culture, bacterial, any source, except blood, anaerobic w/isolation 87075", "code_information": [{"code": "87075", "type": "CPT"}, {"code": "32615025", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 167.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Culture, bacterial; quantitative colony count, urine 87086", "code_information": [{"code": "87086", "type": "CPT"}, {"code": "4767322", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Culture, bacterial; with isolation and presumptive id, urine 87088", "code_information": [{"code": "87088", "type": "CPT"}, {"code": "4684283", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Currently on first-line immune checkpoint inhibitors without chemotherapy", "code_information": [{"code": "M1411", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy with insertion of temporary device for ischemic remodeling (ie, pressure necrosis) of bladder neck and prostate", "code_information": [{"code": "53865", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy with renal pelvic sympathetic denervation, radiofrequency ablation, retrograde ureteral approach, including insertion of guide wire, selective placement of ureteral sheath(s) and multiple conformable electrodes, contrast injection(s), an", "code_information": [{"code": "935T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy, flexible; with insertion and expansion of prostatic urethral scaffold using integrated cystoscopic visualization", "code_information": [{"code": "941T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy, flexible; with removal and replacement of prostatic urethral scaffold", "code_information": [{"code": "942T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy, flexible; with removal of prostatic urethral scaffold", "code_information": [{"code": "943T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cytogenomic (genome-wide) analysis, hematologic malignancy, structural variants and copy number variants, optical genome mapping (OGM)", "code_information": [{"code": "81195", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3222.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5066.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5066.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5066.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cytopathology, concentration technique, smears and interpretation 88108", "code_information": [{"code": "88108", "type": "CPT"}, {"code": "23032259", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 75.34, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 80.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cytopathology, evaluation of fine needle aspirate, inter & report 88173", "code_information": [{"code": "88173", "type": "CPT"}, {"code": "22455582", "type": "CDM"}, {"code": "311", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 368.0, "discounted_cash": 128.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 136.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 162.11, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 172.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cytopathology, fluids, non gyn 88104", "code_information": [{"code": "88104", "type": "CPT"}, {"code": "22455586", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 54.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 82.62, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 88.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cytopathology, selective cellular enhancement technique with interpretation 88112", "code_information": [{"code": "88112", "type": "CPT"}, {"code": "22671168", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 63.9, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 68.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cytopathology, smears, any other source; screening & interpretation 88160", "code_information": [{"code": "88160", "type": "CPT"}, {"code": "43011406", "type": "CDM"}, {"code": "311", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 90.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 96.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cytopathology, smears; prep, screen & interpret 88161", "code_information": [{"code": "88161", "type": "CPT"}, {"code": "39230726", "type": "CDM"}, {"code": "311", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 302.0, "discounted_cash": 105.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 112.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 92.48, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 98.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "D Bil", "code_information": [{"code": "82248", "type": "CPT"}, {"code": "1231826", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC", "code_information": [{"code": "744", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10921.42, "maximum": 18749.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10921.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15619.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17181.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18749.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC", "code_information": [{"code": "745", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7117.11, "maximum": 12218.31, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7117.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10179.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11196.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12218.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "D-Dimer", "code_information": [{"code": "85379", "type": "CPT"}, {"code": "633718", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 40.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DACRYOCYSTORHINOSTOMY 68720", "code_information": [{"code": "68720", "type": "CPT"}, {"code": "1480574", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARK FIELD EXAMINATION", "code_information": [{"code": "87164", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARK FIELD EXAMINATION", "code_information": [{"code": "87166", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 45.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 45.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 45.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DART CHONDRAL 1.3MM X 18MM BIOABSORBABLE DOUBLE REVERSED BARBED DESIG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4005B-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 262.32, "discounted_cash": 91.81, "setting": "both", "billing_class": "facility"}]}, {"description": "DART-FIRE EDGE INST PACK 3.0MM HEADLESS D0030000", "code_information": [{"code": "D0030000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 611.63, "discounted_cash": 214.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DBF-SEE B-D405160ZZ INTRODUCER NEEDLE SP 405160", "code_information": [{"code": "405160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.44, "discounted_cash": 1.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DBF-SEE BXT2D73EB85BX GLOVE SURG POLYISO 2D73EB85", "code_information": [{"code": "2D73EB85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.31, "discounted_cash": 2.21, "setting": "both", "billing_class": "facility"}]}, {"description": "DBF-SEE HUD1170HH AIRWAY CATH-GUIDE 60 M 1170", "code_information": [{"code": "1170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.76, "discounted_cash": 3.77, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM 5CC BEAST 100", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "P01-DBM-100S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3370.0, "discounted_cash": 1179.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM FIBER 10CC 1008-100", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "1008-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM GEL 1CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "3102-1101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1057.0, "discounted_cash": 369.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM PUTTY 10CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OBS-10P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4285.0, "discounted_cash": 1499.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM PUTTY 10CC IN2BONES PAA-010", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "PAA-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6994.0, "discounted_cash": 2447.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM PUTTY 1CC ALLOSYNC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ABS-2012-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM PUTTY 2.5CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ABS-2012-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 317.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM PUTTY 5CC ALLOMIX CAUT0500", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "CAUT0500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3200.0, "discounted_cash": 1120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM SPONGE 9 X 9 X 9 MM S99-02", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "S99-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3292.0, "discounted_cash": 1152.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM SPONGE STRIP 35X20X7MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "DBM-SS-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3910.0, "discounted_cash": 1368.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM STRIP LARGE 50 X 20 X 5MM DBMS-20-L", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "DBMS-20-L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM-DRESSING FOAM MEPILEX BORDER 4\"X4\" A 295300", "code_information": [{"code": "295300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM-MBO-MASK OXYGEN MED CONCEN 7TUBING 001201", "code_information": [{"code": "1201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.57, "discounted_cash": 1.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DBM-MBO-MASK OXYGEN MED CONCEN 7TUBING 001201", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "1201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6372.0, "discounted_cash": 2230.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DBRDMT BONE EACH ADDL", "code_information": [{"code": "11047", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT OPN WND ADDL 20CM/<", "code_information": [{"code": "97598", "type": "CPT"}], "standard_charges": [{"minimum": 50.85, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT PRMLG LES W/PDT", "code_information": [{"code": "96574", "type": "CPT"}], "standard_charges": [{"minimum": 770.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN XTRNL GENT PER", "code_information": [{"code": "11006", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DC EOC DOC MED REC", "code_information": [{"code": "M1009", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DC EOC DOC MED REC", "code_information": [{"code": "M1010", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DC EOC DOC MED REC", "code_information": [{"code": "M1011", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DC EOC DOC MED REC", "code_information": [{"code": "M1012", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DC EOC DOC MED REC", "code_information": [{"code": "M1013", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DC EPI CARE DOC MEDREC", "code_information": [{"code": "M1014", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DDAVP 4MCG/ML IV SOL 1ML VIALS/AMPS", "code_information": [{"code": "MED0683", "type": "CDM"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DE JUAN/AWH SUBRETINAL INJECTION 25G", "code_information": [{"code": "12.03.25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEB BONE 20 CM2 W/DRUG DEV", "code_information": [{"code": "C7500", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT & REMOVAL OF FOREIGN BODY AT OPEN FRACTURE SITE 11010", "code_information": [{"code": "11010", "type": "CPT"}, {"code": "1480575", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT ABDOMINAL WALL 11005", "code_information": [{"code": "11005", "type": "CPT"}, {"code": "1480576", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 964.26, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 964.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT BONE 20 SQ CM OR LESS 11044", "code_information": [{"code": "11044", "type": "CPT"}, {"code": "1480578", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2537.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT BONE/SKIN/MUSCLE 11012", "code_information": [{"code": "11012", "type": "CPT"}, {"code": "1480577", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT BURN 5% 16020", "code_information": [{"code": "16020", "type": "CPT"}, {"code": "1480579", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 213.92, "maximum": 8450.0, "gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 213.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT BURN 5-10% 16025", "code_information": [{"code": "16025", "type": "CPT"}, {"code": "1480580", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 402.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT FASCIA/MUSCLE/SQ TISSUE/DERMIS/EPIDERMIS 20 SQ/CM OR LESS 11011", "code_information": [{"code": "11011", "type": "CPT"}, {"code": "1480583", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT MASTOIDECTOMY COMPLEX 69222", "code_information": [{"code": "69222", "type": "CPT"}, {"code": "1480587", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 869.0, "maximum": 8450.0, "gross_charge": 10408.0, "discounted_cash": 3642.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 5037.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT MUSCLE/FASCIA 20 SQ CM OR LESS 11043", "code_information": [{"code": "11043", "type": "CPT"}, {"code": "1480584", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 985.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT NECROTIZING SOFT TISSUE INFECTION 20 SQ CM OR LESS 11004", "code_information": [{"code": "11004", "type": "CPT"}, {"code": "1480586", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 831.93, "maximum": 8450.0, "gross_charge": 2521.0, "discounted_cash": 882.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1220.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 831.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT OF EXTENSIVE INFECTED SKIN EACH ADDITIONAL 10% 11001", "code_information": [{"code": "11001", "type": "CPT"}, {"code": "1480581", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT OF EXTENSIVE INFECTED SKIN FIRST 10% OF BODY SURFACE 11000", "code_information": [{"code": "11000", "type": "CPT"}, {"code": "1480585", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT OF MUSCLE AND/OR FASCIA EPI/DERMIS EA. ADD. 20SQ CM 11046", "code_information": [{"code": "11046", "type": "CPT"}, {"code": "1941667", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT OF NAIL BY ANY METHOD 1 TO 5 11720", "code_information": [{"code": "11720", "type": "CPT"}, {"code": "14526141", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 3461.0, "discounted_cash": 1211.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1675.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT OF NAIL(S) BY ANY METHOD; 6 OR MORE 11721", "code_information": [{"code": "11721", "type": "CPT"}, {"code": "37870761", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT OPEN WOUND INC.TOPICAL APP.WOUND ASSESMENT FIRST 20SQ CM OR LESS 97597", "code_information": [{"code": "97597", "type": "CPT"}, {"code": "1682319", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 108.09, "maximum": 8450.0, "gross_charge": 218.0, "discounted_cash": 76.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT SUBCUTANEOUS TISSUE EPI/DERMIS EA. ADD SEG. 20 SQ CM 11045", "code_information": [{"code": "11045", "type": "CPT"}, {"code": "1941666", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT SUBCUTANEOUS TISSUE FIRST 20CM OR LESS 11042", "code_information": [{"code": "11042", "type": "CPT"}, {"code": "1744367", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 985.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECALCIFICATION PROCEDURE", "code_information": [{"code": "D0475", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECANTER 9 BAG DYNJDEC09", "code_information": [{"code": "DYNJDEC09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DECANTER 9\" BAG", "code_information": [{"code": "DYNJDEC09H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DECLOT VASCULAR DEVICE", "code_information": [{"code": "36593", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMP. PERC. INCL. LAMINOTOMY; EPIDUROGRAPHY AND IMAGING; BILAT 1 INTERSPACE LUMBAR 62330", "code_information": [{"code": "62330", "type": "CPT"}, {"code": "46574245", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 7173.0, "discounted_cash": 2510.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMP.FACIAL NERVE INTRATEMPORAL;INCLUDING MEDIAL TO GENICULATE GANGLION 69725", "code_information": [{"code": "69725", "type": "CPT"}, {"code": "1480590", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS EYE SOCKET", "code_information": [{"code": "61330", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26035", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26037", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS OPTIC NERVE", "code_information": [{"code": "67570", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SMALL BOWEL", "code_information": [{"code": "44021", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD THRC", "code_information": [{"code": "63055", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD THRC", "code_information": [{"code": "63064", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63057", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63066", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION FACIAL NERVE INTRATEMPORAL;LATERAL TO GENICULATE GANGLION 69720", "code_information": [{"code": "69720", "type": "CPT"}, {"code": "1480591", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION FASCIOTOMY MULTIPLE COMPARTMENTS THIGH OR KNEE 27498", "code_information": [{"code": "27498", "type": "CPT"}, {"code": "1480592", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION FASCIOTOMY WRIST W/DEBRIDEMENT 25023", "code_information": [{"code": "25023", "type": "CPT"}, {"code": "1480596", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION FASCIOTOMY WRIST W/FLEXOR MUSCLE W/ DEBRIDEMENT 25025", "code_information": [{"code": "25025", "type": "CPT"}, {"code": "1480597", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION FASCIOTOMY WRIST W/O DEBRIDEMENT 25020", "code_information": [{"code": "25020", "type": "CPT"}, {"code": "1480598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION FASCIOTOMY WRIST/FOREARM/FLEXOR/EXTENSOR W/O DEBRIDMENT 25024", "code_information": [{"code": "25024", "type": "CPT"}, {"code": "1480600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF FOREARM", "code_information": [{"code": "24495", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27892", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27496", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION PLANTAR DIGITAL NERVE 64726", "code_information": [{"code": "64726", "type": "CPT"}, {"code": "10710887", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1037.21, "maximum": 8450.0, "gross_charge": 2143.0, "discounted_cash": 750.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1037.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION TARSAL TUNNEL RELEASE 28035", "code_information": [{"code": "28035", "type": "CPT"}, {"code": "1480595", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION;UNSPECIFIED NERVE(S) 64722", "code_information": [{"code": "64722", "type": "CPT"}, {"code": "1480599", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOR OR SUBMERG ERUPT TOOTH", "code_information": [{"code": "D3921", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEEP BIOPSY SOFT TISSUE LEG OR ANKLE AREA 27614", "code_information": [{"code": "27614", "type": "CPT"}, {"code": "1480601", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEEP BRAIN STIMULATOR ACTIVA RC", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "37612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53972.0, "discounted_cash": 18890.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC", "code_information": [{"code": "294", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7803.27, "maximum": 13396.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7803.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11160.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12276.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13396.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC", "code_information": [{"code": "295", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5986.28, "maximum": 10276.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5986.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8561.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9417.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10276.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [{"code": "56", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13354.01, "maximum": 22925.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13354.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19099.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21009.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22925.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [{"code": "57", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7710.2, "maximum": 13236.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7710.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11027.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12129.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13236.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDROSTERONE", "code_information": [{"code": "82626", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 101.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 101.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 101.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDROSTERONE", "code_information": [{"code": "82627", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 32.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELAY OF FLAP AT EYES NOSE EARS LIPS 15630", "code_information": [{"code": "15630", "type": "CPT"}, {"code": "1480603", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELAY OF FLAP AT FACIAL AXILLAE/HAND/FEET/GENITALIA 15620", "code_information": [{"code": "15620", "type": "CPT"}, {"code": "1480604", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELAY OF FLAP AT SCALP/ARMS/LEGS 15610", "code_information": [{"code": "15610", "type": "CPT"}, {"code": "1480602", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELAY OF FLAP OR SECTION TRUNK 15600", "code_information": [{"code": "15600", "type": "CPT"}, {"code": "1480605", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELIVER PLACENTA", "code_information": [{"code": "59414", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELIVERY CARTRIDGE VERTEPORT MANIFOLD 10G", "code_information": [{"code": "605-410-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 759.6, "discounted_cash": 265.86, "setting": "both", "billing_class": "facility"}]}, {"description": "DELIVERY COMP IMRT", "code_information": [{"code": "G6016", "type": "HCPCS"}], "standard_charges": [{"minimum": 1579.62, "maximum": 2483.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1579.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2483.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2483.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2483.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELIVERY NEEDLE 12GA X 10CM CURVED-STERILE", "code_information": [{"code": "DLS-7126-01S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.0, "discounted_cash": 76.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DELTA 1.7MM 55 X 55 X 1.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-05355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2807.0, "discounted_cash": 982.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DEMINERALIZED BONE MATRIX BONE VOID FILLER 18ML CERAMENT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "A0210-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11453.0, "discounted_cash": 4008.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DEMO-SMOKING CESSATION COUN", "code_information": [{"code": "G9016", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEMONSTRATE USE HOME INR MON", "code_information": [{"code": "G0248", "type": "HCPCS"}], "standard_charges": [{"minimum": 511.25, "maximum": 803.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENERVATION OF HIP JOINT", "code_information": [{"code": "27035", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENGUE VACC QUAD 2 DOSE SUBQ", "code_information": [{"code": "90584", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENGUE VACC QUAD 3 DOSE SUBQ", "code_information": [{"code": "90587", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [{"code": "158", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5475.92, "maximum": 9400.79, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5475.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7831.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8614.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9400.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [{"code": "157", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9588.02, "maximum": 16460.26, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9588.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13712.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15084.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16460.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITHOUT CC/MCC", "code_information": [{"code": "159", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4033.64, "maximum": 6924.75, "estimated_discounted_cash": 24295.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4033.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5768.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6345.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6924.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTISTRY SS", "code_information": [{"code": "G0067", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEOXYCORTISOL", "code_information": [{"code": "82634", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEOXYRIBONUCLEASE ANTIBODY", "code_information": [{"code": "86215", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEP SCR NOT DOC, RNG", "code_information": [{"code": "G8432", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEPO-MEDROL/METHYLPREDNISOLONE ACETATE 40MG/ML", "code_information": [{"code": "MED0068", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPO-MEDROL/METHYLPREDNISOLONE ACETATE 80MG/ML 1ML VIAL", "code_information": [{"code": "MED0069", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 20.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPRESSOR TONGUE 5 1/2IN WOOD LF STRL", "code_information": [{"code": "MDS202073", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT F/N/HF/G ADD", "code_information": [{"code": "15136", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT FACE/NCK/HF/G", "code_information": [{"code": "15135", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT T/A/L ADD-ON", "code_information": [{"code": "15131", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT TRNK/ARM/LEG", "code_information": [{"code": "15130", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABRASION FACE 15780", "code_information": [{"code": "15780", "type": "CPT"}, {"code": "1480606", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2537.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABRASION OTHER THAN FACE", "code_information": [{"code": "15782", "type": "CPT"}], "standard_charges": [{"minimum": 1067.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SEGMENTAL FACE", "code_information": [{"code": "15781", "type": "CPT"}], "standard_charges": [{"minimum": 1067.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SUPRFL ANY SITE", "code_information": [{"code": "15783", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMAL ALLOAID MATRIX 4X7CM ADM-4X7", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ADM-4X7", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7931.0, "discounted_cash": 2775.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DERMAL FILLER INJECTION(S)", "code_information": [{"code": "G0429", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMAPURE 9CM X 12CM ALLOGRAFT DERMAL 091200HD", "code_information": [{"code": "Q4152", "type": "HCPCS"}, {"code": "91200HD", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DERMATOLIPECTOMY THIGH 15832", "code_information": [{"code": "15832", "type": "CPT"}, {"code": "1480612", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMATOLOGY SS", "code_information": [{"code": "G4000", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMIS DECELLULARIZED 40MM X 70MM X 3.0MM AFLEX301", "code_information": [{"code": "Q4125", "type": "HCPCS"}, {"code": "AFLEX301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7611.0, "discounted_cash": 2663.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DESIGN CUSTOM BREAST IMPLANT", "code_information": [{"code": "19396", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESIGN MLC DEVICE FOR IMRT", "code_information": [{"code": "77338", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 565.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1222.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1921.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1921.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1921.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 599.64, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 639.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESOXYCORTICOSTERONE", "code_information": [{"code": "82633", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 79.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 124.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 124.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 124.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY INTERNAL HEMORRHOIDS", "code_information": [{"code": "46930", "type": "CPT"}], "standard_charges": [{"minimum": 763.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY NERVE OF EYE MUSCLE", "code_information": [{"code": "67345", "type": "CPT"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT NEURO.AGENT TRIGEM NERVE 2ND & 3RD DIV.BRANCH AT FORAMEN OVALE W/IMAG 64610", "code_information": [{"code": "64610", "type": "CPT"}, {"code": "1480614", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT NEUROLYTIC AGENT TRIGEM.NERVE 2ND & 3RD DIV.BRANCH AT FORAMEN OVALE 64605", "code_information": [{"code": "64605", "type": "CPT"}, {"code": "1480615", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT NEUROLYTIC AGENT TRIGEM.NERVE;SUPRA/INFRAORBITAL & MENTAL/INFERIOR 64600", "code_information": [{"code": "64600", "type": "CPT"}, {"code": "1480616", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LES 2-14", "code_information": [{"code": "17003", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LESION", "code_information": [{"code": "17000", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46900", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEURO AGENT PARAVERT FACET W/IMAGE CERV.OR THOR. SINGLE 64633", "code_information": [{"code": "64633", "type": "CPT"}, {"code": "1807636", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1794.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGENT GENICULAR NERVE BRANCH W/IMAGING 64624", "code_information": [{"code": "64624", "type": "CPT"}, {"code": "45577565", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGENT INTERCOSTAL NERVE 64620", "code_information": [{"code": "64620", "type": "CPT"}, {"code": "1480617", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGENT OTHER PERIPHERAL NERVE OR BRANCH 64640", "code_information": [{"code": "64640", "type": "CPT"}, {"code": "1480618", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGENT PARAVERTEBRAL FACET JT NERVE W/ IMAGE LUMB/SACRAL EACH 64636", "code_information": [{"code": "64636", "type": "CPT"}, {"code": "1582413", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1794.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGENT/PUDENDAL NERVE 64630", "code_information": [{"code": "64630", "type": "CPT"}, {"code": "1480620", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGENT;CELIAC PLEXUS 64680", "code_information": [{"code": "64680", "type": "CPT"}, {"code": "1480621", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGT PARARVERT FACET JT W/IMAGE LUM/SAC SINGLE JT 64635", "code_information": [{"code": "64635", "type": "CPT"}, {"code": "1481273", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66700", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66740", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CONDYLOMA ANUS-ELECTRODESICCATION 46910", "code_information": [{"code": "46910", "type": "CPT"}, {"code": "1480624", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 763.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION LEASION PENIS BY CYROABLATION 54056", "code_information": [{"code": "54056", "type": "CPT"}, {"code": "1480625", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION LEASION PENIS BY ELECTRODESICCATION 54055", "code_information": [{"code": "54055", "type": "CPT"}, {"code": "1480626", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 402.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION LESION ANUS-EXTENSIVE 46924", "code_information": [{"code": "46924", "type": "CPT"}, {"code": "1480628", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION LESION ANUS-LASER SURGERY 46917", "code_information": [{"code": "46917", "type": "CPT"}, {"code": "1480629", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION LESION PENIS BY LASER 54057", "code_information": [{"code": "54057", "type": "CPT"}, {"code": "1480627", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION LESION PENIS-EXTENSIVE-ANY MEANS 54065", "code_information": [{"code": "54065", "type": "CPT"}, {"code": "1480630", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION NEURO AGENT EA ADD FACET JT CERVICAL/THORACIC W/GUIDE 64634", "code_information": [{"code": "64634", "type": "CPT"}, {"code": "1643974", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF BENIGN LESIONS 15+ LESIONS 17111", "code_information": [{"code": "17111", "type": "CPT"}, {"code": "1479863", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF BENIGN LESIONS UP TO 14 LESIONS 17110", "code_information": [{"code": "17110", "type": "CPT"}, {"code": "1479862", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; LESS THAN 10 SQCM 17106", "code_information": [{"code": "17106", "type": "CPT"}, {"code": "4567494", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY 67227", "code_information": [{"code": "67227", "type": "CPT"}, {"code": "1480632", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF LESION(S) VULVA;EXTENSIVE 56515", "code_information": [{"code": "56515", "type": "CPT"}, {"code": "1480634", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF LESION(S) VULVA;SIMPLE 56501", "code_information": [{"code": "56501", "type": "CPT"}, {"code": "1480635", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17107", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17108", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF VAGINAL LESION; EXTENSIVE ANY MEANS 57065", "code_information": [{"code": "57065", "type": "CPT"}, {"code": "1480638", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF VAGINAL LESION; SIMPLE ANY MEANS 57061", "code_information": [{"code": "57061", "type": "CPT"}, {"code": "1480639", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PAPILLOMA/CHONDYLOMA PENIS-SIMPLE CHEMICAL 54050", "code_information": [{"code": "54050", "type": "CPT"}, {"code": "1480640", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION RECTAL TUMOR", "code_information": [{"code": "45190", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECT AGENT NOS DNA AMP", "code_information": [{"code": "87798", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECT AGENT NOS DNA DIR", "code_information": [{"code": "87797", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 120.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 120.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 120.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 43.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 43.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECT AGENT NOS DNA QUANT", "code_information": [{"code": "87799", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECT AGNT MULT DNA AMPLI", "code_information": [{"code": "87801", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 179.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 281.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 281.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 281.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 101.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 101.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECT AGNT MULT DNA DIREC", "code_information": [{"code": "87800", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 61.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 175.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 175.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 175.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 62.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 62.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECTION TEST FOR HUMAN PAPILLOMAVIRUS (HPV) 87624", "code_information": [{"code": "87624", "type": "CPT"}, {"code": "46403370", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 70.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECTOR CO2 18MM 15MM 5MM CONNECTION PORT CO2 FOR ENDO TUBE PLACEMENT EASY CAP", "code_information": [{"code": "PEDICAP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DETECTOR CO2 22MM 15MM 25ML CO2 RESPIRATION BREATH TO BREATH FOR ATTCHMNT TO END", "code_information": [{"code": "NPBEASYCAP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DETECTOR EASY CAP II CO2 EASYCAP II", "code_information": [{"code": "EASYCAP II", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DETERMINE REFRACTIVE STATE", "code_information": [{"code": "92015", "type": "CPT"}], "standard_charges": [{"minimum": 87.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEV INTERROG REMOTE 1/2/MLT", "code_information": [{"code": "93295", "type": "CPT"}], "standard_charges": [{"minimum": 200.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 200.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVEL TST PHYS/QHP 1ST HR", "code_information": [{"code": "96112", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVEL TST PHYS/QHP EA ADDL", "code_information": [{"code": "96113", "type": "CPT"}], "standard_charges": [{"minimum": 262.22, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 412.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 412.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 412.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVELOPMENTAL SCREEN W/SCORE", "code_information": [{"code": "96110", "type": "CPT"}], "standard_charges": [{"minimum": 44.5, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVICE 2.9MM AVETA DISPOSABLE RESECTING 204-167", "code_information": [{"code": "204-167", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1184.0, "discounted_cash": 414.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE 2.9MM AVETA SMOL DISPOSABLE RESECTING 210-100", "code_information": [{"code": "210-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1277.75, "discounted_cash": 447.21, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE 24FR X 5CM OPTILUME DCB AND INFLATION OPTBDL7003B", "code_information": [{"code": "OPTBDL7003B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5464.05, "discounted_cash": 1912.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE 3.9MM AVETA DISPOSABLE RESECTING 216-041", "code_information": [{"code": "216-041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2008.0, "discounted_cash": 702.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE 3.9MM AVETA MAX DISPOSABLE RESECTING 210-084", "code_information": [{"code": "210-084", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2233.0, "discounted_cash": 781.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE 30FR X 5CM OPTILUME DCB AND INFLATION OPTBDL7005B", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "OPTBDL7005B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5464.05, "discounted_cash": 1912.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE 4-0 VLOC90 BARBED SUTURE P-12 VLOCM0023", "code_information": [{"code": "VLOCM0023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE BIOPSY BONE CONICAL TIP DESIGN KYPHX EXPRESS", "code_information": [{"code": "F07A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 293.64, "discounted_cash": 102.77, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE BIRTH CONTROL PERMANENT CONTRACEPTION TUBAL OCCLUSION SYS ESSURE", "code_information": [{"code": "A4264", "type": "HCPCS"}, {"code": "ESS305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3811.0, "discounted_cash": 1333.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CANNULA 5.5MM X 75MM ORANGE SMOOTH CLEAR", "code_information": [{"code": "214106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CAPTURING 25 CM SUT CAPIOINSTR", "code_information": [{"code": "831-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 945.0, "discounted_cash": 330.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CAPTURING 25 CM SUT STANDARD OR OPEN ACCESS PUSH CATCH", "code_information": [{"code": "M0068311251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1324.0, "discounted_cash": 463.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CAPTURING 3.0 X 6.3MM SLIM SUTURE CAPIO HEAD WIDTH 11MM 25CM", "code_information": [{"code": "M0068318261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1349.0, "discounted_cash": 472.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CLARIFIX CRYOTHERAPY CFX-2000", "code_information": [{"code": "CFX-2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2190.0, "discounted_cash": 766.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CLOSE ENDOSCOPIC TROCAR SITE 173022", "code_information": [{"code": "173022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 63.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE COLLECTION VITAGEL CELLPAKER", "code_information": [{"code": "2113-0010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CUTTING 5MM 35 CM HANDPIECE VESSEL SEALING THUNDERBEAT INLINE GRIP", "code_information": [{"code": "TB-0510IC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1086.0, "discounted_cash": 380.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE DISSECT TISSUE FOR TONSILLECTOMY AND ADENOIDECTOMY PLASMABLADE TNAINSTR", "code_information": [{"code": "PS300-002E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 579.0, "discounted_cash": 202.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE ELECTROSURGICL TISSUE 10CORD FT3000", "code_information": [{"code": "FT3000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 178.0, "discounted_cash": 62.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE ENDO GIA ARTIC 45 VASC MED RELOAD EGIA45AVM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EGIA45AVM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1082.0, "discounted_cash": 378.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE ENDO GIA ARTIC 60 MED THK REL EGIA60AMT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "EGIA60AMT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 804.0, "discounted_cash": 281.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE ENDO GIA ARTIC 60 VASC MED RE EGIA60AVM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EGIA60AVM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 932.0, "discounted_cash": 326.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FILTRATION 2.64MM GLAUCOMA P 50 MODELINTERNAL LUMEN EX PRESS", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "47053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2359.0, "discounted_cash": 825.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXATION TIGHTROPE BTB DEPLOYING SUTURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588BTB-J", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 994.0, "discounted_cash": 347.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXATION ZIPLOOP SZ1 TOGGLELOC AC JOINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "904834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1101.0, "discounted_cash": 385.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN 30MM FEMORAL FXTN ACL PCL RECONSTRUCTION ARTHRO W/ ULTRABRAID #5 LE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72200149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN 5MM 30 TACK ABSORBL FXTN RATCHETED HANDLE FOR LAPATOSCOPIC HERNIA R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABSTACK30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1280.06, "discounted_cash": 448.02, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN ANKLE SYNDESMOSIS ZIPLOOP TECHNOLOGY ZIPTIGHT SS STRLINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909857", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1438.0, "discounted_cash": 503.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN ANKLE SYNDESMOSIS ZIPLOOP TECHNOLOGY ZIPTIGHT TI STRLINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1438.0, "discounted_cash": 503.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN FEMRL W/ ZIPLOOP TECHNOLOGY FOR BONE TO BONE GRAFTS TOGGLELOCINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909849", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2534.0, "discounted_cash": 886.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FOLEY SECUREMENT STATLOCK FOL0100", "code_information": [{"code": "FOL0100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 5MM AUTOSUTURE STAT TACK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OMS-TTSS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 5MM SQUEEZE HANDLE 15 SHOT ABSORBATACK DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABSTACK15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 852.0, "discounted_cash": 298.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 5MM TACKER AUTO SUT SNGL USE", "code_information": [{"code": "OMS-TTSD30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 759.0, "discounted_cash": 265.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN FEMORAL W/ ZIPLOOP TECHNOLOGY IMPLANT SYS TOGGLELOC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2101.0, "discounted_cash": 735.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN MENISCAL REPAIR SYS CURVED LOW PROFILE FAST-FIX 360", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202468", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 968.0, "discounted_cash": 338.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN MENISCAL REPAIR SYS REVERSE CURVED FAST-FIX 360", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 968.0, "discounted_cash": 338.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN MENISCAL REPAIR SYS STRAIGHT LOW PROFILE FAST-FIX 360", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202467", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 968.0, "discounted_cash": 338.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN TIGHTROPE BTB BONE TENDON BONE ACL BTB TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588BTB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE HANDLING PHYS/QHP", "code_information": [{"code": "99002", "type": "CPT"}], "standard_charges": [{"minimum": 27.03, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 42.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 42.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 42.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVICE HANDPIECE AVETA WAVE DISPOSABLE RESECTING 3.9MM 210-2005", "code_information": [{"code": "210-2005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1971.0, "discounted_cash": 689.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE JAW LAPAROSCOPIC SEALER/DIVIDER LATCHING HDLE LXMJ37L", "code_information": [{"code": "LXMJ37L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1098.42, "discounted_cash": 384.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE LIGASURE EXACT DISSECTOR LF2019", "code_information": [{"code": "LF2019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1308.66, "discounted_cash": 458.03, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE LIGASURE MARYLAND JAW LF1937", "code_information": [{"code": "LF1937", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1049.1, "discounted_cash": 367.19, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE MARYLAND JAW LAPAROSCOPIC LF1944", "code_information": [{"code": "LF1944", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1240.0, "discounted_cash": 434.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE MENISCAL REPAIR TRUESPAN MITEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1323.0, "discounted_cash": 463.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE PIN AND REAMER 10.5MM KNEE FLIPCUTTER IIINSTR", "code_information": [{"code": "AR-1204AF-105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE REAMER 11MM PIN KNEE FLIPCUTTER IIINSTR", "code_information": [{"code": "AR-1204AF-110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE REMOVAL TISSUE HYSTEROSCOPIC MYOSURE DISP", "code_information": [{"code": "10-401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2921.0, "discounted_cash": 1022.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE REPAIR ANCHOR TISSUE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XC-201-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3823.0, "discounted_cash": 1338.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE RESECTING AVETA MAX 3.9MM DISP 210-2013", "code_information": [{"code": "210-2013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2244.75, "discounted_cash": 785.66, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE RESECTION AVETA FLEX 2.9MM DISP 210-2011", "code_information": [{"code": "210-2011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1861.5, "discounted_cash": 651.53, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SKIN CLOSURE 8i ZIPLINE", "code_information": [{"code": "PS2080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.4, "discounted_cash": 66.99, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE STABLZN FOLEY SWIVEL TRICOT STATLOCK LF", "code_information": [{"code": "FOL0102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE STIMULATOR NERVE HND HELD VARI STIM III DISP", "code_information": [{"code": "8562010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 99.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SURG SUT ASSISTANT ENDO LF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SW100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 262.0, "discounted_cash": 91.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUT 15CM 14G TROC SITE FACIA", "code_information": [{"code": "PC-120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURE PASSER GREEN GENIE STERILE 710001", "code_information": [{"code": "710001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.63, "discounted_cash": 47.47, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURE RETRIEVER HOFFEE STERILE 710000", "code_information": [{"code": "710000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.55, "discounted_cash": 53.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURE STITCH ENDOSCOPIC 10MM 173016", "code_information": [{"code": "173016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 582.0, "discounted_cash": 203.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING 10MM REPROCESS ENDO STITCH DISP", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "173016R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 430.0, "discounted_cash": 150.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING 12MM GUN UNIVERSAL ENDO GIAINSTR", "code_information": [{"code": "30449", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1034.0, "discounted_cash": 361.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING 45-2 UNIVERSAL STRAIGHT RELOAD ENDO GIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 673.0, "discounted_cash": 235.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING 45-2.5 WHT UNIVERSAL STRAIGHT RELOAD ENDO GIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 673.0, "discounted_cash": 235.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING 45-4.8 15MM GRN UNIVERSAL STRAIGHT ENDO GIA", "code_information": [{"code": "30423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 506.0, "discounted_cash": 177.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING 5MM W/ STPCCK VALVE FOR USE W/ VERSAPORT RT REUSABLE CANNULA AND", "code_information": [{"code": "175770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 22.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING FIXATE AUTOMATIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FB-101-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 1 36X36 1/2 CIR TPR SXPD2B405", "code_information": [{"code": "SXPD2B405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 2-0 24X24 3/8 CIR REV SXPD2B419", "code_information": [{"code": "SXPD2B419", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 3-0 30X30 3/8 CIR REV SXMD2B412", "code_information": [{"code": "SXMD2B412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 3-0 7X7 STRATAFIX SXMD2B404", "code_information": [{"code": "SXMD2B404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 4-0 14X14 3/8 CIR REV SXMD2B407", "code_information": [{"code": "SXMD2B407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 4-0 30X30 3/8 CIR REV SXMD2B409", "code_information": [{"code": "SXMD2B409", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE REMOVAL MYOSURE REACH", "code_information": [{"code": "10-403FC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 864.0, "discounted_cash": 302.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TRUCLEAR INCISOR PLUS 7209509", "code_information": [{"code": "7209509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1238.0, "discounted_cash": 433.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE UTERINE KIT ABLATION IMPEDANCE CONTROL HANDLE ENDOMETRIUM NOVASURE DISPOSABLE BLUE MANUAL NS2", "code_information": [{"code": "NS2013US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2168.1, "discounted_cash": 758.84, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE V-LOC 90 ABS CLOS 3-0 CL 18 P VLOCM0024", "code_information": [{"code": "VLOCM0024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE VISCOSURGICAL .50 ML OPHTHALMIC 4 PCT CHONDROITIN SULFATE 3 PCT HYALURONA", "code_information": [{"code": "8065183905", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.18, "discounted_cash": 44.16, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE VISCOSURGICAL 1.0 ML OPHTHALMIC 4 PCT CHONDROITIN SULFATE 1.7 PCT SODIUM", "code_information": [{"code": "8065183710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE VLOC 180 ABS 0 GREEN GS25 24I VLOCL0436", "code_information": [{"code": "VLOCL0436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE VLOC 180 ABS 2-0 CL 24 P-14 VLOCL0135", "code_information": [{"code": "VLOCL0135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE WOUND CLOSER 3-0 GR 6 V-20 V-LOC VLOCL0604", "code_information": [{"code": "VLOCL0604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE WOUND CLOSURE V-LOC VLOCN0604", "code_information": [{"code": "VLOCN0604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICEINFLATION 20 ML 30 ATM MAXIMUM PRESSURE SPHERE", "code_information": [{"code": "CID-20-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICEINFLATION BLLN SINUS RELIEVA", "code_information": [{"code": "BID30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVISE BOWEL POUCH", "code_information": [{"code": "44316", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVLOPMENT TEST INTERPT&REP", "code_information": [{"code": "G0451", "type": "HCPCS"}], "standard_charges": [{"minimum": 346.36, "maximum": 544.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 346.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE PANEL", "code_information": [{"code": "80420", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 202.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 412.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 649.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 649.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 649.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 233.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 233.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE/DECADRON 10MG/1ML VIAL", "code_information": [{"code": "MED0070", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXAMETHASONE/DECADRON 4 MG/1ML 1ML VIAL", "code_information": [{"code": "MED0071", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXTENZA 0.4MG OPTHALMIC INSERT 10248019", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1096", "type": "HCPCS"}, {"code": "10248019", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1037.4, "discounted_cash": 363.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXTENZA 0.4MG OPTHALMIC INSERT 10248019", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1096", "type": "HCPCS"}, {"code": "10248019", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1037.4, "discounted_cash": 363.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXTROSE-WATER 50% SYRINGE 50ML (MEDID)", "code_information": [{"code": "MED0760", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DGP ANTIBODY EACH IG CLASS", "code_information": [{"code": "86258", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLASS MCRSCP SLD LEVEL III SURG PATH 0752T", "code_information": [{"code": "752T", "type": "CPT"}, {"code": "46199540", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "gross_charge": 49.47, "discounted_cash": 17.31, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLASS MCRSCP SLD LEVEL IV SURG PATH 0753T", "code_information": [{"code": "753T", "type": "CPT"}, {"code": "46200937", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "gross_charge": 209.0, "discounted_cash": 73.15, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLASS MCRSCP SLD LEVEL V SURG PATH 0754T", "code_information": [{"code": "754T", "type": "CPT"}, {"code": "46211348", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 722.7, "maximum": 1136.47, "gross_charge": 283.41, "discounted_cash": 99.19, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP B1 MAROW SMR", "code_information": [{"code": "855T", "type": "CPT"}], "standard_charges": [{"minimum": 1601.91, "maximum": 2519.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP BLD SMR PRPH", "code_information": [{"code": "854T", "type": "CPT"}], "standard_charges": [{"minimum": 64.34, "maximum": 101.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 101.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 101.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 101.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CSLT COMPRE", "code_information": [{"code": "840T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CSLT CYT 1ST", "code_information": [{"code": "843T", "type": "CPT"}], "standard_charges": [{"minimum": 58.62, "maximum": 92.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CSLT CYT EA", "code_information": [{"code": "844T", "type": "CPT"}], "standard_charges": [{"minimum": 58.62, "maximum": 92.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CSLT MAT PRP", "code_information": [{"code": "839T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CSLT SLD ELS", "code_information": [{"code": "838T", "type": "CPT"}], "standard_charges": [{"minimum": 85.25, "maximum": 134.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP C/V", "code_information": [{"code": "831T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP CONCTRJ", "code_information": [{"code": "829T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP OTH PRP", "code_information": [{"code": "833T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP OTH SCR", "code_information": [{"code": "832T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP OTH XTN", "code_information": [{"code": "834T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP SLCTV", "code_information": [{"code": "830T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP SMEARS", "code_information": [{"code": "827T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP SMPL FL", "code_information": [{"code": "828T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP ELECTRON MIC", "code_information": [{"code": "856T", "type": "CPT"}], "standard_charges": [{"minimum": 1601.91, "maximum": 2519.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP FNA 1ST EA", "code_information": [{"code": "835T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP FNA EA ADDL", "code_information": [{"code": "836T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP FNA I&R", "code_information": [{"code": "837T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP IMFLUOR 1ST", "code_information": [{"code": "845T", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP IMFLUOR EA", "code_information": [{"code": "846T", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP ISH 1ST", "code_information": [{"code": "848T", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP ISH EA ADL 1", "code_information": [{"code": "849T", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP ISH EA MULT", "code_information": [{"code": "850T", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP MPHMTRC 1ST", "code_information": [{"code": "851T", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP MPHMTRC ALYS", "code_information": [{"code": "763T", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP MPHMTRC EA 1", "code_information": [{"code": "852T", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP MPHMTRC EA M", "code_information": [{"code": "853T", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP PTH CSLT 1ST", "code_information": [{"code": "841T", "type": "CPT"}], "standard_charges": [{"minimum": 58.62, "maximum": 92.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP PTH CSLT EA", "code_information": [{"code": "842T", "type": "CPT"}], "standard_charges": [{"minimum": 58.62, "maximum": 92.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL IMM 1ST 0760T", "code_information": [{"code": "760T", "type": "CPT"}, {"code": "46277824", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "gross_charge": 143.5, "discounted_cash": 50.23, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL IMM EA 1", "code_information": [{"code": "761T", "type": "CPT"}], "standard_charges": [{"minimum": 164.5, "maximum": 258.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 164.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 258.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 258.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 258.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL IMM EA M", "code_information": [{"code": "762T", "type": "CPT"}], "standard_charges": [{"minimum": 722.7, "maximum": 1136.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL SP GRPIII", "code_information": [{"code": "759T", "type": "CPT"}], "standard_charges": [{"minimum": 1601.91, "maximum": 2519.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL SPC GRPII", "code_information": [{"code": "757T", "type": "CPT"}], "standard_charges": [{"minimum": 85.25, "maximum": 134.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL SPC HCHEM", "code_information": [{"code": "758T", "type": "CPT"}], "standard_charges": [{"minimum": 179.21, "maximum": 281.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 179.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 281.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 281.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 281.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LEVEL II", "code_information": [{"code": "751T", "type": "CPT"}], "standard_charges": [{"minimum": 58.62, "maximum": 92.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LEVEL VI", "code_information": [{"code": "755T", "type": "CPT"}], "standard_charges": [{"minimum": 1601.91, "maximum": 2519.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD SPC GRPI", "code_information": [{"code": "756T", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP XM ARCH TISS", "code_information": [{"code": "847T", "type": "CPT"}], "standard_charges": [{"minimum": 58.62, "maximum": 92.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DI GNOTYP SLC4A1 EXON 19", "code_information": [{"code": "183U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 266.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAB MANAGE TRN  PER INDIV", "code_information": [{"code": "G0108", "type": "HCPCS"}], "standard_charges": [{"minimum": 247.93, "maximum": 389.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 247.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 389.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 389.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 389.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAB MANAGE TRN IND/GROUP", "code_information": [{"code": "G0109", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.36, "maximum": 107.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 107.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 107.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 107.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETES PREV ONLINE/ELEC", "code_information": [{"code": "488T", "type": "CPT"}], "standard_charges": [{"minimum": 71.53, "maximum": 112.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETES PREV STANDARD CURR", "code_information": [{"code": "403T", "type": "CPT"}], "standard_charges": [{"minimum": 71.53, "maximum": 112.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH CC", "code_information": [{"code": "638", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5349.39, "maximum": 9183.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5349.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7650.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8415.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9183.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH MCC", "code_information": [{"code": "637", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8373.86, "maximum": 14375.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8373.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11976.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13174.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14375.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES WITHOUT CC/MCC", "code_information": [{"code": "639", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3708.2, "maximum": 6366.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3708.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5303.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5833.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6366.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAG BRONCHOSCOPE/CATHETER", "code_information": [{"code": "31643", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAG TST DETECT MUCOS ABNORM", "code_information": [{"code": "D0431", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY", "code_information": [{"code": "46601", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY & BIOPSY", "code_information": [{"code": "46607", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY SPX", "code_information": [{"code": "46600", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [{"code": "31505", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC RAD SS", "code_information": [{"code": "G4001", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALATOR BALLOON SINUS XPRESS ULTRA 6MM X 20MM", "code_information": [{"code": "ULF-106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3474.0, "discounted_cash": 1215.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALATOR BALLOON SINUS XPRESS ULTRA 6MM X 8MM", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "ULF-206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3172.0, "discounted_cash": 1110.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALATOR CLIP I62-60-32", "code_information": [{"code": "I62-60-32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.5, "discounted_cash": 167.48, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALYSIS CIRCUIT EMBOLJ", "code_information": [{"code": "36909", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS ONE EVALUATION", "code_information": [{"code": "90945", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS REPEATED EVAL", "code_information": [{"code": "90947", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS TRAINING COMPLETE", "code_information": [{"code": "90989", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS TRAINING INCOMPL", "code_information": [{"code": "90993", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAS BP > OR = 90", "code_information": [{"code": "G8755", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAS BP LESS 90", "code_information": [{"code": "G8754", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIATHERMY EG MICROWAVE", "code_information": [{"code": "97024", "type": "CPT"}], "standard_charges": [{"minimum": 31.8, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIET COUNSEL AT HOSPICE", "code_information": [{"code": "G9474", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [{"code": "375", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7345.83, "maximum": 12610.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7345.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10506.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11556.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12610.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [{"code": "374", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12614.32, "maximum": 21655.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12614.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18041.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19845.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21655.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "376", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5468.01, "maximum": 9387.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5468.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7820.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8602.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9387.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIHYDROTESTOSTERONE", "code_information": [{"code": "82642", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIL MACULA/FUNDUS EXAM/W DOC", "code_information": [{"code": "G8397", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA DIFF TER", "code_information": [{"code": "61642", "type": "CPT"}], "standard_charges": [{"minimum": 2297.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA VSL SM TER", "code_information": [{"code": "61641", "type": "CPT"}], "standard_charges": [{"minimum": 2297.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAT XST TRC NDURLGC PX", "code_information": [{"code": "50436", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAT XST TRC NEW ACCESS RCS", "code_information": [{"code": "50437", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATATION BILIARY ENDOSCOPIC-W/O STENT 47555", "code_information": [{"code": "47555", "type": "CPT"}, {"code": "1480641", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATATION ESOPHAGEAL BY UNGUIDED SOUND OR BOUGIE 43450", "code_information": [{"code": "43450", "type": "CPT"}, {"code": "1480643", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATATION RECTUM UNDER ANESTHESIA 45910", "code_information": [{"code": "45910", "type": "CPT"}, {"code": "1480644", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATATION URETHRAL STRICTURE BY FILIFORM FOLLOWER-MALE-INITIAL 53620", "code_information": [{"code": "53620", "type": "CPT"}, {"code": "1480645", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 402.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATATION URETHRAL STRICTURE BY FILIFORM FOLLOWER-MALE-SUBSEQUENT 53621", "code_information": [{"code": "53621", "type": "CPT"}, {"code": "1480646", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATATION URETHRAL STRICTURE BY SOUND OR DILATOR W/ANESTHESIA 53605", "code_information": [{"code": "53605", "type": "CPT"}, {"code": "1480647", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATATION URETHRAL STRICTURE BY SOUND OR DILATOR-MALE/INITIAL 53600", "code_information": [{"code": "53600", "type": "CPT"}, {"code": "1480648", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATATION URETHRAL STRICTURE BY SOUND OR DILATOR-MALE/SUBSEQUENT 53601", "code_information": [{"code": "53601", "type": "CPT"}, {"code": "1480649", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE BILIARY DUCT/AMPULLA", "code_information": [{"code": "47542", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE ESOPHAGUS", "code_information": [{"code": "43453", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE IC VASOSPASM INIT", "code_information": [{"code": "61640", "type": "CPT"}], "standard_charges": [{"minimum": 3365.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE TEAR DUCT OPENING", "code_information": [{"code": "68801", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION AND CURETTAGE OF CERVICAL STUMP 57588", "code_information": [{"code": "57558", "type": "CPT"}, {"code": "1480651", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5228.0, "discounted_cash": 1829.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION AND CURETTAGE; NON-OBSTETRICAL 58120", "code_information": [{"code": "58120", "type": "CPT"}, {"code": "1480650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION BALLOON 6 X 16MM EUSTACHIAN TUBE", "code_information": [{"code": "EU061655", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2682.75, "discounted_cash": 938.96, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATION OF ANAL SPHINCTER", "code_information": [{"code": "45905", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF CERVICAL CANAL", "code_information": [{"code": "57800", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42650", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42660", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53660", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53661", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53665", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF VAGINA", "code_information": [{"code": "57400", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION SEEKER FRONTAL NUVENT EM 6.0MM X 17.0MM", "code_information": [{"code": "1830617FRT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1980.0, "discounted_cash": 693.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATION URTR/URT RS&I", "code_information": [{"code": "74485", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 12170.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2967.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7741.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12170.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12170.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12170.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 190.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 202.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATOR BALLON MAXILLARY 6.0MM X 7.0MM EM", "code_information": [{"code": "1830507MAX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1167.0, "discounted_cash": 408.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR BALLOON ENDO 6.0 FR 15.0-16.5-180MM", "code_information": [{"code": "M00558370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.0, "discounted_cash": 166.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR BLLN 5MM 4 CM URETERAL ASCEND AQ", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "AUBS-5-4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR ENDOSCOPIC CRE 180CM 8CM 6FR 18-20MM ESOPHAGEAL FIX WIRE BALLOON CATHETER PEBAX STERILE LATE", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "M00558380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 177.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR HEALICOIL 5.5MM REGEN THREADED", "code_information": [{"code": "72203952", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR KIT SAFEOP STIMULATING STERILE - OVAL AIX1335-S", "code_information": [{"code": "AIX1335-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2463.75, "discounted_cash": 862.31, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR PROBE SZ 1 AVS ARIA", "code_information": [{"code": "48755001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1268.0, "discounted_cash": 443.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR PROBE SZ 2 AVS ARIA", "code_information": [{"code": "48755002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1268.0, "discounted_cash": 443.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR PROBE SZ 3 AVS ARIA", "code_information": [{"code": "48755003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1268.0, "discounted_cash": 443.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR SURG 4FR 12.5IN URETHRAL WOVEN FILIFORM SPIRAL TIP", "code_information": [{"code": "22104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR SURG 6FR 12.5IN URETHRAL WOVEN FILIFORM STRAIGHT TIP LF", "code_information": [{"code": "21906", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETHRAL 10FR WOVEN PHILLIPS FOLLOWER SURG LF", "code_information": [{"code": "21510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETHRAL 12FR WOVEN PHILLIPS FOLLOWER CATH LF STRL", "code_information": [{"code": "21512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETHRAL 14FR WOVEN PHILLIPS FOLLOWER CATH LF STRL", "code_information": [{"code": "21514", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETHRAL 16FR WOVEN PHILLIPS FOLLOWER CATH LF", "code_information": [{"code": "21516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETHRAL 18FR WOVEN PHILLIPS FOLLOWER CATH LF", "code_information": [{"code": "21518", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETHRAL 24FR WOVEN PHILLIPS FOLLOWER CATH LF STRL", "code_information": [{"code": "21524", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETHRAL 4FR 12.5IN FILIFORM WOVEN STRAIGHT TIP LF", "code_information": [{"code": "21904", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETHRAL 8FR WOVEN PHILLIPS FOLLOWER SURG LF", "code_information": [{"code": "21508", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATORS INSULATED 8 13 18MM I62-60-31", "code_information": [{"code": "I62-60-31", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.6, "discounted_cash": 47.46, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHTHERIA ANTIBODY", "code_information": [{"code": "86648", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHTHERIA ANTITOXIN", "code_information": [{"code": "90296", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPROPYLACETIC ACID FREE", "code_information": [{"code": "80165", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIRECT ADVANCED LIFE SUPPORT", "code_information": [{"code": "99288", "type": "CPT"}], "standard_charges": [{"minimum": 691.36, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 691.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1086.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1086.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1086.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIRECT IMMUNOFLUORESCENCE", "code_information": [{"code": "D0482", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIRECT LARYNGOSCOPY BIOPSY W/OPERATING MICROSCOPE/TELESCOPE 31536", "code_information": [{"code": "31536", "type": "CPT"}, {"code": "1480653", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIRECT LARYNGOSCOPY W/EXCISION OF TUMOR W/MICROSOCPE 31541", "code_information": [{"code": "31541", "type": "CPT"}, {"code": "1480654", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIRECT LARYNGOSCOPY WITH BIOPSY 31535", "code_information": [{"code": "31535", "type": "CPT"}, {"code": "1480655", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIRECT REPAIR ANEURYSM OR PSEUDOANEURYSM OR EXC. AND GRAFT W/ OR W/O PATCH 35045", "code_information": [{"code": "35045", "type": "CPT"}, {"code": "4734921", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2615.05, "maximum": 9735.0, "gross_charge": 5403.0, "discounted_cash": 1891.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2615.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIS SITE TELE SVCS RHC/FQHC", "code_information": [{"code": "G2025", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISABILITY EXAMINATION", "code_information": [{"code": "99456", "type": "CPT"}], "standard_charges": [{"minimum": 1246.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1246.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1958.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1958.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1958.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION OF SHOULDER SECONDARY CLOSURE OR SCAR REVISION 23921", "code_information": [{"code": "23921", "type": "CPT"}, {"code": "1482052", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHOULDER", "code_information": [{"code": "23920", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISC BRUSH 11440-000", "code_information": [{"code": "11440-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DISC CERVICAL 5MM X 15MM X 15MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "MB3555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12772.0, "discounted_cash": 4470.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DISC CERVICAL 6MM X 15MM X 15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MB3556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12772.0, "discounted_cash": 4470.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DISC CERVICAL PROSTHESIS MOBI-C 13X15 H6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MB3356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12400.0, "discounted_cash": 4340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISC CUTTER 30277-200", "code_information": [{"code": "30277-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1135.18, "discounted_cash": 397.31, "setting": "both", "billing_class": "facility"}]}, {"description": "DISC IMPLANT 6MM X 15MM X 17MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "MB3576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DISCECTOMY ANTERIOR W/DEC OF SPINAL CORD AND/OR ROOT W/OST 63076", "code_information": [{"code": "63076", "type": "CPT"}, {"code": "1700056", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISCECTOMY ANTERIOR WITH DECOMPRESSION; CERVICAL SINGLE INTERSPACE 63075", "code_information": [{"code": "63075", "type": "CPT"}, {"code": "1480659", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISCECTOMY ANTERIOR WITH DECOMPRESSION; THORACIC SINGLE INTERSPACE 63077", "code_information": [{"code": "63077", "type": "CPT"}, {"code": "1480660", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISCISSION OF SECONDARY MEMBRANEOUS CATARACT;LASER SURGERY 66821", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "1480661", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1874.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISCS MTP LENGTHENING 20 X 19MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PMTP-19020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4940.0, "discounted_cash": 1729.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISE EVAL SLEEP DISORDERED BREATHING FLX DX 42975", "code_information": [{"code": "42975", "type": "CPT"}, {"code": "46007547", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 91.96, "maximum": 8450.0, "gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 91.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISK CERVICAL ARTHROPLASTY M STD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MB3376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12772.0, "discounted_cash": 4470.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DISK FILTER MEDICATION 5UM BMG415008H", "code_information": [{"code": "BMG415008H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "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": 5657.19, "maximum": 9711.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5657.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8091.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8900.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9711.99, "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": 11433.0, "maximum": 19627.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11433.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16351.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17986.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19627.62, "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": 4034.25, "maximum": 6925.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4034.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5769.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6346.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6925.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [{"code": "439", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5141.35, "maximum": 8826.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5141.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7353.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8088.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8826.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [{"code": "438", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9719.42, "maximum": 16685.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9719.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13900.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15290.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16685.83, "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": 3688.12, "maximum": 6331.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3688.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5274.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5802.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6331.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [{"code": "445", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6554.43, "maximum": 11252.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6554.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9374.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10311.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11252.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [{"code": "444", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10168.34, "maximum": 17456.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10168.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14542.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15997.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17456.52, "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": 4967.38, "maximum": 8527.75, "estimated_discounted_cash": 25637.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4967.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7104.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7814.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8527.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISP 18MM X 8CM ANGLED TUBE 9569818", "code_information": [{"code": "9569818", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DISP 18MM X 9CM ANGLED TUBE 9569819", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9569819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DISPENSER TAPE 40IN 3IN LG", "code_information": [{"code": "387401300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DISPLACEMENT THERAPY PROETZ TYPE 30210", "code_information": [{"code": "30210", "type": "CPT"}, {"code": "1772193", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISPOSABEL ONE STEP CANNULA SYSTEM 27GA/0.4MM", "code_information": [{"code": "1272.ED204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 823.0, "discounted_cash": 288.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DISPOSABLE ENDOSCOPE VALVE SET CLEANGUARD 200310", "code_information": [{"code": "200310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DISPOSABLE KIT FOR 1.8 QFIX MINI HIP", "code_information": [{"code": "72290126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1364.0, "discounted_cash": 477.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DISPOSABLE NEURO MONITORING PROBE 4014-00", "code_information": [{"code": "4014-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 847.35, "discounted_cash": 296.57, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECT BRAIN W/SCOPE", "code_information": [{"code": "62161", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISSECTION LYMPH NODE AXILLARY-COMPLETE 38745", "code_information": [{"code": "38745", "type": "CPT"}, {"code": "1480663", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISSECTION/EXCISION DEEP CERVICAL LYMPH NODES 38510", "code_information": [{"code": "38510", "type": "CPT"}, {"code": "1480664", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISSECTOR BALLOON TROCAR SPACEMAKER", "code_information": [{"code": "OMSXB2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 696.0, "discounted_cash": 243.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDO 10-12MM SPACEMAKER BBT OVAL BALLOON", "code_information": [{"code": "SMBTTOVL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1181.0, "discounted_cash": 413.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDO 5 MM 36 CM ROTIC W/ UNIVERSAL CAUTERY RATCHET HANDLE", "code_information": [{"code": "174213", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 607.0, "discounted_cash": 212.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDOPATH BLUNT TIP 3/PK BTD05", "code_information": [{"code": "BTD05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.85, "discounted_cash": 5.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDOPATH CURVE 5MM -ORDR QTY 6 5DCD", "code_information": [{"code": "5DCD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDOSCOPIC 5MM 176645", "code_information": [{"code": "176645", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDOSCOPY SPACEMAKER PDB LATEX FREE ROUND BALLOON STERILE DISPOSABLE", "code_information": [{"code": "OMS-PDB1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 401.94, "discounted_cash": 140.68, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR SONICISION CORDLESS ULTRASONIC 39CM 14.5MM BLADE", "code_information": [{"code": "SCD396", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1627.0, "discounted_cash": 569.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR SURG 3.5MM X 13 CM CURVED", "code_information": [{"code": "AR-8350CDS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ULTRASONIC 48CM SONICISION CORDLESS", "code_information": [{"code": "SCD48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1838.0, "discounted_cash": 643.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSOLVE CLOT HEART VESSEL", "code_information": [{"code": "92975", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISSOLVE CLOT HEART VESSEL", "code_information": [{"code": "92977", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIST REVAS LIGATION HEMO", "code_information": [{"code": "36838", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL CLAVICLE REPAIR ASSEMBLY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2658T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DISTAL RASP SMART TOE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "XRP001001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DISTANCE LEARNING ATTENDANCE", "code_information": [{"code": "G9887", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.53, "maximum": 112.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTRACTOR PIN 12MM 02.600.022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.600.022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DISTRACTOR PINS 12MM-STERILE 02.600.022.02S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.600.022.02S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DISTRACTOR PINS-STERILE 14MM LENGTH U44-640-14S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "U44-640-14S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1918.0, "discounted_cash": 671.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DISTRACTOR UC HIP SUPINE ADV AHTB", "code_information": [{"code": "72204088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1805.0, "discounted_cash": 631.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVERTICULECTOMY URETHRAL-FEMALE 53230", "code_information": [{"code": "53230", "type": "CPT"}, {"code": "1480666", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVERTICULECTOMY URETHRAL-MALE 53235", "code_information": [{"code": "53235", "type": "CPT"}, {"code": "1480667", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58605", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVISON OF PLANTAR FASCIA AND MUSCLE 28250", "code_information": [{"code": "28250", "type": "CPT"}, {"code": "1915662", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH 1ST VSL", "code_information": [{"code": "34710", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH EA ADDL", "code_information": [{"code": "34711", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DMD DUP/DELET ANALYSIS", "code_information": [{"code": "81161", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 348.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 711.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1118.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1118.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1118.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 401.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 401.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME SUPPLY OR ACCESSORY, NOS", "code_information": [{"code": "A9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DMPK GENE CHARAC ALLELES", "code_information": [{"code": "81239", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DMPK GENE DETC ABNOR ALLELE", "code_information": [{"code": "81234", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA ANALYSIS APOE ALZHEIMER", "code_information": [{"code": "S3852", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA ANALYSIS DEAFNESS", "code_information": [{"code": "S3844", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA ANALYSIS RET-ONCOGENE", "code_information": [{"code": "S3840", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA ANTB 2STRAND HI AVIDITY", "code_information": [{"code": "39U", "type": "CPT"}], "standard_charges": [{"minimum": 19.79, "maximum": 55.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA ANTIBODY NATIVE", "code_information": [{"code": "86225", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA ANTIBODY SINGLE STRAND", "code_information": [{"code": "86226", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA/RNA AMPLIFIED PROBE", "code_information": [{"code": "87150", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA/RNA DIRECT PROBE", "code_information": [{"code": "87149", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA/RNA SEQUENCING", "code_information": [{"code": "87153", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 178.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 294.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 462.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 462.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 462.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DO GNOTYP ART4 EXON 2", "code_information": [{"code": "184U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 266.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC 2ND RECOM HZV 2-6 MO INT", "code_information": [{"code": "M1238", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC 2X RE-ASSESS FILT REMOV", "code_information": [{"code": "G9543", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC >1 DOSE REDUC TECH", "code_information": [{"code": "G9637", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC >1 SINUS CT W 90D DX", "code_information": [{"code": "G9351", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC ACTIVE INJ DRUG USE", "code_information": [{"code": "G9518", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC CHLAM SCR TEST W/FOLLOW", "code_information": [{"code": "G9820", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC COMM RISK CALC", "code_information": [{"code": "G9316", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC COUNT OF CT IN 12MO", "code_information": [{"code": "G9321", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC DAILY ASPIRIN OR CONTRA", "code_information": [{"code": "G9277", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC ESRD DIA TRANS PREG", "code_information": [{"code": "G9231", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC FCN/CARE PLAN W/30 DAYS", "code_information": [{"code": "G8942", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC FUNCT AND CARE PLAN", "code_information": [{"code": "G8539", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC FUNCT NO DEFICIENCIES", "code_information": [{"code": "G8542", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC HX RENAL FAIL OR CR+ >=4", "code_information": [{"code": "G9722", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC IMM CKPT INHIB HLD", "code_information": [{"code": "M1183", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC IMMUNE HEP B ANTITNF", "code_information": [{"code": "G8869", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC KHE NOT PEF W/EFGR/UACR", "code_information": [{"code": "M1190", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC KHE PEF W/EFGR/UACR", "code_information": [{"code": "M1189", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MD RSN NO ANTIPLA", "code_information": [{"code": "G9610", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED NOT PRESB", "code_information": [{"code": "G8968", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED PT REAS NO HCC SCRN", "code_information": [{"code": "G9456", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED REAS NO HCV TEST", "code_information": [{"code": "G9452", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED REAS NO PNEUMOCOCCAL", "code_information": [{"code": "G8865", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN <3 COLON", "code_information": [{"code": "G9998", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN FOR F/U IMAG", "code_information": [{"code": "G9549", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN FOR FOLLUP IMAGE", "code_information": [{"code": "G9555", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO ADR DEP THRPY", "code_information": [{"code": "G9895", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO COMBO THRPY", "code_information": [{"code": "G9957", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO CST/IST RX", "code_information": [{"code": "M1184", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO DAILY ASPIRIN", "code_information": [{"code": "G9794", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO FLLW UP", "code_information": [{"code": "G9755", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO FLU VAX", "code_information": [{"code": "M1169", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO HCV SCRN", "code_information": [{"code": "G9384", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO HZV", "code_information": [{"code": "M1175", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO MEDREC", "code_information": [{"code": "G8430", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO PCV", "code_information": [{"code": "M1178", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO PROPH ANTIEM", "code_information": [{"code": "G9776", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO PT CAT", "code_information": [{"code": "G9429", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO SRN TB", "code_information": [{"code": "M1004", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO TD/TDAP", "code_information": [{"code": "M1172", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO TEMP >= 35.5", "code_information": [{"code": "G9772", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NOT PERF CYSTOSC", "code_information": [{"code": "G9607", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NOT SEEN", "code_information": [{"code": "M1325", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN PRESC ANBX", "code_information": [{"code": "G9712", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN SCOPE PT >= 86Y", "code_information": [{"code": "G9660", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MEDRSN NO HIST TYPE RPT", "code_information": [{"code": "G9288", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC MEDRSN NO HISTO TYPE", "code_information": [{"code": "G9282", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC NEG ELD REQ", "code_information": [{"code": "G8734", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC NO DAILY ASPIRIN", "code_information": [{"code": "G9278", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC NO DICOM, CT OTHER FAC", "code_information": [{"code": "G9753", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC OF DSM-IV INIT EVAL", "code_information": [{"code": "G9212", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC OF NON TOBACCO USER", "code_information": [{"code": "G9275", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC OF PT PRM HDA DX AND OTR", "code_information": [{"code": "M1028", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC OF TOBACCO USER", "code_information": [{"code": "G9276", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC ORDER ANTI-PLAT", "code_information": [{"code": "G9609", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PAT DECLINED THERAPY", "code_information": [{"code": "G9765", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC POS ELDER MAL SCRN PLAN", "code_information": [{"code": "G8733", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT DISCHG <=2D", "code_information": [{"code": "G9255", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT DISCHG >2D", "code_information": [{"code": "G9254", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT DX BIPOL", "code_information": [{"code": "G9717", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT HCV ABY RNA TST", "code_information": [{"code": "M1235", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT NOT ON STATIN", "code_information": [{"code": "G9508", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT PAL OR HOSPICE", "code_information": [{"code": "G9996", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT PAL OR HOSPICE", "code_information": [{"code": "M1307", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT PREG DUR MSRMT PD", "code_information": [{"code": "G9997", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT PREG DUR MSRMT PD", "code_information": [{"code": "M1298", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT REAS NO PNEUMOCOCCAL", "code_information": [{"code": "G8866", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT REAS NOT REC HCV SRN", "code_information": [{"code": "G9385", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT RSN NO ADR DEP THRPY", "code_information": [{"code": "G9896", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT RSN NO PRESC WARF/FDA", "code_information": [{"code": "G8969", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PT UNABLE COMM", "code_information": [{"code": "G2183", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PTS RSN NO F/U XM", "code_information": [{"code": "M1330", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC PTS RSN NO F/U XM", "code_information": [{"code": "M1335", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO AHI OR RDI", "code_information": [{"code": "G8843", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO MIN INV DX", "code_information": [{"code": "G8876", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO POS AIR PRESS", "code_information": [{"code": "G8849", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO SLEEP APNEA", "code_information": [{"code": "G8840", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO STATIN MED DISCH", "code_information": [{"code": "G8817", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO STATIN THERAPY", "code_information": [{"code": "G8815", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO STATIN THERAPY", "code_information": [{"code": "G9940", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC REAS ON STATIN OR CONTRA", "code_information": [{"code": "G9507", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC REASS APPR REMO FILT 3MS", "code_information": [{"code": "G9542", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC RSN ELECT C-SEC/INDUCT", "code_information": [{"code": "G9361", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC RSN HEP B STAT NOT ASSES", "code_information": [{"code": "G9504", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC RSN NO 10 YR FOLLOW", "code_information": [{"code": "G9862", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC RSN NO HBP SCRN OR F/U", "code_information": [{"code": "G9745", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC RSN NO HBP SCRN OR F/U", "code_information": [{"code": "M1288", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC RSN NO STATIN", "code_information": [{"code": "G9781", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC SEX ACTIVITY", "code_information": [{"code": "G9818", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC SHARE DEC PRIOR PROC", "code_information": [{"code": "G9296", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC SHNT/TUM/COAG", "code_information": [{"code": "G9595", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC SYS RSN <3 COLON", "code_information": [{"code": "G9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC SYSM RSN IMG HD", "code_information": [{"code": "M1029", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC TYPE NSM LUNG CA", "code_information": [{"code": "G9289", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC VIRAL LOAD <200", "code_information": [{"code": "G9243", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC VIRAL LOAD >=200", "code_information": [{"code": "G9242", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCREV CUR MEDS BY ELIG CLIN", "code_information": [{"code": "G8427", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1107", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1112", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1117", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1122", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1127", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1131", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY LAPS LIV", "code_information": [{"code": "666T", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 6125.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN CDVR", "code_information": [{"code": "664T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN LIV", "code_information": [{"code": "665T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY RCP UTER", "code_information": [{"code": "667T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONOR PANCREATECTOMY", "code_information": [{"code": "48550", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONOR PNEUMONECTOMY", "code_information": [{"code": "32850", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONUT HEAD 9 FOAM POSITIONER FP-HEAD9", "code_information": [{"code": "FP-HEAD9", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DOOR TO PUNC TIME <2HRS", "code_information": [{"code": "G9580", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOOR TO PUNC TIME >2HR, NRG", "code_information": [{"code": "G9582", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER COLOR FLOW ADD-ON", "code_information": [{"code": "93325", "type": "CPT"}], "standard_charges": [{"minimum": 98.52, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 154.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 154.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 154.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO EXAM HEART", "code_information": [{"code": "93320", "type": "CPT"}], "standard_charges": [{"minimum": 157.35, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 157.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO EXAM HEART", "code_information": [{"code": "93321", "type": "CPT"}], "standard_charges": [{"minimum": 87.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER FLOW TESTING", "code_information": [{"code": "93990", "type": "CPT"}], "standard_charges": [{"minimum": 494.27, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 494.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOSE OPTIMIZATION AUC - 5FU", "code_information": [{"code": "S3722", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOUBLE TRANSFER TOE-HAND", "code_information": [{"code": "26554", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DPYD GENE COMMON VARIANTS", "code_information": [{"code": "81232", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 445.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DR. URSO CATARACT MIXTURE", "code_information": [{"code": "MED0072", "type": "CDM"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN 19FR ROUND 1/4\" TROCAR 2231", "code_information": [{"code": "2231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN APPENDIX ABSCESS OPEN", "code_information": [{"code": "44900", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY NEEDLE", "code_information": [{"code": "51100", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY TROCAR/CATH", "code_information": [{"code": "51101", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN BLAKE HBLS 15FR W BND 2233", "code_information": [{"code": "2233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN CHEST 1 PATIENT TUBE DRY SUCTION OASIS", "code_information": [{"code": "3600-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.0, "discounted_cash": 37.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN FLUTE WITH TROCAR FULL ROUND 15FR", "code_information": [{"code": "B072189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN JP ROUND 10FR SILICONE JP-2186", "code_information": [{"code": "JP-2186", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN OPEN ABDOM ABSCESS", "code_information": [{"code": "49040", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN LUNG LESION", "code_information": [{"code": "32200", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN RETROPERI ABSCESS", "code_information": [{"code": "49060", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS OPEN", "code_information": [{"code": "58820", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS PERCUT", "code_information": [{"code": "58822", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN PANCREATIC PSEUDOCYST", "code_information": [{"code": "48510", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN PENROSE .25IN STERILE 30416-025", "code_information": [{"code": "30416-025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 0.25IN X 18IN CLOSED WOUND DRAIN WOUND CARE LATEX STRL", "code_information": [{"code": "DYND50420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 1/2 X 18IN PIN", "code_information": [{"code": "20416-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.71, "discounted_cash": 2.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 1/2IN X 18ININCISION CLOSED WOUND DRAINAGE WOUND CARE LTX STRL", "code_information": [{"code": "DYND50422", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.94, "discounted_cash": 1.73, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 18IN LATEX FREE DYND50427", "code_information": [{"code": "DYND50427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE DRAIN 18X1 2 067 STAND 30416-050", "code_information": [{"code": "30416-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.28, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN RESERVOIR 100CC CLR EVACUATOR BULB JACKSON-PRATT SILICONE 70740 (USE 0070740 PART NUMBER)", "code_information": [{"code": "70740 (USE 0070740 PART NUMBER)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND 19FR CLR HUBLESS FLUTED", "code_information": [{"code": "JA-27621526193", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND CHANNEL FULL-FLUTED 10FR 072186", "code_information": [{"code": "72186", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND CHANNEL FULL-FLUTED 15FR 072188", "code_information": [{"code": "72188", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND CHANNEL TROCAR 15FR 072189", "code_information": [{"code": "72189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BONE LESION", "code_information": [{"code": "23035", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BURSA", "code_information": [{"code": "23031", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN SILCN BLAKE 10FR ROUND 1 8 TRC LF 2227", "code_information": [{"code": "2227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SILICONE 10FR", "code_information": [{"code": "70310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SPINAL CORD CYST", "code_information": [{"code": "62268", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN THYROID/TONGUE CYST", "code_information": [{"code": "60000", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN WOUND 10MM 3/16IN SILICONE FLAT FULL FLUTED ETHICON BLAKE STRL", "code_information": [{"code": "2215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND 10MM SILICONE FLAT FULL FLUTED ETHICON BLAKE STRL", "code_information": [{"code": "2214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 73.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND ROUND 10FR SILICONE HUBLESS ETHICON BLAKE STRL", "code_information": [{"code": "2226", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND ROUND 15FR SILICONE FULL FLUTED ETHICON STRL", "code_information": [{"code": "2188", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND ROUND 19FR SILICONE ETHICON BLAKE STRL", "code_information": [{"code": "2190", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND ROUND 19FR SILICONE HUBLESS BLAKE", "code_information": [{"code": "2230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND TROCAR PERFORATED 19FR 1 0070330", "code_information": [{"code": "70330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20604", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20611", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE ABDOM ABSCESS OPEN", "code_information": [{"code": "49020", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE ABSCESS OR HEMATOMA NASAL SPTUM 30020", "code_information": [{"code": "30020", "type": "CPT"}, {"code": "36235650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE EXTERIOR AUDITORY CANAL ABSCESS 69020", "code_information": [{"code": "69020", "type": "CPT"}, {"code": "45704681", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 692.0, "discounted_cash": 242.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 334.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE EXTERNAL EAR ABSCESS OR HEMATOMA COMPLICATED 69005", "code_information": [{"code": "69005", "type": "CPT"}, {"code": "1480668", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE EXTERNAL EAR ABSCESS OR HEMATOMA SIMPLE 69000", "code_information": [{"code": "69000", "type": "CPT"}, {"code": "1480669", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38300", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38305", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE MOUTH ROOF LESION", "code_information": [{"code": "42000", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF ABDOMEN", "code_information": [{"code": "48000", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BLADDER ABSCESS", "code_information": [{"code": "51080", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "21510", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "26992", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "27303", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GUM LESION", "code_information": [{"code": "41800", "type": "CPT"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HIP JOINT", "code_information": [{"code": "27030", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF KIDNEY LESION", "code_information": [{"code": "50390", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "40800", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "40801", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41000", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41005", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41006", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41007", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41008", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41009", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41015", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41016", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41017", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41018", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30000", "type": "CPT"}], "standard_charges": [{"minimum": 598.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST UNI OR BILATERAL ABDOMINAL APPROACH 58805", "code_information": [{"code": "58805", "type": "CPT"}, {"code": "8675628", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S) UNILATERAL OR BILATERAL VAGINAL APPROACH 58800", "code_information": [{"code": "58800", "type": "CPT"}, {"code": "2042286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "45000", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1871.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "52700", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45020", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY CYST", "code_information": [{"code": "42409", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42300", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42305", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42310", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42320", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SCROTAL WALL ABSCESS 55100", "code_information": [{"code": "55100", "type": "CPT"}, {"code": "1480671", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63172", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63173", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42720", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42725", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53040", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53060", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53080", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53085", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE PALMAR BURSA SINGLE 26025", "code_information": [{"code": "26025", "type": "CPT"}, {"code": "1480672", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE PALMAR BURSA-MULTIPLE 26030", "code_information": [{"code": "26030", "type": "CPT"}, {"code": "1480673", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE PANCREATIC PSEUDOCYST-PERCUTANEOUS 48511", "code_information": [{"code": "1480675", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAINAGE TENDON SHEATH/DIGIT/PALM 26020", "code_information": [{"code": "26020", "type": "CPT"}, {"code": "1480676", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAPE ADHESIVE STERI 15IN X 15IN", "code_information": [{"code": "1020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ARTHROSCOPY W POUCH HEAVY DUTY E 59413", "code_information": [{"code": "59413", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ASTOUND 3 QTR SHEET", "code_information": [{"code": "9349", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.41, "discounted_cash": 2.59, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE BEACH CHAIR SHOULDER STERILE DYNJP8412", "code_information": [{"code": "DYNJP8412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE BILATERAL LIMB T- STERILE DYNJP8006", "code_information": [{"code": "DYNJP8006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE C-ARM MINIVIEW 6600/6800 KIT VMC60-5402", "code_information": [{"code": "VMC60-5402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE C-ARM MOBILE X-RAY 27\" X 24\" X 70\" GUSSETED 07-CA106", "code_information": [{"code": "7-CA106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.13, "discounted_cash": 4.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE C-ARM MOBILE XRAY W TIES 42X74 VAE5601", "code_information": [{"code": "VAE5601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE C-ARM NAVIGATION 7800-000-300SR", "code_information": [{"code": "7800-000-300SR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.55, "discounted_cash": 53.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE CAMERA ELAST TIP VCD5105", "code_information": [{"code": "VCD5105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE CAMERA PERF TIP VCD5103", "code_information": [{"code": "VCD5103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE COVER MAYO STAND 8339", "code_information": [{"code": "8339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.89, "discounted_cash": 3.11, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE COVER TABLE POLY REINF 44X90", "code_information": [{"code": "8377", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.92, "discounted_cash": 2.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE DOME COVER 22\" D SNAP KAP 03-KP22", "code_information": [{"code": "3-KP22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.06, "discounted_cash": 1.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE EXTREMITY 89X128 ST 12 CS DYNJP8002", "code_information": [{"code": "DYNJP8002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.51, "discounted_cash": 11.03, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE EXTREMITY FULL FABRIC 29414", "code_information": [{"code": "29414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE EXTREMITY ULTRAGUARD", "code_information": [{"code": "DYNJP8002UG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE FLUOROSCOPE 44 X 36 ADHESIVE VAE5619", "code_information": [{"code": "VAE5619", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.95, "discounted_cash": 3.13, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE FLUROSCOPE 30IN X 36IN BANDED BAG ELASTIC BAND FOR USE UNIVERSAL FLUROSCOP", "code_information": [{"code": "29-63039", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE GENERAL ENDOSCOPY 9458", "code_information": [{"code": "9458", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE HAND EXTREMITY TIBURON", "code_information": [{"code": "29427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE HIP TIBURON W POUCHES 5 EA CS", "code_information": [{"code": "29439", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.39, "discounted_cash": 26.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE HORIZONTAL ISOLATION JOIMAX JMHID3224", "code_information": [{"code": "JMHID3224", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE IMPERVIOUS U-SPLIT 60 X 72IN", "code_information": [{"code": "8476", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.99, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE INCISE 36X17.5 INVISISHEILD DYNJSD1050Z", "code_information": [{"code": "DYNJSD1050Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.48, "discounted_cash": 5.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE INCISE ANTIMICROBL 23 X 17 6650EZ", "code_information": [{"code": "6650EZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.75, "discounted_cash": 9.01, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE INVISISHEILD SMALL 12''X18'' DYNJSD1000", "code_information": [{"code": "DYNJSD1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE IOBAN 129X100 ISOLATION MMM6619H", "code_information": [{"code": "MMM6619H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.69, "discounted_cash": 30.69, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE IOBAN2 INCISEANTIMCRBL 23\"X33\" 6651EZ", "code_information": [{"code": "6651EZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE LAPAROTOMY 30.5X24 29410", "code_information": [{"code": "29410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE LEICA/WILD MICROSCOPE 54\" X 120\" W/ANGLED LENS", "code_information": [{"code": "5452-UC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MAGNETIC 10\" X 16\" 31140570", "code_information": [{"code": "31140570", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MAGNETIC INSTRUMENT DYNJMDS1H", "code_information": [{"code": "DYNJMDS1H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.37, "discounted_cash": 5.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MICROSCOPE 50CM 180CM WITHOUT SIDE OBSERVER STRL", "code_information": [{"code": "8222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MS LEICA 54 X120 W/ANGLED GLASS LENS VMD50-5412AGL", "code_information": [{"code": "VMD50-5412AGL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE NAV STERILE Z 9999-999-NV88", "code_information": [{"code": "9999-999-NV88", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.55, "discounted_cash": 53.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE OEC / GE 9800 STERILE 07-PK804", "code_information": [{"code": "7-PK804", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.41, "discounted_cash": 12.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE OEC/GE 6600 C-ARM 07-PK801", "code_information": [{"code": "7-PK801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.18, "discounted_cash": 9.51, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE OPHTHALMIC 40IN X 48IN MID SZINCISE SNGL FLUID CATCH BAG MICRO-EMBOSSED PL", "code_information": [{"code": "8065104020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.53, "discounted_cash": 12.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE OPHTHALMIC 40IN X 48IN OVAL APERTURE SNGL FLUID CATCH BAG MICRO-EMBOSSED P", "code_information": [{"code": "8065104120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE OPHTHALMOLOGY 165 X 254IN FABRIC NONWOVEN RECTANGULAR INCISE FLUID CATCH BAG FULL BODY BLUE", "code_information": [{"code": "8065103020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.04, "discounted_cash": 26.26, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ORTHOMAX ARTHROSCOPY T- WITH POUCH 130\" X 89\" X 126\" DYNJP8104", "code_information": [{"code": "DYNJP8104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.31, "discounted_cash": 30.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE PROCEDURE 000-0212", "code_information": [{"code": "-0212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 230.0, "discounted_cash": 80.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE STERI 1012 FLOUROSCOPE 1012", "code_information": [{"code": "1012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE STERI U-DRAPE 1015", "code_information": [{"code": "1015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE STERI U-DRAPE SUB IS MMM1010Z 1010", "code_information": [{"code": "1010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE STERIDRAPE ISOLATION W ACCESS 6617", "code_information": [{"code": "6617", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE STERILE-Z SURGICAL PT COVER UNIV 5574", "code_information": [{"code": "5574", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.16, "discounted_cash": 52.21, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SUPER C-ARM KIT 12 I.I. VMC60-5429", "code_information": [{"code": "VMC60-5429", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.07, "discounted_cash": 12.62, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 102IN X 53IN TOP 5 STRONG FIBER LAYER PLYPRPLN DRPINCLUDES: ABSORB RE", "code_information": [{"code": "DYNJP4002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 112IN X 137IN X 89IN HIP ABSORB REINFORCED FENESTRATED W/ POUCH STOP", "code_information": [{"code": "DYNJP8201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 15IN X 10IN CHEST BREAST PROXIMA FENESTRATED SMS LF DISP", "code_information": [{"code": "DYNJP2491", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 29IN X 29IN LAPAROTOMY TRANSVERSE FENESTRATION DRPINCLUDES: ABSORB RE", "code_information": [{"code": "DYNJP3005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.83, "discounted_cash": 9.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 31 X 51 MED ABSORB PREVENT FABRIC W/ ADHSV APERTURE AND POUCH STERI-D", "code_information": [{"code": "1030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 35.375 X 17.625 LGINCISE STERI-DRAPE LF STRL 1050", "code_information": [{"code": "1050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 38IN X 16IN X 32IN UNDER BUTTOCKS 5 STRONG FIBER LAYER PCH PLYPRPLN D", "code_information": [{"code": "DYNJP6002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 47IN X 51IN STERI OD", "code_information": [{"code": "M1015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 53IN X 114IN X 132IN HND EXTREMITY FENESTRATED PROXIMA LF STRL DISP", "code_information": [{"code": "DYNJP8005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 53IN X 77IN THREE QUARTER PP LF STRL DISP", "code_information": [{"code": "DYNJP2414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 53IN X 77IN THREE QUARTER REINFORCED GENERAL PURP PROXIMA ECLIPSE LF", "code_information": [{"code": "DYNJP2416", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.68, "discounted_cash": 4.44, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 54IN X 72IN IMPERVIOUS U DRP PROXIMA LF", "code_information": [{"code": "DYNJP2499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 74IN X 121IN BILATERAL LIMB PROXIMA LF STRL DISP", "code_information": [{"code": "DYNJP8004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 76IN X 120IN U DRP SPLIT TUBE HOLDER EVOLUTION STRL", "code_information": [{"code": "89301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.36, "discounted_cash": 12.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 77IN X 102IN X 121IN THYROID T SHEET PLYPRPLN DRPINCLDUES: ABSORB REI", "code_information": [{"code": "DYNJP7003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 78IN X 102IN X 121IN LAPAROTOMY SHT 5 STRONG FIBER LAYER PLYPRPLN DRP", "code_information": [{"code": "DYNJP3003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.94, "discounted_cash": 9.78, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 89IN X 128IN STANDARD EXTREMITY PP LF", "code_information": [{"code": "DYNJP8002A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG LAPAROTOMY 5 STRONG FIBER LAYER DRPINCLUDES: ABSORB REINFORCEMENT 14I", "code_information": [{"code": "DYNJP3008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.08, "discounted_cash": 15.43, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG LAPAROTOMY CHOLECYSTECTOMY W/ TROUGHS AURORA", "code_information": [{"code": "DYNJP3102A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG MICROSCOPE DRP STRL FIELD OPMI", "code_information": [{"code": "306070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG OPHTHALMIC FULL BODY 5 STRONG FIBER LAYER PLYPRPLN DRPINCLUDES: 2 FLU", "code_information": [{"code": "DYNJP7006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURGICAL 15 X 26IN UTILITY TAPE STRL", "code_information": [{"code": "DYNJP2406", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURGICAL 3 QTR 56 X 77 REINF", "code_information": [{"code": "29350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE T 90IN X 122IN X 114IN SURG ARTHRO FENESTRATED ABSORB REINFORCEMENT SMS W/", "code_information": [{"code": "DYNJP8102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE THYROID W ARMBOARD COVERS 29522", "code_information": [{"code": "29522", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.29, "discounted_cash": 9.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TIBURON BILATERAL EXTRIMITY", "code_information": [{"code": "29417", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TOWEL 18IN X 24IN STRL", "code_information": [{"code": "MCTD1010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TOWEL LARGE INVISISHIELD", "code_information": [{"code": "DYNJSD1010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TRANSVERSE LAP SHEET TIBURON", "code_information": [{"code": "29421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.61, "discounted_cash": 9.66, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE U LNG 47IN X 70IN CLR SURG WITHOUT COVERS WITHOUT POUCH AND HOLDER STERI D", "code_information": [{"code": "1019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE UNDER BUTTOCK FLUID COLL POUCH II 8482", "code_information": [{"code": "8482", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE UROCATCHER 64IN X 7/8IN TUBING", "code_information": [{"code": "O-UC32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE-STERI LARGE IOBAN 2 ISOLATION 6619", "code_information": [{"code": "6619", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.69, "discounted_cash": 30.69, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPEINCISE 60CM X 45CM STERI DRP", "code_information": [{"code": "1050steri", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAW BLOOD OFF VENOUS DEVICE", "code_information": [{"code": "36591", "type": "CPT"}], "standard_charges": [{"minimum": 278.03, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRE W/O RTNOPTHY", "code_information": [{"code": "M1221", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRE WTH INTERP RTNOPTHY", "code_information": [{"code": "M1220", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN L", "code_information": [{"code": "16030", "type": "CPT"}], "standard_charges": [{"minimum": 598.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESSING ADHSV 6IN X 8IN TRANSPARENT FILM TEGADERM LF", "code_information": [{"code": "1628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING AG AQUACEL SURGICAL 3.5X9.75 STERILE SILVER", "code_information": [{"code": "412011A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 111.0, "discounted_cash": 38.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING ANTIMICROBIAL 4IN X 8IN 10 CM X 20 CM POST OP MEPILEX AG", "code_information": [{"code": "395890", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.66, "discounted_cash": 27.18, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BILAYER MATRIX WOUND BMW4101", "code_information": [{"code": "BMW4101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12245.0, "discounted_cash": 4285.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BIOPATCH 1 DISK CHG 7MM CENTER 4152", "code_information": [{"code": "4152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BIOPATCH CHG 0.75 DISK 1.5MM CENTER 4151", "code_information": [{"code": "4151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BIOPATCH CHG DISC 1\" 4MM HOLE 4150", "code_information": [{"code": "4150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING CHANGE NOT FOR BURN", "code_information": [{"code": "15852", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESSING COVER 3.5 CM X 6 CM SURG AQUACEL", "code_information": [{"code": "412010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING COVER 3.5IN X 3.75IN SURG AQUACEL LF", "code_information": [{"code": "412009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING COVER SURGI AQUACEL AG 3.5X10", "code_information": [{"code": "412011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 111.0, "discounted_cash": 38.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE XEROFORM CURAD 1X8 ST CUR253180", "code_information": [{"code": "CUR253180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE XEROFORM CURAD 5X9 ST CUR253590", "code_information": [{"code": "CUR253590", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE XEROFORM PETRO 1X8", "code_information": [{"code": ".", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GRAFT MICRO KERECIS OMEGA3 19CM 50205P02D0D", "code_information": [{"code": "Q4158", "type": "HCPCS"}, {"code": "50205P02D0D", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2379.0, "discounted_cash": 832.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING HEMOSTATIC SEALK 1X2IN SK-IX-22", "code_information": [{"code": "SK-IX-22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.25, "discounted_cash": 83.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING HEMOSTATIC SURGICEL SNOW 4X4CM", "code_information": [{"code": "2083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 347.0, "discounted_cash": 121.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING HOLDER NASAL DALE", "code_information": [{"code": "H84106001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.87, "discounted_cash": 11.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING ISLAND SILVERLON 4X10 ID-410", "code_information": [{"code": "ID-410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.17, "discounted_cash": 30.86, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING MEDIPORE+PAD SOFT ADH 3.5 X 8 3570", "code_information": [{"code": "3570", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING MEDIPR+PD SFT ADH 3.5 X 6 3569", "code_information": [{"code": "3569", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING MEDIPRE+PAD SFT ADH 3.5X10\" 3571", "code_information": [{"code": "3571", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PICO 4 X 16CM", "code_information": [{"code": "66800953", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 213.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PROTECTIVE DISK 1IN 7MM W/ CHG BIOPATCH", "code_information": [{"code": "ET 4152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PURAPLY MICRONIZED WOUND MATRIX 500MG 515-061", "code_information": [{"code": "Q4195", "type": "HCPCS"}, {"code": "515-061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2320.0, "discounted_cash": 812.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING SILVERLON ISLAND 4X6 PD 2X4 ID-46", "code_information": [{"code": "ID-46", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.76, "discounted_cash": 20.22, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING SNS NASAL VISCOUS DISSOLVABLE CARBOXYMETHYLCELLULOSE SINU FOAM LF ADLT", "code_information": [{"code": "RR650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING STRATASORB 4 X 4IN ISLAND", "code_information": [{"code": "MSC3044Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING STRATASORB COMP ISLAND 4X10 MSC30410", "code_information": [{"code": "MSC30410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING SURESITE 123 8 X 12IN TRANSPARENT", "code_information": [{"code": "MSC2712", "type": "CDM"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING TEGADERM TRNSPR FILM FRAME 8X12 1629", "code_information": [{"code": "1629", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.06, "discounted_cash": 3.17, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING TEGADERM+PAD 2 3 8X4 3584", "code_information": [{"code": "3584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING VASELINE 1.0 X 8.0IN CISION GAUZE PETROLATUM NONADHERENT", "code_information": [{"code": "8884417601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WND 2 3/8IN X 2 3/4IN TRANSPARENT ADHSV COMFORMING PATIENT CARE W/ WIND", "code_information": [{"code": "1624W", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WND 2IN X 2IN BILAYER MATRIX IDEAL FOR PARTIAL AND FULL THICKNESS SOFT", "code_information": [{"code": "Q4104", "type": "HCPCS"}, {"code": "BMW2021", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4152.0, "discounted_cash": 1453.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WND 4IN X 10IN TRANSPARENT FILM ADHSV CONFORMING PATIENT CARE TEGADERM", "code_information": [{"code": "1627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WND 4IN X 4 3/4IN TRANSPARENT FILM ADHSV CONFORMING PATIENT CARE TEGADE", "code_information": [{"code": "1626W", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 3IN UNNA BOOT", "code_information": [{"code": "UNNA3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 3IN X 4IN NON ADHERENT PRIMARY PAD TEFLA LF STRL", "code_information": [{"code": "1050 (TELFA)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 3IN X 6IN NON ADHERENT PAINLESS TEFLA LF STRL", "code_information": [{"code": "1169 DRSG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 3IN X 8IN OIL EMULSION DBD LF STRL", "code_information": [{"code": "NON250381", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 4IN X 12IN PICO", "code_information": [{"code": "66800952", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 4IN X 4IN EXTRA THIN DUODERM", "code_information": [{"code": "187955", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 4IN X 8IN PICO", "code_information": [{"code": "66800951", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 6GM CELLERATERX COLLAGEN", "code_information": [{"code": "CRXG-6GMBX-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 8CM FIRM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "5400-020-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND EAR GLASSCOCK ADLT", "code_information": [{"code": "S-1000.", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND EAR PLASTIC SHELL GLASSCOCK PEDI", "code_information": [{"code": "S-1003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND PREVENA PLUS HYDROLLOID DISPOSABLE", "code_information": [{"code": "PRE4001US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1215.78, "discounted_cash": 425.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSINGS PACKING GAUZE IODOFORM 1/2 INCH", "code_information": [{"code": "NON256125H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.39, "discounted_cash": 3.29, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSINGS PACKING GAUZE PLAIN 1/2 INCH", "code_information": [{"code": "NON255125H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSINGS PACKING GUAZE IODOFORM 1/4 INCH", "code_information": [{"code": "NON256145H", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSINGS XEROFORM 5 X 9", "code_information": [{"code": "CUR253590(d)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSNG MEPILX AG 4X10 10X25CM POST-OP 395790", "code_information": [{"code": "395790", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.16, "discounted_cash": 25.61, "setting": "both", "billing_class": "facility"}]}, {"description": "DRG TUNNELER", "code_information": [{"code": "MN15000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.2, "discounted_cash": 169.47, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIL BIT SHORT 4.5MM W QC", "code_information": [{"code": "71173507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 759.0, "discounted_cash": 265.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL . 2.5 X 50MM SOLID CUTTING DRLL-SSC-25050", "code_information": [{"code": "DRLL-SSC-25050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 285.82, "discounted_cash": 100.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.3MM QUICK RELEASE", "code_information": [{"code": "320-1613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 374.03, "discounted_cash": 130.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.3MM X 100MM SOLID AO", "code_information": [{"code": "P99-100-1310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 558.0, "discounted_cash": 195.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.5 RAIL CUTTER BIT", "code_information": [{"code": "6975150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.02, "discounted_cash": 148.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.5M VLP MINI-MOD QUICK CONNECT 74461502", "code_information": [{"code": "74461502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 895.77, "discounted_cash": 313.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.5MM VLP MINI-MOD LONG AO QUICK CONNECT 71177196", "code_information": [{"code": "71177196", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 933.43, "discounted_cash": 326.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.6 X 90 MM", "code_information": [{"code": "DRILL-1.6/090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.6MM PILOT", "code_information": [{"code": "510-16-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.6MM X 96MM 705133", "code_information": [{"code": "705133", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.7 X 120MM CAN AO P99-110-1712", "code_information": [{"code": "P99-110-1712", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 859.0, "discounted_cash": 300.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.7MM RECON PILOT TLD-17", "code_information": [{"code": "TLD-17", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 462.55, "discounted_cash": 161.89, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.8MM DISP", "code_information": [{"code": "DRILL-1.8/090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 12MM 8801-90067", "code_information": [{"code": "8801-90067", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 14MM 02-01614", "code_information": [{"code": "2-01614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 14MM STRYKR", "code_information": [{"code": "48771614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2 MM FOR 2.7 MM DISTAL LOCKING SCREWS", "code_information": [{"code": "AR-2669", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.0 X 130MM TRIMED", "code_information": [{"code": "DRILL-2.0/130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.0MM CALIBRATED PILOT", "code_information": [{"code": "510-20-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 99.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.0MM CANNULATED AO", "code_information": [{"code": "XFO041710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.0MM X 100MM TWIST QUICK CONNECT DB20-100", "code_information": [{"code": "DB20-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 81.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.0MM X 40MMSOLID SIDE CUTTING", "code_information": [{"code": "DRILL-SSC-20040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 154.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.0MM X 6MM HEADLESS SCREW SYSTEM T001120116", "code_information": [{"code": "T001120116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 942.0, "discounted_cash": 329.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.0MM X 80MM HUMERAL PLATING SYSTEM DRLL-SSC-20080", "code_information": [{"code": "DRLL-SSC-20080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.0X110 SOLID P99-100-2011", "code_information": [{"code": "P99-100-2011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.2MM 45810003", "code_information": [{"code": "45810003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.2MM OVERDRILL 330-22-011", "code_information": [{"code": "330-22-011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.3 X 120MM TRIMED", "code_information": [{"code": "DRILL-2.3/120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.3MM X 40MM DRLL-SSC-23040", "code_information": [{"code": "DRLL-SSC-23040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 162.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.4MM G3606010", "code_information": [{"code": "G3606010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.4MM X 14MM CANNULATED FOR 22MM PIN", "code_information": [{"code": "1910-2212S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 983.0, "discounted_cash": 344.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.5 CH15003", "code_information": [{"code": "CH15003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 672.5, "discounted_cash": 235.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.5MM CALIBRATED PILOT", "code_information": [{"code": "510-25-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.5MM HEXTIP 6 INCH", "code_information": [{"code": "HT-2502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 132.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.5MM X 110MM TWIST QUICK CONNECT DB25-110", "code_information": [{"code": "DB25-110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 81.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.5MM X 20MM X 100MM QC", "code_information": [{"code": "DA2520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.5MM X 40MM", "code_information": [{"code": "DRILL-SSC-25040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.6MM MICRORAPTOR KNOTLESS 72205169", "code_information": [{"code": "72205169", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.7 CD-MF-1027", "code_information": [{"code": "CD-MF-1027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1178.0, "discounted_cash": 412.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.7 D27", "code_information": [{"code": "D27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 954.95, "discounted_cash": 334.23, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.7 X 152MM 76308842", "code_information": [{"code": "76308842", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1049.1, "discounted_cash": 367.19, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.7MM BIT CMP FT CALIBRATED AR-8737-35", "code_information": [{"code": "AR-8737-35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.7MM X 40MM DRLL-SSC-27040", "code_information": [{"code": "DRLL-SSC-27040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 482.0, "discounted_cash": 168.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.7MM X 80MM DRLL-SSC-27080", "code_information": [{"code": "DRLL-SSC-27080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.27, "discounted_cash": 99.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.7MMC CANNULATED QUICK CONNECT DRLL-CDC-27", "code_information": [{"code": "DRLL-CDC-27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 507.87, "discounted_cash": 177.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.7X100MM QC CANNULATED Z402-100-27", "code_information": [{"code": "Z402-100-27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 941.5, "discounted_cash": 329.53, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.8 X 150MM CANN", "code_information": [{"code": "P99-110-2815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 711.0, "discounted_cash": 248.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.8MM", "code_information": [{"code": "MS-DC28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.8MM A", "code_information": [{"code": "MS-0028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.8MM YUKON 7601-90010", "code_information": [{"code": "7601-90010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.0 CH15004", "code_information": [{"code": "CH15004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 941.5, "discounted_cash": 329.53, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.0MM WRIGHT", "code_information": [{"code": "DSDS0030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.06, "discounted_cash": 163.82, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.2 QUICK STEP REAMER XDB01018", "code_information": [{"code": "XDB01018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1184.0, "discounted_cash": 414.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.2MM 45765003", "code_information": [{"code": "45765003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.2MM X 100MM 10505U 10505U", "code_information": [{"code": "10505U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 582.0, "discounted_cash": 203.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.2X145MM", "code_information": [{"code": "700358S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.3MM X 175MM JONES FRACTURE JF-DRILL-45", "code_information": [{"code": "JF-DRILL-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.5 CD-MF-1035", "code_information": [{"code": "CD-MF-1035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1602.0, "discounted_cash": 560.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.5MM / 195MM AO FIT TWIST 700353", "code_information": [{"code": "700353", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.5MM OVERDRILL 330-35-011", "code_information": [{"code": "330-35-011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.5MM SMALL EVOS W/AO QC SHORT OVER", "code_information": [{"code": "71175027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.55, "discounted_cash": 466.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.5MM X 50MM DRLL-SSC-35050", "code_information": [{"code": "DRLL-SSC-35050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 449.77, "discounted_cash": 157.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.5MM.", "code_information": [{"code": "320-35-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 956.0, "discounted_cash": 334.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3/16 SQ 2.9 X 140MM CANNULATED CONNECTION P99-110-2914", "code_information": [{"code": "P99-110-2914", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 4.5 VILEX 2410-150-45", "code_information": [{"code": "2410-150-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1011.0, "discounted_cash": 353.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 4.5MM CM-9138", "code_information": [{"code": "CM-9138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.0, "discounted_cash": 159.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 4MM 2900-03-0400", "code_information": [{"code": "2900-03-0400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1011.0, "discounted_cash": 353.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL A/O 3.2 X 145MM 700358", "code_information": [{"code": "700358", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ACP 11MM 7786711", "code_information": [{"code": "7786711", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 185.02, "discounted_cash": 64.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ACUMED", "code_information": [{"code": "80-0946", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2001.0, "discounted_cash": 700.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ALTIVATE REVERSE GLENOID PERIPHERAL 3.5MM 804-06-331", "code_information": [{"code": "804-06-331", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.28, "discounted_cash": 387.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ANCHOR-C 12MM DRILL 48328912", "code_information": [{"code": "48328912", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL AO 2.0MM (FOR 2.7MM SCREWS)", "code_information": [{"code": "703701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 165.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ARSENAL PILOT 2.2MM 330-22-001", "code_information": [{"code": "330-22-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 232.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ASSEMBLY 2.15MM CANNULATED", "code_information": [{"code": "P40-920-2107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 817.0, "discounted_cash": 285.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ASSEMBLY 2.8MM CANNULATED", "code_information": [{"code": "P40-920-2607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL AT3 MINI 80-4142", "code_information": [{"code": "80-4142", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1466.0, "discounted_cash": 513.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT & DRILL GUIDE FOR 4.75MM SUTURE ANCHOR THN00201", "code_information": [{"code": "THN00201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1210.5, "discounted_cash": 423.68, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT .059 AR-18700-20", "code_information": [{"code": "AR-18700-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.2MM D12", "code_information": [{"code": "D12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 954.95, "discounted_cash": 334.23, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.3 MM", "code_information": [{"code": "52020-00130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 183.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.3MM ORTHOLOC 3DI", "code_information": [{"code": "52031330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.02, "discounted_cash": 148.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.4X150MM ASNIS 4.0MM", "code_information": [{"code": "702448", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 503.0, "discounted_cash": 176.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.5MM SOLID 600709", "code_information": [{"code": "600709", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 744.0, "discounted_cash": 260.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.6MM MPN10016", "code_information": [{"code": "MPN10016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 184.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.7MM CANNNULATED", "code_information": [{"code": "MSN10001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.9 MM AOS", "code_information": [{"code": "4008-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 767.0, "discounted_cash": 268.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.9MM MPN10019", "code_information": [{"code": "MPN10019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 12MM 02-01612", "code_information": [{"code": "2-01612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 12MM 02-13G12", "code_information": [{"code": "2-13G12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 14MM HYPER-C 02-13G14", "code_information": [{"code": "2-13G14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 150MM X 45MM Z", "code_information": [{"code": "Z410-150-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0 (DEPUY)", "code_information": [{"code": "2312-20-204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0 001-120116", "code_information": [{"code": "1-120116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 446.22, "discounted_cash": 156.18, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0 MM (PARAGON)", "code_information": [{"code": "P99-100-2014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0 MM 705137", "code_information": [{"code": "705137", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 459.0, "discounted_cash": 160.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0 X 80MM CANN AO", "code_information": [{"code": "110018532", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM CALIBRATED LONG AR-8963-05", "code_information": [{"code": "AR-8963-05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 109.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM KIT AO FOR 2.0MM LAG SCREWS LSK 120", "code_information": [{"code": "LSK 120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 870.0, "discounted_cash": 304.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM NOVASTEP", "code_information": [{"code": "XDB01002D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 928.0, "discounted_cash": 324.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM QR SURGIBIT W DEPTH MARK 80-1976", "code_information": [{"code": "80-1976", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 712.0, "discounted_cash": 249.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM WMT", "code_information": [{"code": "DSDS0020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM X 24MM 58850020", "code_information": [{"code": "58850020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.02, "discounted_cash": 148.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM X 30MM", "code_information": [{"code": "58880020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.0, "discounted_cash": 148.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM XFO", "code_information": [{"code": "XFO012001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 183.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MMMM CANNULATED", "code_information": [{"code": "MSN10002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0X15 PL918115", "code_information": [{"code": "PL918115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 99.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.2MM 135MM CLAVICLE PLATING SYSTEM 233500022", "code_information": [{"code": "233500022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.2MM CANNULATED", "code_information": [{"code": "DSDS0022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.2MM COMP FT CALIBRATED", "code_information": [{"code": "AR-8737-58", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.3MM NOVASTEP", "code_information": [{"code": "XDB1003D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 557.0, "discounted_cash": 194.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.4MM ORTHOLOC 3DI", "code_information": [{"code": "52032430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 579.0, "discounted_cash": 202.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.51 10TSA DRILL 2.5/110TSA", "code_information": [{"code": "DRILL 2.5/110TSA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5MM A0 FOR 3.5MM SCREWS DBK 135", "code_information": [{"code": "DBK 135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5MM CANNULATED", "code_information": [{"code": "57S02025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.75, "discounted_cash": 164.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5MM DALIBRATED AR-8916-06", "code_information": [{"code": "AR-8916-06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 235.13, "discounted_cash": 82.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5MM DB25", "code_information": [{"code": "DB25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 81.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5MM DEPUY", "code_information": [{"code": "230790005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5MM QC 135MM 45MM CALIBRATION 03.133.102", "code_information": [{"code": "3.133.102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 154.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5MM TLD-25", "code_information": [{"code": "TLD-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 462.55, "discounted_cash": 161.89, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5MM X 60MM 58850025", "code_information": [{"code": "58850025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.0, "discounted_cash": 148.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.6 X 10MM L61MM AO", "code_information": [{"code": "A-3731", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 171.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.6MM CANNULATED CDB 026", "code_information": [{"code": "CDB 026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 781.0, "discounted_cash": 273.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7 340-27-001", "code_information": [{"code": "340-27-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7MM 125MM QC 03.133.105", "code_information": [{"code": "3.133.105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 158.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7MM 145MM CLAVICLE PLATING SYSTEM 233500027", "code_information": [{"code": "233500027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7MM DIAMETER127.0MM TOTAL/102.0MM EFFECTIVE", "code_information": [{"code": "KM166-315-28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 77.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7MM GRIDLOCK ANKLE", "code_information": [{"code": "320-27-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7MM LOCKING CORTICAL", "code_information": [{"code": "2142-27-070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7MMX50MM DRLL-SSC-27050", "code_information": [{"code": "DRLL-SSC-27050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 285.82, "discounted_cash": 100.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.8MM QR SURGIBIT W DEPTH MARK", "code_information": [{"code": "80-2379", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 410.33, "discounted_cash": 143.62, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.8MM X 60MM 58850028", "code_information": [{"code": "58850028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.02, "discounted_cash": 148.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.8MM/QC/165MM", "code_information": [{"code": "KM166-310-288", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.0MM", "code_information": [{"code": "310-31-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.0MM X 60MM CANN 58850030", "code_information": [{"code": "58850030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.02, "discounted_cash": 148.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.0MM X POST", "code_information": [{"code": "102-00002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 687.0, "discounted_cash": 240.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.0MMX70MM DRLL-30070", "code_information": [{"code": "DRLL-30070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1180.91, "discounted_cash": 413.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.2 542051", "code_information": [{"code": "542051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 963.02, "discounted_cash": 337.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.2 BIT TWIST", "code_information": [{"code": "502015650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 119.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.2 MM CALIBRATED PERCUTANEOUS", "code_information": [{"code": "324.212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 632.0, "discounted_cash": 221.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.3MMX25MM SINGLE USE 7005-3325S", "code_information": [{"code": "7005-3325S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5/QC/110MM", "code_information": [{"code": "KM166-310-35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5MM 340-35-001", "code_information": [{"code": "340-35-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.6, "discounted_cash": 225.96, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5MM ANC132", "code_information": [{"code": "ANC132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 770.0, "discounted_cash": 269.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5MM D35", "code_information": [{"code": "D35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1102.9, "discounted_cash": 386.02, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5MM GRIDLOCK OVER", "code_information": [{"code": "320-35-011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5MM P06N0071", "code_information": [{"code": "P06N0071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.75, "discounted_cash": 164.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5MM STRYKER", "code_information": [{"code": "45-35020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 226.0, "discounted_cash": 79.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5MM X 60MM 58850035", "code_information": [{"code": "58850035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.02, "discounted_cash": 148.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.8MMX X250MM TROCAR TIP P99-100-3825", "code_information": [{"code": "P99-100-3825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1252.0, "discounted_cash": 438.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0 220MM CANNULATED DRILL-4.0/220C", "code_information": [{"code": "DRILL-4.0/220C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1317.0, "discounted_cash": 460.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0 CANNULATED TWIST 2.7 X 160MM A-8004.01", "code_information": [{"code": "A-8004.01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 963.02, "discounted_cash": 337.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0 X 12MM VA STRYKR", "code_information": [{"code": "48771612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0MM GRIDLOCK SCREW", "code_information": [{"code": "310-40-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 232.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0MM IS1105", "code_information": [{"code": "IS1105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1195.0, "discounted_cash": 418.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0MM X 60MM 58850040", "code_information": [{"code": "58850040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 119.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.2X360MM LOCKING 2351-4236S", "code_information": [{"code": "2351-4236S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 647.0, "discounted_cash": 226.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.3MM PERCUTANEUOUS 300MM CALIBRATED 324.213", "code_information": [{"code": "324.213", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 632.0, "discounted_cash": 221.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.5 700354", "code_information": [{"code": "700354", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 205.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.5MM", "code_information": [{"code": "AM-5010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.6MM X 300MM CANNULATED P99-110-4630", "code_information": [{"code": "P99-110-4630", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1252.0, "discounted_cash": 438.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 5.0X230 STERILE", "code_information": [{"code": "1806-5000S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 547.0, "discounted_cash": 191.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 5MMX100MM", "code_information": [{"code": "310.61", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 7.0MM CANNULATED PILOT", "code_information": [{"code": "215-70-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1146.0, "discounted_cash": 401.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 8MM QUATTRO", "code_information": [{"code": "CM-9580", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ACUTRAK 2 MINI LONG", "code_information": [{"code": "AT2M-L1813", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1403.0, "discounted_cash": 491.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ANKLE FX 2.7MM", "code_information": [{"code": "AR-8827D-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 293.93, "discounted_cash": 102.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT AO 02.5MM X 215MM 542021", "code_information": [{"code": "542021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1022.2, "discounted_cash": 357.77, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT AO 2.0 X 135 MM 542000", "code_information": [{"code": "542000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 882.32, "discounted_cash": 308.81, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT AO 2.5 MM X 135 MM 542020", "code_information": [{"code": "542020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 844.66, "discounted_cash": 295.63, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT AO 2.7 X 125 MM 542002", "code_information": [{"code": "542002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 922.67, "discounted_cash": 322.93, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT AO 4.5MM X 135MM 542054", "code_information": [{"code": "542054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 863.49, "discounted_cash": 302.22, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARSENAL 2.7MM 330-27-001", "code_information": [{"code": "330-27-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 956.0, "discounted_cash": 334.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT AWL CURVED 3.2MM", "code_information": [{"code": "193-1100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 232.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN 2.0MM", "code_information": [{"code": "71177110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1550.0, "discounted_cash": 542.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN 3.0MM", "code_information": [{"code": "210-40-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.6, "discounted_cash": 225.96, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANNLATED LONG", "code_information": [{"code": "XFO043101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 605.25, "discounted_cash": 211.84, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANNULATED 26013200", "code_information": [{"code": "26013200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANNULATED 3.6MM AR-8741-32", "code_information": [{"code": "AR-8741-32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANNULATED 8MM BGH 2 KIT 46-0036-S", "code_information": [{"code": "46-0036-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3514.95, "discounted_cash": 1230.23, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CORNER ANKLE INFINITY", "code_information": [{"code": "33600048", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 712.0, "discounted_cash": 249.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT COUNTERSINK", "code_information": [{"code": "IW130516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 394.0, "discounted_cash": 137.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT COUNTERSINK 3.0MM", "code_information": [{"code": "210-40-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT DISTAL", "code_information": [{"code": "XFO102001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT EVOS SMALL 2.5MM W/AO QC SHORT", "code_information": [{"code": "71175023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 968.4, "discounted_cash": 338.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT FAST 2.0MM", "code_information": [{"code": "FDB2.0", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 81.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT FAST 2.5MM", "code_information": [{"code": "FDB2.5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 81.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT FIXATION 1.2MMX25MML81MMAO A-3230", "code_information": [{"code": "A-3230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 584.0, "discounted_cash": 204.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT INION 1.5MM", "code_information": [{"code": "IF5-2001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT MICA CANN. DRILL BIT 2.2MM X 60MM", "code_information": [{"code": "57S00022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 642.91, "discounted_cash": 225.02, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT NON-LOCKING SHORT 705032", "code_information": [{"code": "705032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 706.0, "discounted_cash": 247.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT PROXIMAL 4.5MM", "code_information": [{"code": "212-45-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT PROXIMAL CANN 2.0MM", "code_information": [{"code": "212-20-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT QUICK CONNECT AO 1.8MM", "code_information": [{"code": "7117-4905", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 549.0, "discounted_cash": 192.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT QUICK CONNECT AO 2.0MM", "code_information": [{"code": "7117-4910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.76, "discounted_cash": 192.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT QX 2.0 140M 03.133.101", "code_information": [{"code": "3.133.101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 545.0, "discounted_cash": 190.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SOLID CORE 1.3MM MPN10013", "code_information": [{"code": "MPN10013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SOLID CORE 2.0MM MPN10020", "code_information": [{"code": "MPN10020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SOLID CORE AO/QC 2.8MM MPN10028", "code_information": [{"code": "MPN10028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SOLID CORE AO/QC 3.5MM MPN10035", "code_information": [{"code": "MPN10035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT STYLE B 15MM CD-DB-1515-SB", "code_information": [{"code": "CD-DB-1515-SB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2188.0, "discounted_cash": 765.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNDESMONIC 320-40-012", "code_information": [{"code": "320-40-012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BONE 8MM DIA FOR BONE GRAFT SYS", "code_information": [{"code": "BG-8010-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2233.0, "discounted_cash": 781.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BONE CANNULATED HEAD FOR 4.3 MM SCREW", "code_information": [{"code": "4411-2011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 176.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BONE PHALINX CANNULATED MD 2.55MM", "code_information": [{"code": "45303055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.63, "discounted_cash": 213.72, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CAL 2.4MM CD-SB-1024", "code_information": [{"code": "CD-SB-1024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1602.0, "discounted_cash": 560.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CALIBRATED CANNULATED 2.6MM CD-FX-1026", "code_information": [{"code": "CD-FX-1026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1602.0, "discounted_cash": 560.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CALIBRATED SOLID ONE 3.5MM CD-MF-1535", "code_information": [{"code": "CD-MF-1535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1602.0, "discounted_cash": 560.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CALLIBRATED OVAL 2.7MM CD-MF-1527", "code_information": [{"code": "CD-MF-1527", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1602.0, "discounted_cash": 560.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN 2.5MM OS900036-NS", "code_information": [{"code": "OS900036-NS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 823.0, "discounted_cash": 288.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN AO LARGE 5.6MM", "code_information": [{"code": "702611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1130.0, "discounted_cash": 395.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN DISTAL CUTTING 2.7MM X 70MM IJS-E IJS-CDC-2770", "code_information": [{"code": "IJS-CDC-2770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1241.0, "discounted_cash": 434.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATE AO COUPLING 2.1MM", "code_information": [{"code": "45-30005S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 794.0, "discounted_cash": 277.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.0MM TH-DRILL-25", "code_information": [{"code": "TH-DRILL-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 462.55, "discounted_cash": 161.89, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.1MM AO COUPLING DISP", "code_information": [{"code": "45-30005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 501.0, "discounted_cash": 175.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.25MM", "code_information": [{"code": "5-617", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 657.0, "discounted_cash": 229.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.3MM DRILL 707230001", "code_information": [{"code": "707230001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 505.72, "discounted_cash": 177.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.45MM", "code_information": [{"code": "5-611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.4MM", "code_information": [{"code": "110008486", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 656.0, "discounted_cash": 229.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.55MM", "code_information": [{"code": "5-612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 435.0, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.65MM", "code_information": [{"code": "5-614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 657.0, "discounted_cash": 229.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.6MM X 130MM", "code_information": [{"code": "P99-110-2613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.7MM MANUALINSTR", "code_information": [{"code": "316-0327", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 956.0, "discounted_cash": 334.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.7MM Q/C", "code_information": [{"code": "-1147-026-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 923.0, "discounted_cash": 323.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2.8 MM AOS", "code_information": [{"code": "4010-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 826.0, "discounted_cash": 289.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 2MM X 1.7MM AO COUPLING STRL DISP", "code_information": [{"code": "45-20005S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 699.4, "discounted_cash": 244.79, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 3.0MM AO COUPLING DISP STRL", "code_information": [{"code": "45-30001S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 3.5 X 160MM 3/16 SQ CONNECTION", "code_information": [{"code": "P99-110-3516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 576.0, "discounted_cash": 201.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 3.5MM", "code_information": [{"code": "AR-8956C-35PD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 184.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 3.5MM X 50MM", "code_information": [{"code": "S100214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 4.0MM", "code_information": [{"code": "AR-8956C-40PD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 4.6MM X 220MM 3/16IN SQUARE CONNECTIONINSTR", "code_information": [{"code": "P99-110-4622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 236.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 4.9MM LARGE AO FITTING", "code_information": [{"code": "705252", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 830.0, "discounted_cash": 290.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED 7.5MM MEDSHAPE 2900-16-075", "code_information": [{"code": "2900-16-075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1884.0, "discounted_cash": 659.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED AO FITTING 2.7MM", "code_information": [{"code": "705250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 827.0, "discounted_cash": 289.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED AO FITTING 3.5MM", "code_information": [{"code": "705251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 827.0, "discounted_cash": 289.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED POLYAXIAL LOCKING SCREW 2.0MM DRLL-PLS-20", "code_information": [{"code": "DRLL-PLS-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.0, "discounted_cash": 164.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED SOLID 2.45MM", "code_information": [{"code": "5-610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 657.0, "discounted_cash": 229.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATED W/ DEPTH STOP 2.4MM", "code_information": [{"code": "7-40230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 893.0, "discounted_cash": 312.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CETRA 4.0 X 14MM", "code_information": [{"code": "86-9014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CLAW II 2.8MM BIT 40250028", "code_information": [{"code": "40250028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL COUNTERSINK 1.7MM COMBO SHRT MANUAL", "code_information": [{"code": "316-0127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1175.0, "discounted_cash": 411.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL COUNTERSINK 2.7MM CANNULATED DRLL-CSK-27", "code_information": [{"code": "DRLL-CSK-27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 236.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL COUNTERSINK 3.5MM CANNULATED DRLL-CSK-35", "code_information": [{"code": "DRLL-CSK-35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 236.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL COUNTERSINK 6.5MM DRLL-CSK-65", "code_information": [{"code": "DRLL-CSK-65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL EVOS LARGE 3.7MM W/AO QC SHORT 71175618", "code_information": [{"code": "71175618", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1563.66, "discounted_cash": 547.28, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL EVOS SMALL 2.0MM W/AO QC LONG 71175020", "code_information": [{"code": "71175020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL EVOS SMALL 2.5MM", "code_information": [{"code": "71175022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 853.0, "discounted_cash": 298.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL FAST GUIDE FOR CERVICAL PLATE SYSTEM 8801-90076", "code_information": [{"code": "8801-90076", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL FEMORAL 10MM LOW PROFILE", "code_information": [{"code": "906576", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 789.0, "discounted_cash": 276.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL FEMORAL 8MM LOW PROFILE", "code_information": [{"code": "906572", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 789.0, "discounted_cash": 276.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL FLIPCUTTER III AR-1204FF", "code_information": [{"code": "AR-1204FF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1210.12, "discounted_cash": 423.54, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL FLUTED SPADE PILOT 2.6MM", "code_information": [{"code": "214-00-015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL FOR 2.0MM SCREW CALIBRATED CANNULATED AO QC", "code_information": [{"code": "OS900035-NS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 864.0, "discounted_cash": 302.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL FOR 3.0MM SCREW CALIBRATED CANNULATED AO QC", "code_information": [{"code": "OS900037-NS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 950.0, "discounted_cash": 332.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL FREEHAND 4.2X185MM 2351-4218S", "code_information": [{"code": "2351-4218S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 225.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL FUSION 2.3MM HAT TRICK PIP", "code_information": [{"code": "72204599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE 2.0MM/2.2MM CURVED CROWN G01 00081", "code_information": [{"code": "G01 00081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE 2.4MM PDG-AIM-24", "code_information": [{"code": "PDG-AIM-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1008.75, "discounted_cash": 353.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE 3.5MM/2.7MM WITH STOP TWO INSERTS", "code_information": [{"code": "312.85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE T8 2.0MM COMP/POLY AX", "code_information": [{"code": "703684", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1219.0, "discounted_cash": 426.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL HAND IVAS 11G", "code_information": [{"code": "306-811-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL HARD BONE FOR 1.4MM ICONIX KNOTLSS 3911-714-571", "code_information": [{"code": "3911-714-571", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 591.8, "discounted_cash": 207.13, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL HARD BONE FOR 2.9MM QUATTRO", "code_information": [{"code": "CM-9324ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL HEAD 2.5MM RELIEF AO", "code_information": [{"code": "110027746", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 117.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL HEAD RELIEF 3.0MM", "code_information": [{"code": "110027747", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 117.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL HND 10GA FOR USE W/ IVAS", "code_information": [{"code": "306-810-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL INSERT TROCAR 1.4MM", "code_information": [{"code": "P99-195-1407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 401.0, "discounted_cash": 140.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL INSERT TROCAR TIP 1.1X70MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-195-1107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL KIT INSTAFIX 1.5MM", "code_information": [{"code": "400-1115-SP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1205.0, "discounted_cash": 421.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL LAG 2.5MM X 26MM AO END FOR 2.3 MM SCREW", "code_information": [{"code": "60-25326", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 331.0, "discounted_cash": 115.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL LEFT STANDARD BLOCK A-2727.03", "code_information": [{"code": "A-2727.03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1184.0, "discounted_cash": 414.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL LEOS SUBCHONDRAL 2.0MM 7624-2820", "code_information": [{"code": "7624-2820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 692.41, "discounted_cash": 242.34, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL LONG AT3 STANDARD 80-4147", "code_information": [{"code": "80-4147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1466.0, "discounted_cash": 513.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL LOW PROFILE FLEXIBLE 1.7MM 3911-714-571A", "code_information": [{"code": "3911-714-571A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.37, "discounted_cash": 162.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL MAX VPC 1.8MM CANNULATED", "code_information": [{"code": "231201025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.41, "discounted_cash": 218.19, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL MINI QC VLP MINI-MOD-1.1 MM", "code_information": [{"code": "74461500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1057.17, "discounted_cash": 370.01, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL OVER 2.0MM 2.5MM TC SERIES CANNINTERNAL FXTN SYS TI6INSTR", "code_information": [{"code": "FS3042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 738.0, "discounted_cash": 258.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL OVER CANNULATED 7.0MM", "code_information": [{"code": "P99-110-7020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PAC CANNULATED 71935069", "code_information": [{"code": "71935069", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1452.0, "discounted_cash": 508.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PACK OPTABLATE 11G 9700-811-000", "code_information": [{"code": "9700-811-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 851.84, "discounted_cash": 298.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PATELLAR RESURFACING GENESIS IIINSTR", "code_information": [{"code": "71440360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 134.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PERIPHERAL", "code_information": [{"code": "804-07-147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT 2.0 MM SHORT", "code_information": [{"code": "320-5020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.27, "discounted_cash": 83.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT 2.0MM", "code_information": [{"code": "320-2120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 169.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT 2.5MM", "code_information": [{"code": "320-2125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 637.0, "discounted_cash": 222.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT 3.4MM SPADE HAMMER TOE", "code_information": [{"code": "214-00-006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT 3.5MM 330-35-001", "code_information": [{"code": "330-35-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 232.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT CANN 2.7MM", "code_information": [{"code": "320-2627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.0, "discounted_cash": 387.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT CANN 4.0MM 320-2640", "code_information": [{"code": "320-2640", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1094.0, "discounted_cash": 382.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT CANNULATED 4.5MM 210-45-001", "code_information": [{"code": "210-45-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT GUIDE 20MM 510-20-001", "code_information": [{"code": "510-20-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 186.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT SHORT 2.0MM", "code_information": [{"code": "320-2020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 213.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT SPADE 3.0MM", "code_information": [{"code": "214-00-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT SPADE 4.5", "code_information": [{"code": "214-00-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT THREDAD", "code_information": [{"code": "214-00-013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PROFILE MINI CMP FT", "code_information": [{"code": "AR-8737-47", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL QUICK 2.0MM", "code_information": [{"code": "80-0318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 326.59, "discounted_cash": 114.31, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL QUICK CONNECT 1.9MM CANNULATED DRLL-CDC-19", "code_information": [{"code": "DRLL-CDC-19", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 507.87, "discounted_cash": 177.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL QUICK RELEASE 3.5MM X 5IN", "code_information": [{"code": "MS-DC35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SCREW 2.6MM W/ AO CONNECTION FOR USE W/ 3.5MM SCREW", "code_information": [{"code": "703702", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 162.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SCREW 25MM FLEXIBLEINSTR", "code_information": [{"code": "71362925", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 419.0, "discounted_cash": 146.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SCREW 35MM FLEXIBLEINSTR", "code_information": [{"code": "71362935", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 419.0, "discounted_cash": 146.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SCREW ANCHOR-C 4.0 X 14MM SELF DRILLING SCREW 48335414", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48335414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SCREW BIT 1.7MM CANNULATED DART-FIRE COMPRESSION SCREW DSDS0017", "code_information": [{"code": "DSDS0017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 467.0, "discounted_cash": 163.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SCREW ESCALATE 2.0 X 8MM SELF DRILLING SCREW 48570208", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48570208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SCRW 4MM NON CANNULATED BIOTENODESIS SCREW SYS ACCESSORIES BIO-TENODESISIN", "code_information": [{"code": "AR-1204D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.0, "discounted_cash": 159.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SKULL FOR IMPLANTATION", "code_information": [{"code": "61107", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRILL SMALL 2.0MM EVOS W/A0 QC SHORT", "code_information": [{"code": "71175021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 968.4, "discounted_cash": 338.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SMALL PHALINX 2.45MM", "code_information": [{"code": "45303145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 196.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SMALL PHALINX 2.65MM", "code_information": [{"code": "45303165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SML FRAG 2.5X125MM", "code_information": [{"code": "700347", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 539.0, "discounted_cash": 188.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SOLID 2.4 X 110MM", "code_information": [{"code": "P99-100-2414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SOLID SIDE CUTTING 2.0MM X 40MM DRLL-SSC-20040", "code_information": [{"code": "DRLL-SSC-20040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 232.23, "discounted_cash": 81.28, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SOLID SIDE CUTTING 2.5MM X 40MM DRLL-SSC-25040", "code_information": [{"code": "DRLL-SSC-25040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.34, "discounted_cash": 83.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SPINDLE PILOT 4.5", "code_information": [{"code": "214-00-007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STANDARD 2.7MM", "code_information": [{"code": "-2360-205-27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.0, "discounted_cash": 65.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEM 7.0 MUC 5MM CANNULATED CHARLOTTE F and A SYSTEM 44180010", "code_information": [{"code": "44180010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEM BIT 1.3MM ORTHOLOC PLATING SYSTEM 52021130", "code_information": [{"code": "52021130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 119.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEM BIT 2.0/2.4 1.3MM ORTHOLOC PLATING SYSTEM 5202000130", "code_information": [{"code": "5202000130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 42.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEM CANNULATED BIT 3.0MM CHARLOTTE F and A SYSTEM 44112003", "code_information": [{"code": "44112003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 467.0, "discounted_cash": 163.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEM JONES 3.2MM CANNULATED CHARLOTTEF and A SYSTEM 56013200", "code_information": [{"code": "56013200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 574.0, "discounted_cash": 200.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEM LISFRANC BIT 3.7MM CHARLOTTE F and A SYSTEM 43513700", "code_information": [{"code": "43513700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 435.78, "discounted_cash": 152.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STOP 2.0MM CANNULATED", "code_information": [{"code": "ZTH-DDRL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SURG 1.6MM X 81MM 25MM STOP TWIST AO QUICK COUPLING FOR 1.2 MM SCREW", "code_information": [{"code": "A-3430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 341.33, "discounted_cash": 119.47, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SURG 1.6MM X 86MM 25MM STOP TWIST AO QUICK COUPLING FOR 1.2 MM SCREW", "code_information": [{"code": "A-3434", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 366.85, "discounted_cash": 128.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SURG 2.3MM", "code_information": [{"code": "60-23341", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 426.0, "discounted_cash": 149.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SURG 2.3MM ICONIX DISP", "code_information": [{"code": "3910-500-569", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.75, "discounted_cash": 164.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SURG 3.2MM 2 FLUTE LNG GRADUATED", "code_information": [{"code": "71751149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 746.0, "discounted_cash": 261.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SURG 3.2MM 2 FLUTE SHRT GRADUATED", "code_information": [{"code": "71751148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SURG 4.3MM", "code_information": [{"code": "702743", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 429.0, "discounted_cash": 150.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SURGICAL 1.2MM X 81MM 25MM STOP TWIST AO QUICK COUPLING FOR 1.5 MM SCREW", "code_information": [{"code": "A-3230/1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 584.0, "discounted_cash": 204.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SURGICAL 1MM X 76MM 20MM STOP AO QUICK COUPLING TWIST FOR 1.2 MM SCREW", "code_information": [{"code": "A-3130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 584.0, "discounted_cash": 204.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SURGICAL BIOWICK SURELOCK 2.7MM STERILE DISPOSABLE", "code_information": [{"code": "CM-6101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 184.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SYSTEM MEDTRONIC MIDAS REX MR8 MATCH HEAD FLUTED 14CM 3MM MR8-T14MH30", "code_information": [{"code": "MR8-T14MH30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 448.5, "discounted_cash": 156.98, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 01.8, L122MM, AO 2.2 CAN", "code_information": [{"code": "A-3738", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1362.0, "discounted_cash": 476.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 1.0MM DIA 60-10115", "code_information": [{"code": "60-10115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 379.61, "discounted_cash": 132.86, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 1.4MM X 27MM AO END", "code_information": [{"code": "60-14326", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 407.0, "discounted_cash": 142.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 1.9MM AO SHAFT END", "code_information": [{"code": "60-19340", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 385.0, "discounted_cash": 134.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 1.9MM X 27MM AO END", "code_information": [{"code": "60-19326", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 377.0, "discounted_cash": 131.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 1MM AO END", "code_information": [{"code": "60-10322", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 385.0, "discounted_cash": 134.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 2.0MM AO SHAFT END", "code_information": [{"code": "60-20385", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 498.0, "discounted_cash": 174.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 2.35 X 38 X 151MM", "code_information": [{"code": "A-3837", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 171.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 2MM X 102MM 50MM AO COUPLING", "code_information": [{"code": "45-27010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 162.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 3.2MM X 145MM QUICK COUPLING AO STYLEINSTR", "code_information": [{"code": "310.31", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 286.0, "discounted_cash": 100.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL VALOR NAIL 4.3MM LONG STERILE 415S002352", "code_information": [{"code": "415s002352", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 712.85, "discounted_cash": 249.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL VALOR NAIL 4.3MM SHORT STERILE 415S002351", "code_information": [{"code": "415s002351", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 712.85, "discounted_cash": 249.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL VALOR NAIL FREE HAND STERILE 415S002350", "code_information": [{"code": "415S002350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 712.85, "discounted_cash": 249.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL VLP MINI-MOD 1.5MM LONG MINI QC 74462004", "code_information": [{"code": "74462004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 933.43, "discounted_cash": 326.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL X-SMALL PHALINX 2.22MM", "code_information": [{"code": "45303125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.0, "discounted_cash": 192.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL \u00c3\u02dc2.2MM VDB01000", "code_information": [{"code": "VDB01000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 793.55, "discounted_cash": 277.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL \u00c3\u02dc3.0MM VDB01001", "code_information": [{"code": "VDB01001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 793.55, "discounted_cash": 277.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL, 2.7MM AO (FOR 3.5MM SCREWS)", "code_information": [{"code": "703703", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 165.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 1.5MM ACUTRAK QUICK REL SOLID HEX TIP SURG 80-0583", "code_information": [{"code": "80-0583", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.16, "discounted_cash": 154.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 1.6MM HEX SCREW", "code_information": [{"code": "DSDS0160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 2.0MM AO CONNECTION SOLID SHAFT", "code_information": [{"code": "DRVR-S20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 154.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 2.2MM ARSENAL 330-22-003", "code_information": [{"code": "330-22-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1011.0, "discounted_cash": 353.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 2.5MM (STRYKER ORTHO)", "code_information": [{"code": "702485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 948.0, "discounted_cash": 331.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 2.7MM 3.5MM 330-10-008", "code_information": [{"code": "330-10-008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 3.0MM PREHENSOR ANC119-US", "code_information": [{"code": "ANC119-US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 3.4MM SPADE", "code_information": [{"code": "214-00-009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 3.5MM 330-35-003", "code_information": [{"code": "330-35-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 956.0, "discounted_cash": 334.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 3.5MM HEX POWER", "code_information": [{"code": "804-03-022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 4.5MM CANNULATED 210-45-003", "code_information": [{"code": "210-45-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 712.85, "discounted_cash": 249.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 5.5MM CANNULATED", "code_information": [{"code": "215-55-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER AI CONNECTION SQUARE TIP 2.0MM DRVR-AOS-520", "code_information": [{"code": "DRVR-AOS-520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.0, "discounted_cash": 159.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER AO CONNECTION POLYAXIAL LOCKING SCREW DRVR-AOS-PLS", "code_information": [{"code": "DRVR-AOS-PLS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER AO CONNECTION SQUARE TIP 2.0MM DRVR-AOS-S20", "code_information": [{"code": "DRVR-AOS-S20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 293.48, "discounted_cash": 102.72, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER ARSENAL 2.2MM 330-07-008", "code_information": [{"code": "330-07-008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER ARSENAL 2.7/3.5MM", "code_information": [{"code": "330-10-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 232.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER BIT SPINDLE 4.5MM", "code_information": [{"code": "214-00-011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER BLADE AO SELF RETAINING T6 705132", "code_information": [{"code": "705132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 890.39, "discounted_cash": 311.64, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER BONE CANNULATED HEXALOBULAR AO BT10", "code_information": [{"code": "110008449", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1286.0, "discounted_cash": 450.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER CANN 7.0MM TRILLIANT", "code_information": [{"code": "215-70-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1150.0, "discounted_cash": 402.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER CANNULATED SALVATION T25", "code_information": [{"code": "SB090025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1183.0, "discounted_cash": 414.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER CANNULATED SHAFT 2.4MM", "code_information": [{"code": "212-24-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER CANNULATED T10 MSN30002", "code_information": [{"code": "MSN30002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 634.0, "discounted_cash": 221.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER CANNULATED TIGER 3.0/4.0 210-40-008", "code_information": [{"code": "210-40-008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER DART FIRE STAR #8 CANNULATED", "code_information": [{"code": "DSDS0008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER FOR 3MM SHAFT SCREWS M211", "code_information": [{"code": "M211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 132.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER GL 310-40-031", "code_information": [{"code": "310-40-031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER HEX 2.0MM", "code_information": [{"code": "57S02020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.75, "discounted_cash": 164.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER HEX 2.2MM 1.7MMINSTR", "code_information": [{"code": "2312-00-101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER INION HEX IFS-9001", "code_information": [{"code": "IFS-9001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER MONSTER BITE AO P24-905-0001", "code_information": [{"code": "P24-905-0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1635.0, "discounted_cash": 572.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER P06 S0031", "code_information": [{"code": "P06 S0031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 599.87, "discounted_cash": 209.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER PEG 2MM FOR DVR ANATOMIC VOLAR PLATING SYS FAST", "code_information": [{"code": "FPD 2.0", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER PHP T10 DRVR-PHP-T10", "code_information": [{"code": "DRVR-PHP-T10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 408.88, "discounted_cash": 143.11, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER PRO-TOE HEX T8 C2", "code_information": [{"code": "45805003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER RECON SM JOINT P99-191-TRIO", "code_information": [{"code": "P99-191-TRIO", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1205.0, "discounted_cash": 421.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SALVATION T25 NON-CANNULATED SOLID", "code_information": [{"code": "SB090125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.0, "discounted_cash": 387.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SCREW 2MM 2.4MM CANNULATED HEADLESS SHORT", "code_information": [{"code": "316-0302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 776.0, "discounted_cash": 271.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SCREW 2MM 2.4MM LNG HEADLESS TRILOBE QUICK RELEASEINSTR", "code_information": [{"code": "316-0305", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 766.0, "discounted_cash": 268.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SCREW 2MM 2.4MM SHRT TRILOBE HEADLESS SOLID COREINSTR", "code_information": [{"code": "316-0318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 648.0, "discounted_cash": 226.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SCREW 3MM 4MM LNG TRILOBE HEADLESS QUICK RELEASEINSTR", "code_information": [{"code": "316-0315", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 776.0, "discounted_cash": 271.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SCREW 3MM 4MM SHRT TRILOBE HEADLESS QUICK RELEASEINSTR", "code_information": [{"code": "316-0314", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 776.0, "discounted_cash": 271.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SCREWDRIVER 2.3MM", "code_information": [{"code": "62-23333", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 170.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SHAFT COMPRESSION 1.5MM FULLY THREADED CANNULATED MICRO HEX", "code_information": [{"code": "AR-8737-37", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SPADE BIT DRIVER 2.6MM", "code_information": [{"code": "214-00-016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SPEED GUIDE T10 SCREWS 2.7MM", "code_information": [{"code": "703945", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1297.0, "discounted_cash": 453.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER STEM T-10 AZDR10", "code_information": [{"code": "AZDR10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.45, "discounted_cash": 193.01, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER STERILE SINGLE USE T15 P07S0041", "code_information": [{"code": "P07S0041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SURG 3.0/4.0 CANNULATED 211-40-003", "code_information": [{"code": "211-40-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 753.2, "discounted_cash": 263.62, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T10 HEXALOBE", "code_information": [{"code": "AR-8944DH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T10 HEXALOBE, C MP FT", "code_information": [{"code": "AR-8737-38", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 728.99, "discounted_cash": 255.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T10 SELF RETAINING TXD-T10", "code_information": [{"code": "TXD-T10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 793.55, "discounted_cash": 277.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T15 4.0/5.0 COLAG CANNULATED P06 N0421", "code_information": [{"code": "P06N0421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 599.87, "discounted_cash": 209.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T7 CANNULATED AO", "code_information": [{"code": "110018531", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 914.0, "discounted_cash": 319.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T7 SOLID AO STERILE 5MS P06S0021", "code_information": [{"code": "P06S0021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T8 001-000011", "code_information": [{"code": "1-000011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1237.4, "discounted_cash": 433.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T8 TH-DT8", "code_information": [{"code": "TH-DT8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.45, "discounted_cash": 193.01, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER TAP 3.2 AO SHAFT", "code_information": [{"code": "TAP-3.2AO", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 494.96, "discounted_cash": 173.24, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER UNIVERSAL QC T-10 DRVR-UQC-T10", "code_information": [{"code": "DRVR-UQC-T10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 293.48, "discounted_cash": 102.72, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER UNIVERSAL QUICK CONNECT T15 DRVR-UQC-T15", "code_information": [{"code": "DRVR-UQC-T15", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 939.0, "discounted_cash": 328.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER VILEX HEX Z702-25-11", "code_information": [{"code": "Z702-25-11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRL BIT 3.2MM CANN LONG ARTHX", "code_information": [{"code": "AR-8750-09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRN FLT SILICON 7MM X 20CM FUL PERF 0070430", "code_information": [{"code": "70430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRSG MASTISOL ADHSV LIQ LF VIAL", "code_information": [{"code": "F0523-48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRSG XEROFORM 5X9 ST", "code_information": [{"code": "NON253590", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRUG ADMIN & HEMODYNMIC MEAS", "code_information": [{"code": "93463", "type": "CPT"}], "standard_charges": [{"minimum": 448.19, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 448.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 704.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 704.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 704.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY 120+ RX&METABLT", "code_information": [{"code": "328U", "type": "CPT"}], "standard_charges": [{"minimum": 164.78, "maximum": 990.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 629.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 164.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 164.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ACETAMINOPHEN", "code_information": [{"code": "80143", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ADALIMUMAB", "code_information": [{"code": "80145", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY AMIODARONE", "code_information": [{"code": "80151", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY CAFFEINE", "code_information": [{"code": "80155", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 48.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY CLOZAPINE", "code_information": [{"code": "80159", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY CYCLOSPORINE", "code_information": [{"code": "80158", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY EVEROLIMUS", "code_information": [{"code": "80169", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY FELBAMATE", "code_information": [{"code": "80167", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY FLECAINIDE", "code_information": [{"code": "80181", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY INFLIXIMAB", "code_information": [{"code": "80230", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ITRACONAZOLE", "code_information": [{"code": "80189", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY LACOSAMIDE", "code_information": [{"code": "80235", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY LEFLUNOMIDE", "code_information": [{"code": "80193", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY METHOTREXATE", "code_information": [{"code": "80204", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY POSACONAZOLE", "code_information": [{"code": "80187", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY RUFINAMIDE", "code_information": [{"code": "80210", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY SALICYLATE", "code_information": [{"code": "80179", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY VEDOLIZUMAB", "code_information": [{"code": "80280", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 154.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY VORICONAZOLE", "code_information": [{"code": "80285", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASY HYDROXYCHLOROQUINE", "code_information": [{"code": "80220", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG PROPEL 16MM MINI 370 MICROGRAMS MOMETASONE FUROATE BIOABSORBABLE", "code_information": [{"code": "C2625", "type": "HCPCS"}, {"code": "60011", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1216.0, "discounted_cash": 425.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRUG SCREEN AMPHETAMINES 1/2", "code_information": [{"code": "80324", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUAN LAMOTRIGINE", "code_information": [{"code": "80175", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUANT GABAPENTIN", "code_information": [{"code": "80171", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 86.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 86.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 86.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUANT TIAGABINE", "code_information": [{"code": "80199", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUANT ZONISAMIDE", "code_information": [{"code": "80203", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUANTALCOHOLS", "code_information": [{"code": "80320", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING BARBITURATES", "code_information": [{"code": "80345", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING BUPRENORPHINE", "code_information": [{"code": "80348", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING COCAINE", "code_information": [{"code": "80353", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING FENTANYL", "code_information": [{"code": "80354", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING METHADONE", "code_information": [{"code": "80358", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING OXYCODONE", "code_information": [{"code": "80365", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING PREGABALIN", "code_information": [{"code": "80366", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING PROPOXYPHENE", "code_information": [{"code": "80367", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING TAPENTADOL", "code_information": [{"code": "80372", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING TRAMADOL", "code_information": [{"code": "80373", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCRN QUAN LEVETIRACETAM", "code_information": [{"code": "80177", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCRN QUAN MYCOPHENOLATE", "code_information": [{"code": "80180", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCRN QUANT OXCARBAZEPIN", "code_information": [{"code": "80183", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 1-7 CLASSES", "code_information": [{"code": "G0480", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 458.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 143.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 291.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 458.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 458.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 458.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 164.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 164.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 15-21 CLASSES", "code_information": [{"code": "G0482", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 796.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 248.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 506.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 796.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 796.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 796.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 286.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 286.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 22+ CLASSES", "code_information": [{"code": "G0483", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 990.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 308.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 629.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 355.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 355.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 8-14 CLASSES", "code_information": [{"code": "G0481", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 627.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 195.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 399.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 627.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 627.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 627.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 225.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 225.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF SIMPLE ALL CL", "code_information": [{"code": "G0659", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 249.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 89.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 158.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST PRSMV DIR OPT OBS", "code_information": [{"code": "80305", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST PRSMV INSTRMNT", "code_information": [{"code": "80306", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 1-3", "code_information": [{"code": "80375", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 4-6", "code_information": [{"code": "80376", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 7/MORE", "code_information": [{"code": "80377", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRY FLEX AMNION BARRIER 2X4 CM", "code_information": [{"code": "Q4138", "type": "HCPCS"}, {"code": "PM-020204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6077.0, "discounted_cash": 2126.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRY FLEX AMNION BARRIER 4X6 CM", "code_information": [{"code": "Q4138", "type": "HCPCS"}, {"code": "PM-020406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DS SWIVELOCK SL 3.5 X 8.5 W/ FORK EYELET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8978P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G .5 /<", "code_information": [{"code": "17270", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 0.6-1", "code_information": [{"code": "17271", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 1.1-2", "code_information": [{"code": "17272", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 2.1-3", "code_information": [{"code": "17273", "type": "CPT"}], "standard_charges": [{"minimum": 598.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 3.1-4", "code_information": [{"code": "17274", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G >4.0", "code_information": [{"code": "17276", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .5/<", "code_information": [{"code": "17280", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .6-1", "code_information": [{"code": "17281", "type": "CPT"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M1.1-2", "code_information": [{"code": "17282", "type": "CPT"}], "standard_charges": [{"minimum": 598.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M2.1-3", "code_information": [{"code": "17283", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M3.1-4", "code_information": [{"code": "17284", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M>4.0", "code_information": [{"code": "17286", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ LESION LID MARGIN <1CM", "code_information": [{"code": "67850", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L .6-1.0CM", "code_information": [{"code": "17261", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 0.5 CM/<", "code_information": [{"code": "17260", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 1.1-2.0", "code_information": [{"code": "17262", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 2.1-3.0", "code_information": [{"code": "17263", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 3.1-4.0", "code_information": [{"code": "17264", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L >4.0 CM", "code_information": [{"code": "17266", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "419T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "420T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRY EYE LESN,FDR VSSL TECH", "code_information": [{"code": "G0186", "type": "HCPCS"}], "standard_charges": [{"minimum": 985.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 985.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DT VACCINE UNDER 7 YRS IM", "code_information": [{"code": "90702", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP VACCINE < 7 YRS IM", "code_information": [{"code": "90700", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-HEP B-IPV VACCINE IM", "code_information": [{"code": "90723", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV VACCINE 4-6 YRS IM", "code_information": [{"code": "90696", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV-HIB-HEPB VACCINE IM", "code_information": [{"code": "90697", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV/HIB VACCINE IM", "code_information": [{"code": "90698", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL EXCLUSION", "code_information": [{"code": "48547", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL MOTILITY STUDY", "code_information": [{"code": "91022", "type": "CPT"}], "standard_charges": [{"minimum": 422.74, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 422.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 664.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 664.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 664.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUOVISC 40 MG-30 MG/ML 0.5 ML", "code_information": [{"code": "MED0245", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 178.0, "discounted_cash": 62.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DUP-SCAN HEMO COMPL BI STD", "code_information": [{"code": "93985", "type": "CPT"}], "standard_charges": [{"minimum": 1012.66, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1012.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1591.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1591.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1591.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DUP-SCAN HEMO COMPL UNI STD", "code_information": [{"code": "93986", "type": "CPT"}], "standard_charges": [{"minimum": 576.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 576.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 906.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 906.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 906.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DURACLIP HEMO 235CM", "code_information": [{"code": "DC0235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DURASEAL", "code_information": [{"code": "MED0075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1242.0, "discounted_cash": 434.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DX ALY AUD OI SND PRCSR 1ST", "code_information": [{"code": "92622", "type": "CPT"}], "standard_charges": [{"minimum": 656.34, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 656.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1031.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1031.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1031.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX ALY AUD OI SND PRCSR EACH", "code_information": [{"code": "92623", "type": "CPT"}], "standard_charges": [{"minimum": 77.7, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 77.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 122.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 122.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 122.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX ALYS VSTBLR IMPLT UNI 1ST", "code_information": [{"code": "728T", "type": "CPT"}], "standard_charges": [{"minimum": 2.55, "maximum": 4.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX ALYS VSTBLR IMPLT UNI SBQ", "code_information": [{"code": "729T", "type": "CPT"}], "standard_charges": [{"minimum": 2.55, "maximum": 4.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BIPOL, DEATH, NHRES, HOSP", "code_information": [{"code": "G9394", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW ASPIRATIONS", "code_information": [{"code": "38220", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BIOPSIES", "code_information": [{"code": "38221", "type": "CPT"}], "standard_charges": [{"minimum": 763.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BX & ASPIR", "code_information": [{"code": "38222", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BRONCH W/ NAVIGATION", "code_information": [{"code": "C7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/BRUSH", "code_information": [{"code": "31623", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/LAVAGE", "code_information": [{"code": "31624", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX DARK ADAPTATION EXAM I&R", "code_information": [{"code": "92284", "type": "CPT"}], "standard_charges": [{"minimum": 1603.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1603.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX DEGEN NEURO", "code_information": [{"code": "G2151", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPEC", "code_information": [{"code": "43756", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPECS", "code_information": [{"code": "43757", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX FIBERTAK DISPOSABLES KIT", "code_information": [{"code": "AR-8990DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 826.0, "discounted_cash": 289.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPEC", "code_information": [{"code": "43754", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPECS", "code_information": [{"code": "43755", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP EPCAR US CHD I&R", "code_information": [{"code": "76989", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 155.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 244.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 244.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 244.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 416.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 654.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 654.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 654.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 136.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 214.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 214.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 214.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY NEWBORN", "code_information": [{"code": "31520", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX LMBR SPI PNXR W/FLUOR/CT", "code_information": [{"code": "62328", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX MAMMO INCL CAD BI", "code_information": [{"code": "77066", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 526.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 826.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 826.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 826.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 269.29, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 286.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX MAMMO INCL CAD UNI", "code_information": [{"code": "77065", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 411.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 646.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 646.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 646.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 211.43, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 225.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX NTROP EPCR US CHD IMG ACQ", "code_information": [{"code": "76988", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 265.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 416.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 416.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 416.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX URI 3D AFTER OTHER DX", "code_information": [{"code": "G2097", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY AXIAL", "code_information": [{"code": "77080", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 133.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 210.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 210.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 210.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY STUDY", "code_information": [{"code": "77085", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 96.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 103.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY/PERIPHERAL", "code_information": [{"code": "77081", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 102.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 160.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 160.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 160.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXTEND GLENOSPHERE STD D38MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "130760138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DXTEND METAGLENE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "130760000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2812.0, "discounted_cash": 984.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DXTEND MOD EPI 1 ECC RIGHT HA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "130720103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DXTEND MODULAR HUM STEM D12 HA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "130712000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2987.0, "discounted_cash": 1045.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DXTEND SCREW LOCK D4.5X24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "130790024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DXTEND SCREW LOCK D4.5X36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "130790036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DXTEND SCREW NO LOCK D4.5X18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "130770018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DYE INDIA INK", "code_information": [{"code": "B1055-11A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNABRIDGE NITINOL IMPLANT 13MMX10MMX10MM DB-13-1010-A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DB-13-1010-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4573.0, "discounted_cash": 1600.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNACLIP BONE FIXATION SYSYEM 20MM X 18MM X 18MM 3000-00-201818", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3000-00-201818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4479.2, "discounted_cash": 1567.72, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNAFORCE MPJ REAMERSCUP/CONE 22MM", "code_information": [{"code": "70CC-0022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1353.0, "discounted_cash": 473.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNAMIC CAVERNOSOMETRY", "code_information": [{"code": "54231", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNAMIC FINE WIRE EMG", "code_information": [{"code": "96003", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNAMIC SURFACE EMG", "code_information": [{"code": "96002", "type": "CPT"}], "standard_charges": [{"minimum": 100.11, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYSEQUILIBRIUM", "code_information": [{"code": "149", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4483.17, "maximum": 7696.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4483.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6411.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7053.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7696.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DZ NOT ASES, NO RSN", "code_information": [{"code": "M1006", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Decalcification 88311", "code_information": [{"code": "88311", "type": "CPT"}, {"code": "3927418", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 148.0, "discounted_cash": 51.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 54.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 36.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 36.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 12.99, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 14.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Demerol PCA 500mg/50mL", "code_information": [{"code": "MED0230", "type": "CDM"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "Depakote", "code_information": [{"code": "80164", "type": "CPT"}, {"code": "1099845", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 475.0, "discounted_cash": 166.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 176.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Dermal filler inj px/suppl", "code_information": [{"code": "C9800", "type": "HCPCS"}], "standard_charges": [{"minimum": 985.0, "maximum": 985.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 985.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Dermatological care MIPS value pathway", "code_information": [{"code": "M1421", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Diagnostic Hearing Loss Test", "code_information": [{"code": "92561", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Digoxin Level", "code_information": [{"code": "80162", "type": "CPT"}, {"code": "633719", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 475.0, "discounted_cash": 166.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 176.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Direct admission of patient for hospital observation care G0379", "code_information": [{"code": "G0379", "type": "HCPCS"}, {"code": "16017298", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 561.04, "maximum": 881.63, "gross_charge": 326.0, "discounted_cash": 114.1, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 561.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 881.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 881.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 881.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Documentation of medical reason(s) for not performing the PD-L1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize ", "code_information": [{"code": "M1414", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Documentation of medical reason(s) for not recommending a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is >= 66 years old, or life expectancy < 10 years, other medical re", "code_information": [{"code": "M1378", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Documentation of patient reasons for no examination, i.e., refusal of examination or lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail - at least one metho", "code_information": [{"code": "M1392", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Documentation of patient reasons for patients who were not seen for the second PAM survey (e.g., less than four months between baseline PAM assessment and follow-up", "code_information": [{"code": "M1385", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Drug metabolism (adverse drug reactions and drug response), genotyping of 16 genes (ie, ABCG2, CYP2B6, CYP2C9, CYP2C19, CYP2C, CYP2D6, CYP3A5, CYP4F2, DPYD, G6PD, GGCX, NUDT15, SLCO1B1, TPMT, UGT1A1, VKORC1), reported as metabolizer status and transporter", "code_information": [{"code": "533U", "type": "CPT"}], "standard_charges": [{"minimum": 1892.79, "maximum": 2976.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1892.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Drug metabolism, psychiatry (eg, major depressive disorder, general anxiety disorder, attention deficit hyperactivity disorder [ADHD], schizophrenia), whole blood, buccal swab, and pharmacogenomic genotyping of 14 genes and CYP2D6 copy number variant anal", "code_information": [{"code": "476U", "type": "CPT"}], "standard_charges": [{"minimum": 1149.82, "maximum": 1808.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Drug metabolism, psychiatry (eg, major depressive disorder, general anxiety disorder, attention deficit hyperactivity disorder [ADHD], schizophrenia), whole blood, buccal swab, and pharmacogenomic genotyping of 14 genes and CYP2D6 copy number variant anal", "code_information": [{"code": "477U", "type": "CPT"}], "standard_charges": [{"minimum": 1149.82, "maximum": 1808.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Drug metabolism, whole blood, pharmacogenomic genotyping of 40 genes and CYP2D6 copy number variant analysis, reported as metabolizer status", "code_information": [{"code": "516U", "type": "CPT"}], "standard_charges": [{"minimum": 1892.79, "maximum": 2976.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1892.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Duplex scan of hemodialysis fistula, computer-aided, limited (volume flow, diameter, and depth, including only body of fistula)", "code_information": [{"code": "876T", "type": "CPT"}], "standard_charges": [{"minimum": 489.79, "maximum": 769.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E COLI 0157 AG IA", "code_information": [{"code": "87335", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E-KIT FIXATION MED FLOWER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EWK-200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 781.0, "discounted_cash": 273.35, "setting": "both", "billing_class": "facility"}]}, {"description": "E-KIT FLOWER MEDIUM", "code_information": [{"code": "EWK 200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 549.0, "discounted_cash": 192.15, "setting": "both", "billing_class": "facility"}]}, {"description": "EAR PROTECTOR EVALUATION", "code_information": [{"code": "92596", "type": "CPT"}], "standard_charges": [{"minimum": 85.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "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": 7914.59, "maximum": 13587.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7914.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11319.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12451.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13587.39, "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": 12416.01, "maximum": 21315.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12416.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17757.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19533.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21315.21, "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": 4787.32, "maximum": 8218.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4787.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6846.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7531.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8218.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EARDRUM REVISION", "code_information": [{"code": "69450", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EARLY IND/DELIVERY", "code_information": [{"code": "G9356", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EARPIECE ACOUSTIC 4FT CORD", "code_information": [{"code": "H-9506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "EASY CLIP BIOCORTICAL 12X15X13 FIXATION DEVICE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EZB12-15-13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2333.0, "discounted_cash": 816.55, "setting": "both", "billing_class": "facility"}]}, {"description": "EB THERAPY PRESCRIBED", "code_information": [{"code": "M1227", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECCENTRIC GLENOSPHERE 4MM OFFSET 42MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ECG / EEG THERMAL RECORDING PAPER O-T240000031", "code_information": [{"code": "O-T240000031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.98, "discounted_cash": 8.74, "setting": "both", "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93224", "type": "CPT"}], "standard_charges": [{"minimum": 398.93, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 398.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 626.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 626.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 626.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93225", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93226", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93227", "type": "CPT"}], "standard_charges": [{"minimum": 119.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 119.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG RECORD/REVIEW", "code_information": [{"code": "93268", "type": "CPT"}], "standard_charges": [{"minimum": 905.9, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 905.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1423.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1423.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1423.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/MONITORING AND ANALYSIS", "code_information": [{"code": "93271", "type": "CPT"}], "standard_charges": [{"minimum": 750.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 750.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1178.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1178.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1178.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/REVIEW INTERPRET ONLY", "code_information": [{"code": "93272", "type": "CPT"}], "standard_charges": [{"minimum": 114.44, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/SIGNAL-AVERAGED", "code_information": [{"code": "93278", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECH PRI FEM COMP SO SZ 16 71341016", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71341016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9832.0, "discounted_cash": 3441.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHELON FLEX GST 60-3.8MM RELOADS GST60D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GST60D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 259.0, "discounted_cash": 90.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 13X145", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3502.0, "discounted_cash": 1225.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO EXAM OF ABDOMEN", "code_information": [{"code": "76705", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 142.28, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 151.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76516", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76519", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 91.63, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 97.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76529", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 127.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 136.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE THICKNESS", "code_information": [{"code": "76514", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 157.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 157.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 9.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76825", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 851.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 852.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1339.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1339.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1339.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 429.27, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 456.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76826", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 543.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 854.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 854.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 854.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 277.33, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 295.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76827", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 99.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 106.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76828", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 53.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 56.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF HEAD", "code_information": [{"code": "76506", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 191.33, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 203.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM UTERUS", "code_information": [{"code": "76831", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 192.91, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAMINATION PROCEDURE", "code_information": [{"code": "76999", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDANCE RADIOTHERAPY", "code_information": [{"code": "76965", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 67.51, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 72.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDANCE RADIOTHERAPY", "code_information": [{"code": "G6001", "type": "HCPCS"}], "standard_charges": [{"minimum": 226.8, "maximum": 372.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 356.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 356.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 356.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 350.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 372.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR AMNIOCENTESIS", "code_information": [{"code": "76946", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 91.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 91.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 91.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 36.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 39.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR ARTERY REPAIR", "code_information": [{"code": "76936", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 435.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 760.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1195.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1195.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1195.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 397.1, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 422.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR HEART BIOPSY", "code_information": [{"code": "76932", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 148.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 232.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 232.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 232.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR TRANSFUSION", "code_information": [{"code": "76941", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 310.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 487.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 487.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 487.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE OVA ASPIRATION", "code_information": [{"code": "76948", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 177.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 279.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 279.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 279.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 116.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 124.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE VILLUS SAMPLING", "code_information": [{"code": "76945", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 155.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 245.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 245.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 245.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93312", "type": "CPT"}], "standard_charges": [{"minimum": 613.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 613.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 964.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 964.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 964.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93313", "type": "CPT"}], "standard_charges": [{"minimum": 52.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93314", "type": "CPT"}], "standard_charges": [{"minimum": 654.8, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 654.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1028.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1028.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1028.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93315", "type": "CPT"}], "standard_charges": [{"minimum": 2193.27, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2193.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3446.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3446.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3446.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93316", "type": "CPT"}], "standard_charges": [{"minimum": 125.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 125.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93317", "type": "CPT"}], "standard_charges": [{"minimum": 419.57, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 419.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 659.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 659.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 659.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL (TEE)", "code_information": [{"code": "93355", "type": "CPT"}], "standard_charges": [{"minimum": 1044.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1044.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1640.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1640.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1640.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL INTRAOP", "code_information": [{"code": "93318", "type": "CPT"}], "standard_charges": [{"minimum": 2193.27, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2193.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3446.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3446.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3446.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93303", "type": "CPT"}], "standard_charges": [{"minimum": 769.24, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 769.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93304", "type": "CPT"}], "standard_charges": [{"minimum": 554.69, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 554.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 871.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 871.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 871.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHOGRAP TRANS R PROS STUDY", "code_information": [{"code": "76873", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 423.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 666.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 666.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 666.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 238.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 254.11, "methodology": "fee schedule"}], "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": 116218.76, "maximum": 199518.74, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 116218.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 166217.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 182839.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 199518.74, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT ARTERY", "code_information": [{"code": "33949", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT-VENOUS", "code_information": [{"code": "33948", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION ARTERY", "code_information": [{"code": "33947", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION VENOUS", "code_information": [{"code": "33946", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33955", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33956", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33951", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33952", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33953", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33954", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33957", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33958", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33959", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33962", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33963", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33964", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33985", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33986", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33965", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33969", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33966", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33984", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECOG IMPLTD BRN NPGT <30 D", "code_information": [{"code": "95836", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECP CILIARY BODY DESTRUCTION", "code_information": [{"code": "66711", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED APPLICATION OF LONG LEG SPLINT-THIGH TO ANKLE/TOES", "code_information": [{"code": "29505", "type": "CPT"}, {"code": "1559604", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 213.92, "maximum": 8450.0, "gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 213.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED APPLICATION SHORT LEG SPLINT-CALF TO FOOT", "code_information": [{"code": "29515", "type": "CPT"}, {"code": "1559606", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 65.34, "maximum": 8450.0, "gross_charge": 135.0, "discounted_cash": 47.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED APPLICATION SPLINT FINGER-STATIC", "code_information": [{"code": "29130", "type": "CPT"}, {"code": "1559602", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 20.32, "maximum": 8450.0, "gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED APPLICATION SPLINT FOREARM TO HAND", "code_information": [{"code": "29125", "type": "CPT"}, {"code": "1559605", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 65.34, "maximum": 8450.0, "gross_charge": 135.0, "discounted_cash": 47.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED APPLICATION SPLINT SHOULDER TO HAND", "code_information": [{"code": "29105", "type": "CPT"}, {"code": "1559603", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 65.34, "maximum": 8450.0, "gross_charge": 135.0, "discounted_cash": 47.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED APPLICATION, CAST; SHOULDER SPICA 29055", "code_information": [{"code": "29055", "type": "CPT"}, {"code": "1650458", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED ARTHROCENTESIS, ASPIRATION AND/OR INJ, MAJOR JOINT OR BURSA", "code_information": [{"code": "20610", "type": "CPT"}, {"code": "1650388", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED AVULSION NAIL, EA ADD PLATE", "code_information": [{"code": "11732", "type": "CPT"}, {"code": "1650413", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED AVULSION OF NAIL PLATE,PARTIAL OR COMPLETE,SIMPLE; SINGLE", "code_information": [{"code": "11730", "type": "CPT"}, {"code": "1563534", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 213.92, "maximum": 8450.0, "gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 213.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED BIOPSY OF CONJUNCTIVA", "code_information": [{"code": "68100", "type": "CPT"}, {"code": "1559607", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 427.85, "maximum": 8450.0, "gross_charge": 884.0, "discounted_cash": 309.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 427.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION ACROMIOCLAVICULAR DISLOCATION W/O MANIPULATION", "code_information": [{"code": "23540", "type": "CPT"}, {"code": "1559608", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION ARTICULAR FRACTURE", "code_information": [{"code": "26740", "type": "CPT"}, {"code": "1559609", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION CARPAL SCAPHOID FRACTRUE W/O MANIPULATION", "code_information": [{"code": "25622", "type": "CPT"}, {"code": "1559610", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION CLAVICULAR FRACTURE W/O MANIPULATION", "code_information": [{"code": "23500", "type": "CPT"}, {"code": "1559611", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION DISTAL FEMUR EPIPHYSEAL SEPARATION", "code_information": [{"code": "27516", "type": "CPT"}, {"code": "1559612", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION DISTAL PHALANGEAL FX W/O MANIPULATION", "code_information": [{"code": "26750", "type": "CPT"}, {"code": "1559614", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION DISTAL TIBIA", "code_information": [{"code": "27824", "type": "CPT"}, {"code": "1559617", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION FEMUR W/O MANIPULATION", "code_information": [{"code": "27500", "type": "CPT"}, {"code": "1559616", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION FIBULA W/O MANIPULATION", "code_information": [{"code": "27780", "type": "CPT"}, {"code": "1559621", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION HUMERAL SHAFT W/O MANIPULATION", "code_information": [{"code": "24500", "type": "CPT"}, {"code": "1559618", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION NASAL FRACTURE W/O MANIPULATION", "code_information": [{"code": "21310", "type": "CPT"}, {"code": "1559619", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION OF DISTAL RADIUS FRACTURE W/O MANIPULATION", "code_information": [{"code": "25600", "type": "CPT"}, {"code": "1559615", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION PHALANGEAL SHAFT FX W/O MANIPULATION", "code_information": [{"code": "26720", "type": "CPT"}, {"code": "1559620", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION RADIAL HEAD OR NECK W/O MANIPULATION", "code_information": [{"code": "24650", "type": "CPT"}, {"code": "1559622", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION RADIUS W/O MANIPULATION", "code_information": [{"code": "25500", "type": "CPT"}, {"code": "1559623", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION TIBIAL PLATEAU W/O MANIPULATION", "code_information": [{"code": "27530", "type": "CPT"}, {"code": "1559624", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION ULNA PROXIMAL W/O MANIPULATION", "code_information": [{"code": "24670", "type": "CPT"}, {"code": "1559625", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION ULNAR SHAFT W/O MANIPULATION", "code_information": [{"code": "25530", "type": "CPT"}, {"code": "1559626", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED TREATMENT DISTAL FIBULA W/O MANIPULATION", "code_information": [{"code": "27786", "type": "CPT"}, {"code": "1559613", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED TREATMENT OF MANDIBULAR FRACTURE; W/O MANIPULATION", "code_information": [{"code": "21450", "type": "CPT"}, {"code": "1563535", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED TREATMENT OF SCAPULAR FRACTURE; W/O MANIPULATION", "code_information": [{"code": "23570", "type": "CPT"}, {"code": "1563536", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; W/O MANIPULATION", "code_information": [{"code": "23520", "type": "CPT"}, {"code": "1563537", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TREATMENT OF PATELLAR FRACTURE, WITHOUT MANIPULATION", "code_information": [{"code": "27520", "type": "CPT"}, {"code": "1563538", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF BIMALLEOLAR ANKLE FRACTURE, (INCLUDING POTTS); W/O MANIPULATION", "code_information": [{"code": "27808", "type": "CPT"}, {"code": "1563539", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF CARPAL BONE FRACTURE W/O MANIPULATION, EACH BONE", "code_information": [{"code": "25630", "type": "CPT"}, {"code": "1563552", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF FEMORAL FRACTURE, PROXIMAL END, NECK; W/OMANIPULATION", "code_information": [{"code": "27230", "type": "CPT"}, {"code": "1563540", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF FRACTURE OF ORBIT, W/O MANIPULATION", "code_information": [{"code": "21400", "type": "CPT"}, {"code": "1563541", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF GREATER HUMERAL TUBEROSITY FRACTURE; W/O MANIPULATION", "code_information": [{"code": "23620", "type": "CPT"}, {"code": "1563542", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF GREATER TROCHANTERIC FRACTURE, W/O MANIPULATION", "code_information": [{"code": "27246", "type": "CPT"}, {"code": "1563543", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; W/O MANIPULATION", "code_information": [{"code": "24576", "type": "CPT"}, {"code": "1563544", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; W/O MANIPULATION", "code_information": [{"code": "24560", "type": "CPT"}, {"code": "1563583", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; W/O MANIPUL", "code_information": [{"code": "27238", "type": "CPT"}, {"code": "1563545", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF MEDIAL MALLEOLUS FRACTURE; W/O MANIPULATION", "code_information": [{"code": "27760", "type": "CPT"}, {"code": "1563546", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF METACARPAL FRACTURE, SINGLE; W/O MANIPULATION, EACH BONE", "code_information": [{"code": "26600", "type": "CPT"}, {"code": "1563547", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF METATARSAL FRACTURE; W/O MANIPULATION, EACH", "code_information": [{"code": "28470", "type": "CPT"}, {"code": "1563548", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR SUBLUXATION; W/O MANIPULATION", "code_information": [{"code": "1563549", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF PROXIMAL HUMERAL FRACTURE; W/O MANIPULATION", "code_information": [{"code": "23600", "type": "CPT"}, {"code": "1563550", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF RADIAL AND ULNAR SHAFT FRACTURES; W/O MANIPULATION", "code_information": [{"code": "25560", "type": "CPT"}, {"code": "1563551", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF SESAMOID FRACTURE", "code_information": [{"code": "28530", "type": "CPT"}, {"code": "5271825", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF TALUS FRACTURE; W/O MANIPULATION", "code_information": [{"code": "28430", "type": "CPT"}, {"code": "1563555", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF THIGH FEMORAL FRACTURE W/OR W/O INTERCONDYLAR EXTENSION, W/O MANIPULATION", "code_information": [{"code": "27501", "type": "CPT"}, {"code": "1563553", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF THIGH HUMERAL FRACTURE, W/OR W/O INTERCONDYLAR EXTENSION; W/O MANIPULATION", "code_information": [{"code": "24530", "type": "CPT"}, {"code": "1563554", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); W/O MANIPULATION", "code_information": [{"code": "27750", "type": "CPT"}, {"code": "1563556", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMT OF TRIMALLEOLAR ANKLE FRACTURE; W/O MANIPULATION", "code_information": [{"code": "27816", "type": "CPT"}, {"code": "1563557", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLSD TRMTOF CALCANEAL FRACTURE; W/O MANIPULATION", "code_information": [{"code": "28400", "type": "CPT"}, {"code": "1563558", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Closed treatment of phalangeal shaft FX W/Manipulation 26725", "code_information": [{"code": "26725", "type": "CPT"}, {"code": "42982141", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED DEBRIDEMENT BURN 5%", "code_information": [{"code": "16020", "type": "CPT"}, {"code": "1559601", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Excision of skin and subcutaneous tissue for hidradenitis, axillary; 11450", "code_information": [{"code": "11450", "type": "CPT"}, {"code": "29499503", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID)", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "1650391", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 266.67, "maximum": 8450.0, "gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED INCISION AND DRAINAGE FINGER SIMPLE", "code_information": [{"code": "26010", "type": "CPT"}, {"code": "1559627", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 620.0, "discounted_cash": 217.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 300.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED INCISION AND DRAINAGE OF ABSCESS", "code_information": [{"code": "10061", "type": "CPT"}, {"code": "1559628", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS 56405", "code_information": [{"code": "56405", "type": "CPT"}, {"code": "1559630", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED INCISION AND DRAINAGE PERIANAL ABSCESS SUPERFICIAL 46050", "code_information": [{"code": "46050", "type": "CPT"}, {"code": "42583888", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1871.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED INCISION AND DRAINAGE SIMPLE 10060", "code_information": [{"code": "10060", "type": "CPT"}, {"code": "1559629", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 171.82, "maximum": 8450.0, "gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 171.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED INCISION AND DRAINAGE, COMPLEX, 10180", "code_information": [{"code": "10180", "type": "CPT"}, {"code": "31808694", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED INCISION AND REMOVAL OF FOREIGN BODY", "code_information": [{"code": "10120", "type": "CPT"}, {"code": "1559631", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE 51702", "code_information": [{"code": "51702", "type": "CPT"}, {"code": "1563560", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 126.32, "maximum": 8450.0, "gross_charge": 261.0, "discounted_cash": 91.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 126.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED INTRAVENOUS INFUSION; HYDRATION - EACH ADDITIONAL HOUR 96361", "code_information": [{"code": "96361", "type": "CPT"}, {"code": "46328274", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 60.37, "maximum": 8450.0, "gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 60.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED IV INFUSION FOR THERAPY, PROPHYLAXIS OR DIAGNOSIS; ADDL SEQUENTIAL INFUSION UP TO 1 HOUR 96367", "code_information": [{"code": "96367", "type": "CPT"}, {"code": "1563561", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 139.84, "maximum": 8450.0, "gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 139.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED IV INFUSION HYDRATION, INITIAL 31 MINUTES TO 1 HOUR", "code_information": [{"code": "96360", "type": "CPT"}, {"code": "1563565", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 170.05, "maximum": 8450.0, "gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 170.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED IV INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS ; INITIAL, UP TO 1", "code_information": [{"code": "96365", "type": "CPT"}, {"code": "1563566", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 321.05, "maximum": 8450.0, "gross_charge": 326.0, "discounted_cash": 114.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED IV INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS EACH ADDITIONAL HOUR 96366", "code_information": [{"code": "96366", "type": "CPT"}, {"code": "1563562", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 96.93, "maximum": 8450.0, "gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 96.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 152.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 152.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 152.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure) 46040", "code_information": [{"code": "46040", "type": "CPT"}, {"code": "45300337", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Laryngoscopy, flexible fiberoptic, flexible 31575", "code_information": [{"code": "31575", "type": "CPT"}, {"code": "42921191", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 2297.0, "discounted_cash": 803.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1111.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED PRESSURIZED OR NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "1563568", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 811.26, "maximum": 8450.0, "gross_charge": 641.0, "discounted_cash": 224.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 811.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Placement of needle for intraosseous infusion 36680", "code_information": [{"code": "36680", "type": "CPT"}, {"code": "45299116", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 199.89, "maximum": 8450.0, "gross_charge": 413.0, "discounted_cash": 144.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 199.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED REMOVAL FOREIGN BODY NOSE-OFFICE TYPE PROCEDURE 30300", "code_information": [{"code": "30300", "type": "CPT"}, {"code": "1559634", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 65.34, "maximum": 8450.0, "gross_charge": 135.0, "discounted_cash": 47.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS", "code_information": [{"code": "28190", "type": "CPT"}, {"code": "1563569", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED REMOVAL SKIN TAGS,MULTIPLE FIBROCUTANEOUS TAGS,ANY AREA, TO 15 TAGS", "code_information": [{"code": "11200", "type": "CPT"}, {"code": "1650407", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED REPAIR COMPLEX SCP ARM LEG 2.6CM-7.5CM", "code_information": [{"code": "13121", "type": "CPT"}, {"code": "1650427", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED REPAIR WOUND 2.5 CM OR LESS NECK/HANDS/FEET/EXTERNAL GENITALIA", "code_information": [{"code": "12041", "type": "CPT"}, {"code": "1559633", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED REPAIR WOUND 2.5 CM OR LESS SCALP/AXILLAE, TRUNK/EXTREMITIES EXCLUDING HAND/FOOT 12031", "code_information": [{"code": "12031", "type": "CPT"}, {"code": "1559632", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 213.92, "maximum": 8450.0, "gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 213.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Removal Impacted Cerumen Using Irrigation/lavage 69209", "code_information": [{"code": "69209", "type": "CPT"}, {"code": "42961352", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 29.52, "maximum": 8450.0, "gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 29.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED SIMPLE REPAIR FOR SUPERFICIAL WOUNDS SCALP, 7.6 CM TO12.5 CM", "code_information": [{"code": "12004", "type": "CPT"}, {"code": "1563570", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 620.0, "discounted_cash": 217.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 300.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE; 2.6-5 cm 12013", "code_information": [{"code": "12013", "type": "CPT"}, {"code": "1563571", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED SIMPLE REPAIR OF WOUNDS-FACIAL, EARS, MUCOUS MEMBRANES 2.5CM OR LESS", "code_information": [{"code": "12011", "type": "CPT"}, {"code": "1559635", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED SIMPLE REPAIR WOUNDS SCALP,NECK,AXILLAE,GEITALIA,TRUNK,EXT. 2.6CM-7.5CM 12002", "code_information": [{"code": "12002", "type": "CPT"}, {"code": "1559637", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED STRAPPING; ANKLE AND/OR FOOT", "code_information": [{"code": "29540", "type": "CPT"}, {"code": "1563572", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED STRAPPING; ELBOW OR WRIST", "code_information": [{"code": "29260", "type": "CPT"}, {"code": "1563573", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 42.59, "maximum": 8450.0, "gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED STRAPPING; HAND OR FINGER", "code_information": [{"code": "29280", "type": "CPT"}, {"code": "1563574", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 20.32, "maximum": 8450.0, "gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED STRAPPING; KNEE", "code_information": [{"code": "29530", "type": "CPT"}, {"code": "1563575", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 65.34, "maximum": 8450.0, "gross_charge": 135.0, "discounted_cash": 47.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED SVC CKD GRP PER SESSION", "code_information": [{"code": "G0421", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.03, "maximum": 182.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 116.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED SVC CKD IND PER SESSION", "code_information": [{"code": "G0420", "type": "HCPCS"}], "standard_charges": [{"minimum": 495.86, "maximum": 779.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 495.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Simple repair, superficial; 2.5 cm or less 12001", "code_information": [{"code": "12001", "type": "CPT"}, {"code": "36235531", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Spinal puncture, lumbar, diagnostic 62270", "code_information": [{"code": "62270", "type": "CPT"}, {"code": "42982169", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Stereotactic computer-assisted (navigational) procedure; spinal 61783", "code_information": [{"code": "61783", "type": "CPT"}, {"code": "8756932", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED TETANUS TOXOID ADSORBED, FOR INTRAMUSCULAR USE", "code_information": [{"code": "1650480", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ED THER/PROPH/DIAG INJ ; IV PUSH, SINGLE OR INITIAL SUBSTANCE/DRUG", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "1563579", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 174.81, "maximum": 8450.0, "gross_charge": 161.0, "discounted_cash": 56.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 274.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 274.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 274.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED THER/PROPH/DIAG INJ EACH ADD SEQUENTIAL IV PUSH OF A NEW SUBSTANCE/DRUG", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "1563580", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 74.71, "maximum": 8450.0, "gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED THER/PROPH/DIAG INJ EACH ADD SEQUENTIAL IV PUSH OF SAME SUBSTANCE OR DRUG", "code_information": [{"code": "96376", "type": "CPT"}, {"code": "1563577", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 104.91, "maximum": 8450.0, "gross_charge": 295.0, "discounted_cash": 103.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 104.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 164.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 164.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 164.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED THERAPUETIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION SUBCUATANEOUS OR INTRAMSUCULAR", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "1563582", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 266.67, "maximum": 8450.0, "gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED UNLISTED PROCEDURE NOSE 30999", "code_information": [{"code": "30999", "type": "CPT"}, {"code": "45422397", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 110.77, "maximum": 8450.0, "gross_charge": 228.87, "discounted_cash": 80.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 110.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Visit Level 1", "code_information": [{"code": "99281", "type": "CPT"}, {"code": "1558558", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 528.0, "maximum": 8450.0, "gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 528.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Visit Level 2", "code_information": [{"code": "99282", "type": "CPT"}, {"code": "1558559", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 528.0, "maximum": 8450.0, "gross_charge": 1272.0, "discounted_cash": 445.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 528.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Visit Level 3", "code_information": [{"code": "99283", "type": "CPT"}, {"code": "1558560", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 720.0, "maximum": 8450.0, "gross_charge": 1504.0, "discounted_cash": 526.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1133.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1133.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1133.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Visit Level 4", "code_information": [{"code": "99284", "type": "CPT"}, {"code": "1558561", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1651.0, "maximum": 8450.0, "gross_charge": 2912.0, "discounted_cash": 1019.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1651.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2598.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2598.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2598.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Visit Level 5", "code_information": [{"code": "99285", "type": "CPT"}, {"code": "1558562", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1680.0, "maximum": 8450.0, "gross_charge": 5529.0, "discounted_cash": 1935.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2643.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2643.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2643.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED Wound closure utilizing tissue adhesive(s) only", "code_information": [{"code": "G0168", "type": "HCPCS"}, {"code": "1891080", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1886.0, "maximum": 2204.0, "gross_charge": 672.0, "discounted_cash": 235.2, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EE&MJ BSC PRTN ELISA EST DEV", "code_information": [{"code": "95U", "type": "CPT"}], "standard_charges": [{"minimum": 235.26, "maximum": 1111.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 235.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 369.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 369.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 369.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1111.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1111.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG 41-60 MINUTES", "code_information": [{"code": "95812", "type": "CPT"}], "standard_charges": [{"minimum": 1198.33, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1198.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1883.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1883.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1883.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG AWAKE AND ASLEEP", "code_information": [{"code": "95819", "type": "CPT"}], "standard_charges": [{"minimum": 1657.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1657.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2604.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2604.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2604.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG AWAKE AND DROWSY", "code_information": [{"code": "95816", "type": "CPT"}], "standard_charges": [{"minimum": 1370.01, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1370.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2152.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2152.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2152.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG CEREBRAL DEATH ONLY", "code_information": [{"code": "95824", "type": "CPT"}], "standard_charges": [{"minimum": 179.58, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 282.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 282.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 282.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG COMA OR SLEEP ONLY", "code_information": [{"code": "95822", "type": "CPT"}], "standard_charges": [{"minimum": 1468.53, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1468.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2307.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2307.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2307.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG CONT REC W/VID EEG TECH", "code_information": [{"code": "95700", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG DIGITAL ANALYSIS", "code_information": [{"code": "95957", "type": "CPT"}], "standard_charges": [{"minimum": 742.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 742.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1166.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1166.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1166.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG DURING SURGERY", "code_information": [{"code": "95955", "type": "CPT"}], "standard_charges": [{"minimum": 699.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 699.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1098.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1098.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1098.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG EXTND MNTR 61-119 MIN", "code_information": [{"code": "95813", "type": "CPT"}], "standard_charges": [{"minimum": 1420.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1420.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2232.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2232.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2232.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG MONITORING/FUNCTION TEST", "code_information": [{"code": "95958", "type": "CPT"}], "standard_charges": [{"minimum": 1567.09, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1567.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2462.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2462.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2462.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG MONITORING/GIVING DRUGS", "code_information": [{"code": "95954", "type": "CPT"}], "standard_charges": [{"minimum": 1274.62, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1274.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2002.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2002.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2002.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP EA INCR W/VEEG", "code_information": [{"code": "95720", "type": "CPT"}], "standard_charges": [{"minimum": 937.7, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 937.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1473.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1473.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1473.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>36<60 HR W/O VID", "code_information": [{"code": "95721", "type": "CPT"}], "standard_charges": [{"minimum": 940.87, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 940.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1478.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1478.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1478.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>36<60 HR W/VEEG", "code_information": [{"code": "95722", "type": "CPT"}], "standard_charges": [{"minimum": 1144.31, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1144.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1798.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1798.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1798.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>60<84 HR W/O VID", "code_information": [{"code": "95723", "type": "CPT"}], "standard_charges": [{"minimum": 1164.99, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1164.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1830.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1830.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1830.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>60<84 HR W/VEEG", "code_information": [{"code": "95724", "type": "CPT"}], "standard_charges": [{"minimum": 1459.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1459.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2292.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2292.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2292.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>84 HR W/O VID", "code_information": [{"code": "95725", "type": "CPT"}], "standard_charges": [{"minimum": 1325.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1325.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2082.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2082.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2082.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>84 HR W/VEEG", "code_information": [{"code": "95726", "type": "CPT"}], "standard_charges": [{"minimum": 1843.6, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1843.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2897.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2897.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2897.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP 2-12 HR W/O VID", "code_information": [{"code": "95717", "type": "CPT"}], "standard_charges": [{"minimum": 460.89, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 460.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 724.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 724.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 724.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP 2-12 HR W/VEEG", "code_information": [{"code": "95718", "type": "CPT"}], "standard_charges": [{"minimum": 605.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 605.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 951.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 951.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 951.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP EA INCR W/O VID", "code_information": [{"code": "95719", "type": "CPT"}], "standard_charges": [{"minimum": 715.21, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 715.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1123.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1123.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1123.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID 2-12 HR UNMNTR", "code_information": [{"code": "95705", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID 2-12HR CONT MNTR", "code_information": [{"code": "95707", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID EA 12-26HR CONT", "code_information": [{"code": "95710", "type": "CPT"}], "standard_charges": [{"minimum": 2141.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID EA 12-26HR INTMT", "code_information": [{"code": "95709", "type": "CPT"}], "standard_charges": [{"minimum": 2141.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG WO VID 2-12HR INTMT MNTR", "code_information": [{"code": "95706", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG WO VID EA 12-26HR UNMNTR", "code_information": [{"code": "95708", "type": "CPT"}], "standard_charges": [{"minimum": 2141.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD BALLOON DIL ESOPH30 MM/>", "code_information": [{"code": "43233", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD CAUTERY TUMOR POLYP", "code_information": [{"code": "43250", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD ENDO MUCOSAL RESECTION", "code_information": [{"code": "43254", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD ENDOSCOPIC STENT PLACE", "code_information": [{"code": "43266", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD ESOPHAGOGASTRC FNDOPLSTY", "code_information": [{"code": "43210", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL BX 1/MLT", "code_information": [{"code": "653T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL DX BR/WA", "code_information": [{"code": "652T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL TUBE/CATH", "code_information": [{"code": "654T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL DPLMNT BALO", "code_information": [{"code": "43290", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL RMVL BALO", "code_information": [{"code": "43291", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD INJECTION VARICES", "code_information": [{"code": "43243", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43252", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD TUBE/CATH INSERTION", "code_information": [{"code": "43241", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD US EXAM DUODENUM/JEJUNUM", "code_information": [{"code": "43259", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43238", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43242", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD US TRANSMURAL INJXN/MARK", "code_information": [{"code": "43253", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD VOL ADJMT BARIATRIC BALO", "code_information": [{"code": "813T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD W/THRML TXMNT GERD", "code_information": [{"code": "43257", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD W/TRANSMURAL DRAIN CYST", "code_information": [{"code": "43240", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGFR GENE COM VARIANTS", "code_information": [{"code": "81235", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 405.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 827.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 467.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 467.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGIA 45 ARTICULATING VASCULAR EGIA45AV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EGIA45AV", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 953.0, "discounted_cash": 333.55, "setting": "both", "billing_class": "facility"}]}, {"description": "EHRLICHA CHAFFEENSIS AMP PRB", "code_information": [{"code": "87484", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHIA ANTIBODY", "code_information": [{"code": "86666", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EIA HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0432", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 78.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 78.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 78.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 78.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EIC 4845-01 COBLATOR II ENT REFLEX ULT", "code_information": [{"code": "EIC4845-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "EKG FOR INITIAL PREVENT EXAM", "code_information": [{"code": "G0403", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.12, "maximum": 69.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG INTERPRET & REPORT PREVE", "code_information": [{"code": "G0405", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.15, "maximum": 59.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG TRACING FOR INITIAL PREV", "code_information": [{"code": "G0404", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.15, "maximum": 59.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EL-1 FECAL QUAL/SEMIQ", "code_information": [{"code": "82656", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EL-1 FECAL QUANTITATIVE", "code_information": [{"code": "82653", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELCAM FOUR-WAY LARGE BORE POLY 2C6204", "code_information": [{"code": "2C6204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.87, "discounted_cash": 2.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ELD MAL SCRN POS NO PLAN", "code_information": [{"code": "G8735", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELD MALTREATMENT NOT DOC", "code_information": [{"code": "G8535", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC ALY CPX IINS SP/SAC NRV", "code_information": [{"code": "789T", "type": "CPT"}], "standard_charges": [{"minimum": 235.19, "maximum": 369.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 235.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 369.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 369.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 369.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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": [{"minimum": 235.19, "maximum": 369.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 235.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 369.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 369.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 369.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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": 289.25, "maximum": 454.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 289.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 454.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 454.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 454.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC ALYS SMPL PRGRMG IINS", "code_information": [{"code": "589T", "type": "CPT"}], "standard_charges": [{"minimum": 289.25, "maximum": 454.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 289.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 454.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 454.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 454.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC IMPD SPECTRSC 1+SKN LES", "code_information": [{"code": "658T", "type": "CPT"}], "standard_charges": [{"minimum": 141.93, "maximum": 223.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 141.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC STIM OTHER THAN WOUND", "code_information": [{"code": "G0283", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.59, "maximum": 99.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC STIM UNATTEND FOR PRESS", "code_information": [{"code": "G0281", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.59, "maximum": 99.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC. ANALYSIS OF IMPLANTED NEUROSTIM. PULSE GEN. COMPLEX SPINAL CORD W/PROG. EA ADD 30 MIN 95973", "code_information": [{"code": "3307073", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"gross_charge": 3899.0, "discounted_cash": 1364.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEC. ANALYSIS OF PROGRAM IMPLANT PUMP FOR INTRATHECAL OR EPI. DRUG INF. W/REPROGRAM/REFILL 62370", "code_information": [{"code": "62370", "type": "CPT"}, {"code": "2001899", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTIVE SURGERY", "code_information": [{"code": "G9643", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRIC STIMULATION THERAPY", "code_information": [{"code": "97014", "type": "CPT"}], "standard_charges": [{"minimum": 66.77, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20974", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20975", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TEST ONE", "code_information": [{"code": "92594", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 119.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 119.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 119.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TST BOTH", "code_information": [{"code": "92595", "type": "CPT"}], "standard_charges": [{"minimum": 111.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO-OCULOGRAPHY W/I&R", "code_information": [{"code": "92270", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO-UROFLOWMETRY FIRST", "code_information": [{"code": "51741", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROBLADE RESECTOR 4.5MM 7205961", "code_information": [{"code": "7205961", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 624.62, "discounted_cash": 218.62, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTROBLADE RESECTOR 4.5MM ELITE 7209983", "code_information": [{"code": "7209983", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM COMPLETE", "code_information": [{"code": "93000", "type": "CPT"}], "standard_charges": [{"minimum": 44.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM REPORT", "code_information": [{"code": "93010", "type": "CPT"}], "standard_charges": [{"minimum": 38.15, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCOCHLEOGRAPHY", "code_information": [{"code": "92584", "type": "CPT"}], "standard_charges": [{"minimum": 332.16, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 332.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 521.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 521.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 521.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCONVULSIVE THERAPY", "code_information": [{"code": "90870", "type": "CPT"}], "standard_charges": [{"minimum": 495.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 495.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRODE 1 CHANNEL DRAGONFLY LSE500M-5", "code_information": [{"code": "LSE500M-5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BALL 13CM 5MM ELECTROSURGICAL PENCIL TIP LLETZ STRL DISP", "code_information": [{"code": "E1564", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BALL 45DEG SM JOINT COOLCUT", "code_information": [{"code": "AR-9808SJ-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 132.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BALL 5MM 11CM RED LEEP UTAH BALL", "code_information": [{"code": "DBL-511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BAND 12DEG SCOPE W/ CABLE", "code_information": [{"code": "WA22621C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1261.0, "discounted_cash": 441.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BAND 24G 30DEG SCOPE W/ CABLE", "code_information": [{"code": "WA22623C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1261.0, "discounted_cash": 441.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BIPOLAR NOVASURE", "code_information": [{"code": "NS2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2120.0, "discounted_cash": 742.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 1.1IN COATED", "code_information": [{"code": "E1450X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 2.5 E-Z CLEAN MODIFIED 0012M", "code_information": [{"code": "12M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 4IN .093IN COATED ELECTROSURGICAL EXTENDED LF STRL", "code_information": [{"code": "E14504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 4IN .093IN COATEDINSULATED EDGE", "code_information": [{"code": "E14554", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 6.5 E-Z CLEAN 0014", "code_information": [{"code": "14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 6.5 E-Z CLEAN 0014M", "code_information": [{"code": "14M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.52, "discounted_cash": 9.28, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 6IN COATEDINSULATED EDGE", "code_information": [{"code": "E14565-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE COATED NO-HEX E1450G", "code_information": [{"code": "E1450G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE INSULTE COATD SLEEVE 5.1 E1455B", "code_information": [{"code": "E1455B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE MODIFIED 4 E-Z CLEAN 0014AM", "code_information": [{"code": "14AM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.05, "discounted_cash": 9.82, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE CAUTERY X-LO 2.75 INCH", "code_information": [{"code": "E1475X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE COAGULATING 24FR YELLOW POINTED ONE PRONG BALL SHAPED STRL", "code_information": [{"code": "27050L/6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE COAGULATING 3MM 24 TO 26FR YELLOW BALL SHAPED", "code_information": [{"code": "27050N/6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE COATED RED", "code_information": [{"code": "P103A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE COATED STANDARD", "code_information": [{"code": "P0012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.98, "discounted_cash": 3.84, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE CONFIGURATION TISSUE 45CM 5MM ENSEAL TRIO 3MM ETRIO345H", "code_information": [{"code": "ETRIO345H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1142.0, "discounted_cash": 399.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE CROSSMAN TC 10CM DISP", "code_information": [{"code": "TCD-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE CU10CM", "code_information": [{"code": "CU-101018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE CUTTING 0.35MM WIRE DIA 24FR YELLOW ONE PRONG STRL", "code_information": [{"code": "27050G/6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE CUTTING BAND 30DEG MD ACMI TURIS RESECTOSCOPE HIGH FREQ RESECTION", "code_information": [{"code": "WA22523C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1198.0, "discounted_cash": 419.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE DEFIBRILLATION 5.96IN X 5.24IN CONDUCT GEL ADLT", "code_information": [{"code": "11996-000091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ECG Q TRACE GOLD BULK PACK 30807732", "code_information": [{"code": "30807732", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ELECTROSURGICAL 10FTFT SWITCH BLD EDGE SS STRLINSTR DISP", "code_information": [{"code": "E2504H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ELECTROSURGICAL 2.75IN COATED BLADE PTFEINSULATED HEXLOC EDGE STRL DIS", "code_information": [{"code": "E1455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ELECTROSURGICAL 33CM CORBITT SPATULA STRL DISP", "code_information": [{"code": "5600180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ELECTROSURGICAL 6.5IN 3/32IN STD PTFE COATED BLADE EDGE STRLINSTR DISP", "code_information": [{"code": "E1455-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ELECTROSURGICAL 90DEG GRAY ABLATION PROBE SUCT REPROCESS W/ SUCTION SA", "code_information": [{"code": "7210111R", "type": "CDM"}], "standard_charges": [{"gross_charge": 219.0, "discounted_cash": 76.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ELECTROSURGICAL L 32CM 5MM SUCTION 250-070-443", "code_information": [{"code": "250-070-443", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE EMG W/ SUBDERMAL GRND STIM RETURN 18MM", "code_information": [{"code": "8227304", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ESURG BRN 27FR CLN URO KNF PNT RSSCP STRL DISP", "code_information": [{"code": "27050K/6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 580.0, "discounted_cash": 203.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ESURG BRN 3MM RLR BALL RSSCP DISP STRL URO 27FR", "code_information": [{"code": "27050M/6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 580.0, "discounted_cash": 203.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE HK 3.5MM 90DEG SHOULDER KNEE ROTATOR CUFFINSTABILITY FOR ABLATION VAPR", "code_information": [{"code": "225305", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 685.0, "discounted_cash": 239.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE HOOK 3.5MMINTEGRATED HANDPIECE VAPR", "code_information": [{"code": "227305", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 798.0, "discounted_cash": 279.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE INVIVO QUADTRODE MRI ECG 989803179041", "code_information": [{"code": "9.89803E+11", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE INVIVO QUADTRODE MRI ECG 989803179041", "code_information": [{"code": "9.89803E+11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.33, "discounted_cash": 13.07, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LAPAROSCOPIC WIRE L-HOOK COATED E3774-36C", "code_information": [{"code": "E3774-36C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.85, "discounted_cash": 33.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LEAD EXTENSION BLUE 72IN AERO-LL", "code_information": [{"code": "48755028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP 10X10MM DLPS11", "code_information": [{"code": "DLPS11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP 13 CM .093IN 15MM X 12MM ELECTROSURGICAL TUNGSTEN LLETZ STRL", "code_information": [{"code": "E1560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP 24 TO 28FR 45DEG ELECTROSURGERY RESECTOSCOPE KNIFE GYNECOLOGICAL", "code_information": [{"code": "A22255C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP 24FR 12 D MED RESECTOSCOPE ARTHROSCOPIC HIGH FREQUENCY ESURG", "code_information": [{"code": "WA22302D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 479.0, "discounted_cash": 167.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP 24FR MED CUT HIGH FREQUENCY ESURG STRL DISP", "code_information": [{"code": "WA22306D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1198.0, "discounted_cash": 419.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP 24FR RESECTION ELECTROSURGERY STRL DISP", "code_information": [{"code": "A22201C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP 26FR 30DEG RESECTOSCOPE ELECTROSURGERY", "code_information": [{"code": "A22206C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP 5.1IN ELECTROSURGICAL LLETZ TUNGSTEN LOOP TIP", "code_information": [{"code": "ESE1559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE MEDIUM LOOP PLASMABUTTON 30DEG", "code_information": [{"code": "WA22606D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1261.0, "discounted_cash": 441.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE MENISECTOMY 165MM 6.5IN 90DEG ANGLED TIP", "code_information": [{"code": "9737BA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 42.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE MENISECTOMY 6.5IN X 165MM GRAY ACROMIOPLASTYINSULATED HOOK REPROCESS", "code_information": [{"code": "C5012AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE MONOPOLAR 33CM X 5MM L HOOK STRL DISP", "code_information": [{"code": "5600160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE NDL 2.84IN .093IN COATED ELECTROSURGICAL W/ SAFETY SLEEVE", "code_information": [{"code": "E1465B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 23.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE NDL 5.1MM COATED PTFEINSULATED CAUTERY EDGE", "code_information": [{"code": "E1465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE NDL 6.5IN .06IN 2.3 MM EXTD STANDARD ELECTROSURGICAL DISP", "code_information": [{"code": "E15526", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE PAIRED SUBDERMAL 12MM YELLOW 5140-534-624", "code_information": [{"code": "5140-534-624", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE PAIRED SUBDERMAL 18MM BLUE 5140-534-626", "code_information": [{"code": "5140-534-626", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE PAIRED SUBDERMAL 18MM PURPLE 5140-534-627", "code_information": [{"code": "5140-534-627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE PENCIL BLADE SMOKE ATTACHMENT 10IN EDGE BUTTON SWITCH", "code_information": [{"code": "E2450HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE PLASMA LONG OVAL BUTTON WA22741S", "code_information": [{"code": "WA22741S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1283.45, "discounted_cash": 449.21, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE PLASMA LOOP 24FR 12-30 RESCTION OLYMPUS WA22706S", "code_information": [{"code": "WA22706S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.0, "discounted_cash": 387.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE RADIOFREQUENCY 165MM 90DEG MENISCECTOMY ANGLED REPROCESSINSTR", "code_information": [{"code": "C5011AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE RADIOFREQUENCYINTEGRATED FOR VAPR PREMIER50", "code_information": [{"code": "227504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE RESECTION 24 TO 28FR 12DEG 30DEG RESECTOSCOPE GRAVITY STRL DISP", "code_information": [{"code": "A22257C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 430.0, "discounted_cash": 150.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE RESECTION HIGH FREQUENCY BTN PLASMA VAPORATION", "code_information": [{"code": "WA22557C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 479.0, "discounted_cash": 167.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE RETURN 9FT CORDINFNT FOR PATIENT 6-30 POUND POLYHESIVE II LF", "code_information": [{"code": "E7510-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE RF NIMBUS 100MM STERILE NIM-100-10BB", "code_information": [{"code": "NIM-100-10BB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE RF NIMBUS 150MM STERILE NIM-150-10BB", "code_information": [{"code": "NIM-150-10BB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE SPECIALTY 15MM X 12MM ROUND LOOP UTAHLOOP SAFE-T-GAUGE", "code_information": [{"code": "DLP-M11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE SPECIALTY 20MM X 12MM 11MM SHAFT WHT ROUND LOOP UTAHLOOP SAFE-T-GAUGE", "code_information": [{"code": "DLP-W11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE STIM BRAIN ADD-ON", "code_information": [{"code": "95962", "type": "CPT"}], "standard_charges": [{"minimum": 398.93, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 398.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 626.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 626.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 626.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRODE STIMULATION BRAIN", "code_information": [{"code": "95961", "type": "CPT"}], "standard_charges": [{"minimum": 643.68, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 643.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1011.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1011.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1011.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRODE SUBDERMAL 2 CHANNEL SET PAIRED SHARP LANCET TIPPED COLOR CODED STRL DI", "code_information": [{"code": "8227410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 322.89, "discounted_cash": 113.01, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE SUBDERMAL 4 CHANNEL PAIRED PROTECTED PIN", "code_information": [{"code": "8227411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODES 3M CABLE 10 DISPOSABLE", "code_information": [{"code": "TCD-10-3M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTROEJACULATION", "code_information": [{"code": "55870", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROGASTROGRAPHY", "code_information": [{"code": "91132", "type": "CPT"}], "standard_charges": [{"minimum": 958.38, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 958.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1506.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1506.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1506.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROGASTROGRAPHY W/TEST", "code_information": [{"code": "91133", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROMAGNTIC TX FOR ULCERS", "code_information": [{"code": "G0329", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.26, "maximum": 77.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 77.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 77.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 77.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROMYOGRAPHY ANAL OR URETHERAL SPHINCTER-NEEDLE 51785", "code_information": [{"code": "51785", "type": "CPT"}, {"code": "1480678", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 400.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROMYOGRAPHY ANAL OR URETHERAL SPHINCTER-OTHER THAN NEEDLE 51784", "code_information": [{"code": "51784", "type": "CPT"}, {"code": "1480679", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRON MICROSCOPY", "code_information": [{"code": "D0481", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRON MICROSCOPY DX", "code_information": [{"code": "88348", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 650.01, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 692.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIM. PULSE GEN. COMPLEX SPINAL/PERIPH. NERVE W/PROGRAM 95972", "code_information": [{"code": "95972", "type": "CPT"}, {"code": "1618457", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"minimum": 189.14, "maximum": 8450.0, "gross_charge": 3899.0, "discounted_cash": 1364.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 189.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIM. PULSE GEN. SIMPLE SPINAL/PERIPH. NERVE W/PROGRAM 95971", "code_information": [{"code": "95971", "type": "CPT"}, {"code": "1845637", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 185.97, "maximum": 8450.0, "gross_charge": 90.47, "discounted_cash": 31.66, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 185.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 292.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 292.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 292.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRONIC ASSESSMENT OF PROGRAMMABLE PUMP FOR INTRATHECAL/EPIDURAL 62367", "code_information": [{"code": "62367", "type": "CPT"}, {"code": "1480680", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 66.17, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 104.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 104.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHORETIC TEST", "code_information": [{"code": "82664", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 76.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 156.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 246.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 246.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 246.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 88.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 88.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYS MAP 3D ADD-ON", "code_information": [{"code": "93613", "type": "CPT"}], "standard_charges": [{"minimum": 1371.6, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1371.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2155.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2155.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2155.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGIC STUDY", "code_information": [{"code": "93624", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 40787.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25955.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93619", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 40787.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25955.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93620", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 40787.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25955.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93621", "type": "CPT"}], "standard_charges": [{"minimum": 538.77, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 538.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 846.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 846.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 846.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93622", "type": "CPT"}], "standard_charges": [{"minimum": 797.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 797.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1253.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1253.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1253.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93641", "type": "CPT"}], "standard_charges": [{"minimum": 1446.3, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1446.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2272.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2272.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2272.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93642", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4355.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93644", "type": "CPT"}], "standard_charges": [{"minimum": 233.64, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 233.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 367.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 367.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 367.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROSURGICAL SWITCHPEN AND ELECTRODE SINGLE-USE FOR FLUID MEDIA 7205565", "code_information": [{"code": "7205565", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVATION OF DEPRESSED SKULL FRACTURE;COMPOUND OR COMMINUTED EXTRADURAL 62005", "code_information": [{"code": "62005", "type": "CPT"}, {"code": "1480681", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEVATION OF DEPRESSED SKULL FRACTURE;SIMPLE EXTRADURAL 62000", "code_information": [{"code": "62000", "type": "CPT"}, {"code": "1480682", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 9357.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEVATION OF DEPRESSED SKULL FX W/REPAIR OF DURA AND/OR DEBRIDEMENT OF BRAIN 62010", "code_information": [{"code": "62010", "type": "CPT"}, {"code": "1480683", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEVATOR PASSING TUNNELLING FOR SPINAL CORD STIMULATION", "code_information": [{"code": "SC-4230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVIEW LIFTING FLUID", "code_information": [{"code": "ELEVIEW", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 306.88, "discounted_cash": 107.41, "setting": "both", "billing_class": "facility"}]}, {"description": "ELISA HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0433", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 73.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EM 5 PERCENT WL", "code_information": [{"code": "G9880", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EM 9 PERCENT WL", "code_information": [{"code": "G9881", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EM BRIDGE PAYMENT", "code_information": [{"code": "G9890", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EM SESSION REPORTING", "code_information": [{"code": "G9891", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EMA EACH IG CLASS", "code_information": [{"code": "86231", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EMBEDDED IP CATH EXIT-SITE", "code_information": [{"code": "49436", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EMBOLIZATION DOC SEPARATLY", "code_information": [{"code": "G9962", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EMBOLIZATION NOT DOC SEPARAT", "code_information": [{"code": "G9963", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EMBRYO HATCHING", "code_information": [{"code": "89253", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EMERGE CASES", "code_information": [{"code": "M1142", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EMERGENCY MED SS", "code_information": [{"code": "G4003", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EMLA CREAM 2.5%-2.5% 30 GM", "code_information": [{"code": "MED0634", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 23.45, "setting": "both", "billing_class": "facility"}]}, {"description": "EMPOWER 3D KNEE TIBIAL INSERT EPLUS 14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "342-14-708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "EMPOWR TIBIA-POROUS COATED RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "353-02-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ENCEPHALITIS CALIFORN ANTBDY", "code_information": [{"code": "86651", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS EAST EQNE ANBDY", "code_information": [{"code": "86652", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS ST LOUIS ANTBODY", "code_information": [{"code": "86653", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS WEST EQNE ANTBDY", "code_information": [{"code": "86654", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDCAP LOCKING FOR PEDICLE SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS01.9853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO ABL PROC YR PREV IND DT", "code_information": [{"code": "G9822", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO ASSAY SEVEN ANAL", "code_information": [{"code": "81506", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 101.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 99.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 99.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43261", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43262", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO OUTLET RESTRICT W/TUBE", "code_information": [{"code": "C9785", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO RETRACT 10MM", "code_information": [{"code": "176613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO SLEEVE GASTRO W/TUBE", "code_information": [{"code": "C9784", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO SMPL/HYST BX RES DOC", "code_information": [{"code": "G9823", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO SMPL/HYST BX RES NO DOC", "code_information": [{"code": "G9824", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO US-GUIDE HEP PORTO GRAD", "code_information": [{"code": "C9768", "type": "HCPCS"}], "standard_charges": [{"minimum": 1018.38, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOBLADE GASTROC RECESSION SYS", "code_information": [{"code": "AR-8855-DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2124.69, "discounted_cash": 743.64, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOCERVICAL CURETTAGE 57505", "code_information": [{"code": "57505", "type": "CPT"}, {"code": "1480685", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH CC", "code_information": [{"code": "644", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6203.44, "maximum": 10649.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6203.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8872.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9759.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10649.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [{"code": "643", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10144.62, "maximum": 17415.79, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10144.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14508.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15959.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17415.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "645", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4675.39, "maximum": 8026.49, "estimated_discounted_cash": 31148.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4675.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6686.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7355.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8026.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINOLOGY SS", "code_information": [{"code": "G4004", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOILLUMINATION PROBE 27G 3269.D04", "code_information": [{"code": "3269.D04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOILLUMINATION PROBEINCLUDING ILLUMINATED SCLERAL DEPRESSOR 23G/0.6 3269.D06", "code_information": [{"code": "3269.D06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOILLUMINATOR WIDE ANGLE 25GA 8065751185", "code_information": [{"code": "8065751185", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 377.0, "discounted_cash": 131.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOKNOT 0 VICRYL COATED 42 JK10G", "code_information": [{"code": "JK10G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLOOP 0 PDSII LIGATURE 18 EZ10G", "code_information": [{"code": "EZ10G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 32.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX BILIARY TREE", "code_information": [{"code": "47543", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX URTR RNL PLVS", "code_information": [{"code": "50606", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINL IVUS OCT C 1ST", "code_information": [{"code": "92978", "type": "CPT"}], "standard_charges": [{"minimum": 443.43, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 443.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 696.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 696.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 696.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINL IVUS OCT C EA", "code_information": [{"code": "92979", "type": "CPT"}], "standard_charges": [{"minimum": 352.84, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 352.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 554.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 554.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 554.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLYMPHATIC SAC OPERATION W/O SHUNT 69805", "code_information": [{"code": "69805", "type": "CPT"}, {"code": "1480686", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLYMPHATIC SAC OPERATION;WITH SHUNT 69806", "code_information": [{"code": "69806", "type": "CPT"}, {"code": "1480687", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOMETRIAL ABLATION; THERMAL 58353", "code_information": [{"code": "58353", "type": "CPT"}, {"code": "1480688", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOMETRIAL BIOPSY 58100", "code_information": [{"code": "58100", "type": "CPT"}, {"code": "1480689", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOMETRIAL CRYOABLATION W/ ULTRASONIC GUIDANCE 58356", "code_information": [{"code": "58356", "type": "CPT"}, {"code": "1480691", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 9357.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDONEEDLE SIZE 0 110CM 24MM TAPERCUT EC11", "code_information": [{"code": "EC11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 215.0, "discounted_cash": 75.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSCOPIC DECOMPRESSION OF SPINAL CORD INC. LAMINOTOMY PARTIAL FACETECTOMY LUMBAR 62380", "code_information": [{"code": "62380", "type": "CPT"}, {"code": "44660575", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 7147.0, "discounted_cash": 2501.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3459.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC EVALUATION OF SMALL INTESTINAL POUCH W/BIOPSY; INCL. COLLECTION OF SPECIMENS 44386", "code_information": [{"code": "44386", "type": "CPT"}, {"code": "1480693", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC EVALUATION OF SMALL INTESTINAL POUCH; INCL. COLLECTION OF SPECIMENS 44385", "code_information": [{"code": "44385", "type": "CPT"}, {"code": "1480692", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC PANCREATOSCOPY", "code_information": [{"code": "43273", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC US EXAM ESOPH", "code_information": [{"code": "43237", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC VEIN HARVEST", "code_information": [{"code": "33508", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY INTESTINE SMALL-DISTAL DUODENUM NOT INCL. ILEUM 44360", "code_information": [{"code": "44360", "type": "CPT"}, {"code": "1480694", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY LIGATE PERF VEINS", "code_information": [{"code": "37500", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY NASAL ETHMOIDECTOMY PARTIAL 31254", "code_information": [{"code": "31254", "type": "CPT"}, {"code": "1480695", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY NASAL ETHMOIDECTOMY TOTAL 31255", "code_information": [{"code": "31255", "type": "CPT"}, {"code": "1480696", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50951", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) I&R", "code_information": [{"code": "92613", "type": "CPT"}], "standard_charges": [{"minimum": 170.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 170.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) VID", "code_information": [{"code": "92612", "type": "CPT"}], "standard_charges": [{"minimum": 308.35, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 308.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 484.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 484.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 484.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY W/ PERCUTANEOUS PLACEMENT JEJUNOSTOMY TUBE 44372", "code_information": [{"code": "44372", "type": "CPT"}, {"code": "1480701", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY W/BIOPSY INTESTINE SMALL-DISTAL DUODENUM 44361", "code_information": [{"code": "44361", "type": "CPT"}, {"code": "1480700", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY WRIST W/RELEASE OF TRANSVERSE CARPAL LIGAMENT 29848", "code_information": [{"code": "29848", "type": "CPT"}, {"code": "1480703", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCRUB 2 SHEATH 4MM 0D", "code_information": [{"code": "1912000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSKELETON IMPLANT 6 DEG (16MMX14MM) - 7MM 5366-1407-N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5366-1407-N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOVAS ILIAC A DEVICE ADDON", "code_information": [{"code": "34808", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH DELAYED", "code_information": [{"code": "33886", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH TAA ADD-ON", "code_information": [{"code": "33884", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR INCL SUBCL", "code_information": [{"code": "33880", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR W/O SUBCL", "code_information": [{"code": "33881", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TEMPORY VESSEL OCCL", "code_information": [{"code": "61623", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 1 GRAFT", "code_information": [{"code": "34841", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 2 GRAFT", "code_information": [{"code": "34842", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 3 GRAFT", "code_information": [{"code": "34843", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 4 GRAFT", "code_information": [{"code": "34844", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [{"code": "266", "type": "MS-DRG"}], "standard_charges": [{"minimum": 42872.38, "maximum": 73601.22, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42872.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 61316.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67448.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73601.22, "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": 34052.63, "maximum": 58459.91, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34052.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48702.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53572.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58459.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES 1ST", "code_information": [{"code": "36482", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES SBSQ", "code_information": [{"code": "36483", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER 1ST VEIN", "code_information": [{"code": "36478", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER VEIN ADDON", "code_information": [{"code": "36479", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM 1ST VEIN", "code_information": [{"code": "36473", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM ADD-ON", "code_information": [{"code": "36474", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF 1ST VEIN", "code_information": [{"code": "36475", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF VEIN ADD-ON", "code_information": [{"code": "36476", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENT BALLON DILATION INSPIRA AIR 16 X 40MM", "code_information": [{"code": "BC1640A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.0, "discounted_cash": 159.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST DISPR AG IA", "code_information": [{"code": "87336", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST GROUP AG IA", "code_information": [{"code": "87337", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTELLUS XPRESS LOPROFILE 7 X 20MM", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "LPLF-107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2190.0, "discounted_cash": 766.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ENTERECTOMY CADAVER DONOR", "code_information": [{"code": "44132", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CONG ADD-ON", "code_information": [{"code": "44128", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY LIVE DONOR", "code_information": [{"code": "44133", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/O TAPER CONG", "code_information": [{"code": "44126", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/TAPER CONG", "code_information": [{"code": "44127", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROLYSIS 44005", "code_information": [{"code": "44005", "type": "CPT"}, {"code": "11906511", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1619.64, "maximum": 8450.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1619.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS ANTIBODY", "code_information": [{"code": "86658", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS ANTIBODY DFA", "code_information": [{"code": "87267", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS PROBE&REVRS TRNS", "code_information": [{"code": "87498", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTRADA NEEDLE COMPONENT FOR SPINAL CORD", "code_information": [{"code": "SC-4220-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ENUCLEATION OF EYE;WITH IMPLANT MUSCLES ATTACHED 65105", "code_information": [{"code": "65105", "type": "CPT"}, {"code": "1480710", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENUCLEATION OF EYE;WITH IMPLANT MUSCLES NOT ATTACHED 65103", "code_information": [{"code": "65103", "type": "CPT"}, {"code": "1480711", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENUCLEATION OF EYE;WITHOUT IMPLANT 65101", "code_information": [{"code": "65101", "type": "CPT"}, {"code": "1480712", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENVELOPE STEAM ATTEST FLASH OR LOW TEMP", "code_information": [{"code": "M1254E-A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ENVIRONMENTAL MANIPULATION", "code_information": [{"code": "90882", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENZYME CELL ACTIVITY", "code_information": [{"code": "82657", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENZYME CELL ACTIVITY RA", "code_information": [{"code": "82658", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 55.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 112.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 176.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 176.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 176.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 63.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 63.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENZYME HISTOCHEMISTRY", "code_information": [{"code": "88319", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 170.43, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 181.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EOM MEOS PAYMENT", "code_information": [{"code": "M0010", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EOSINOPHIL BLOOD COUNT", "code_information": [{"code": "S3630", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EP CARDIO SS", "code_information": [{"code": "G4002", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPHYS EVAL ICDS SS", "code_information": [{"code": "577T", "type": "CPT"}], "standard_charges": [{"minimum": 4355.14, "maximum": 6843.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4355.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDIDYMECTOMY;BILATERAL 54861", "code_information": [{"code": "54861", "type": "CPT"}, {"code": "1480713", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDIDYMECTOMY;UNILATERAL 54860", "code_information": [{"code": "54860", "type": "CPT"}, {"code": "1480714", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDIDYMOVASOSTOMY BILATERAL 54901", "code_information": [{"code": "54901", "type": "CPT"}, {"code": "1480715", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDIDYMOVASOSTOMY UNILATERAL 54900", "code_information": [{"code": "54900", "type": "CPT"}, {"code": "1480716", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT F/N/HF/G ADDL", "code_information": [{"code": "15116", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT FACE/NCK/HF/G", "code_information": [{"code": "15115", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT T/A/L ADD-ON", "code_information": [{"code": "15111", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT TRNK/ARM/LEG", "code_information": [{"code": "15110", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPILEPSY GEN SEQ ALYS PANEL", "code_information": [{"code": "81419", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3525.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3525.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPINEPHRINE 1 MG/ML INJ 1 ML", "code_information": [{"code": "MED0743", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE 1:10,000 10ML SYRINGE", "code_information": [{"code": "MED0456", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE 1:1000 1MG/ML 1ML", "code_information": [{"code": "MED0076", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 20.3, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE 30MG/30 ML", "code_information": [{"code": "MED0078", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 182.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHrine 1 MG/ML INJ SOL 10 ML", "code_information": [{"code": "MED0886", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.32, "discounted_cash": 10.96, "setting": "both", "billing_class": "facility"}]}, {"description": "EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING DISTAL RADIUS AND ULNA 25455", "code_information": [{"code": "25455", "type": "CPT"}, {"code": "1480717", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING DISTAL RADIUS OR ULNA 25450", "code_information": [{"code": "25450", "type": "CPT"}, {"code": "1480718", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPISIOTOMY OR VAGINAL REPAIR; BY OTHER THAN ATTENDING 59300", "code_information": [{"code": "59300", "type": "CPT"}, {"code": "43029616", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITH MCC", "code_information": [{"code": "150", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8075.18, "maximum": 13863.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8075.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11549.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12704.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13863.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITHOUT MCC", "code_information": [{"code": "151", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4491.69, "maximum": 7711.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4491.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6424.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7066.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7711.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR ANTIBODY", "code_information": [{"code": "86663", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR CAPSID VCA", "code_information": [{"code": "86665", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR NUCLEAR ANTIGEN", "code_information": [{"code": "86664", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 61.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 61.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 61.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER AND IP HOSP <2 IN 12 MOS", "code_information": [{"code": "G9521", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER/IP HOSP =/>2 IN 12 MOS", "code_information": [{"code": "G9522", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERASER 18GA BEVEL TIP WET-FIELD", "code_information": [{"code": "221250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ERCP DUCT STENT PLACEMENT", "code_information": [{"code": "43274", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP EA DUCT/AMPULLA DILATE", "code_information": [{"code": "43277", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP LESION ABLATE W/DILATE", "code_information": [{"code": "43278", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP LITHOTRIPSY CALCULI", "code_information": [{"code": "43265", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE DUCT CALCULI", "code_information": [{"code": "43264", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY DUCT", "code_information": [{"code": "43275", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY&ENDO", "code_information": [{"code": "C7560", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP RMV CALC PANCREATOSCOPY", "code_information": [{"code": "C7544", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP SPHINCTER PRESSURE MEAS", "code_information": [{"code": "43263", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP STENT EXCHANGE W/DILATE", "code_information": [{"code": "43276", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/ PANCREATOSCOPY", "code_information": [{"code": "C7541", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/BX & PANCREATOSCOPY", "code_information": [{"code": "C7542", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "397T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "405U", "type": "CPT"}], "standard_charges": [{"minimum": 53.07, "maximum": 2549.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2549.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2549.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/OTOMY, PANCREATOSCOPY", "code_information": [{"code": "C7543", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/SPECIMEN COLLECTION", "code_information": [{"code": "43260", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROMYCIN OPHTHALMIC 0.5% OINTMENT 3.5 GM", "code_information": [{"code": "MED0077", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% 1GM", "code_information": [{"code": "MED0079", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ES2 RING 48281202", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48281202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ESCHAROTOMY ADDL INCISION", "code_information": [{"code": "16036", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESD ENDOSCOPY OR COLONOSCOPY", "code_information": [{"code": "C9779", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESG PLASMA OVAL BUTTON", "code_information": [{"code": "WA22766S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1322.0, "discounted_cash": 462.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ESG PLASMALOOP MEDIUM 12 INCH WA22702S", "code_information": [{"code": "WA22702S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1150.0, "discounted_cash": 402.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ESOPH BALLOON DISTENSION TST", "code_information": [{"code": "91040", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1923.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3021.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3021.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3021.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY LAP", "code_information": [{"code": "43327", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY THOR", "code_information": [{"code": "43328", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCT TEST > 1HR", "code_information": [{"code": "91038", "type": "CPT"}], "standard_charges": [{"minimum": 1737.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1737.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2729.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2729.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2729.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCTION TEST", "code_information": [{"code": "91037", "type": "CPT"}], "standard_charges": [{"minimum": 510.19, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 510.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 801.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 801.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 801.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH LENGTHENING", "code_information": [{"code": "43338", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43206", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SCLEROSIS INJ", "code_information": [{"code": "43204", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SUBMUCOUS INJ", "code_information": [{"code": "43201", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL MOTILITY STUDY", "code_information": [{"code": "78258", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 833.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1309.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1309.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1309.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 393.9, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 419.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL MUCOSAL INTEGRITY TESTING; ELECTRICAL IMPEDANCE TRANSORAL C9777", "code_information": [{"code": "C9777", "type": "HCPCS"}, {"code": "46463125", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 510.19, "maximum": 6074.0, "gross_charge": 4001.0, "discounted_cash": 1400.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 510.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 801.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 801.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 801.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1936.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93615", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4355.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93616", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4355.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL STETHOSCOPE 18FR. DYNJAES40018", "code_information": [{"code": "DYNJAES40018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [{"code": "391", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7598.88, "maximum": 13045.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7598.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10868.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11954.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13045.4, "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": 4658.36, "maximum": 7997.25, "estimated_discounted_cash": 8042.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4658.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6662.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7328.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7997.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY BALLOON DILATATION 43249", "code_information": [{"code": "43249", "type": "CPT"}, {"code": "1480722", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY FLEX TRANSORAL W/ABLATION OF TUMOR/POLYP/LESION 43270", "code_information": [{"code": "43270", "type": "CPT"}, {"code": "18354053", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY GASTRIC OUTLET DILATATION 43245", "code_information": [{"code": "43245", "type": "CPT"}, {"code": "1480723", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY W/BIOPSY 43239", "code_information": [{"code": "43239", "type": "CPT"}, {"code": "1480724", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY W/GUIDE WIRE DILATATION 43248", "code_information": [{"code": "43248", "type": "CPT"}, {"code": "1480725", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE DIAGNOSTIC 43235", "code_information": [{"code": "43235", "type": "CPT"}, {"code": "1480721", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE W/BAND LIGATION OF ESOPH/GASTRIC VARICES 43244", "code_information": [{"code": "43244", "type": "CPT"}, {"code": "6868778", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 910.88, "maximum": 8450.0, "gross_charge": 1882.0, "discounted_cash": 658.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 910.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE W/CONTROL OF BLEEDING 43255", "code_information": [{"code": "43255", "type": "CPT"}, {"code": "10710884", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 949.6, "maximum": 8450.0, "gross_charge": 1962.0, "discounted_cash": 686.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 949.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE W/PLACEMENT OF PERC. GASTROSTOMY TUBE 43246", "code_information": [{"code": "43246", "type": "CPT"}, {"code": "6557299", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 539.17, "maximum": 8450.0, "gross_charge": 1114.0, "discounted_cash": 389.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 539.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE W/REMOVAL OF TUMORS/POLYPS/LESIONS BY SNARE 43251", "code_information": [{"code": "43251", "type": "CPT"}, {"code": "1602930", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY ABDOMINAL", "code_information": [{"code": "43330", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY THORACIC", "code_information": [{"code": "43331", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOPLASTY CONGENITAL", "code_information": [{"code": "43313", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSC DILATE BALLOON 30", "code_information": [{"code": "43214", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSC FLEX TRNSN BIOPSY", "code_information": [{"code": "43198", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP MUCOSAL RESECT", "code_information": [{"code": "43211", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP STENT PLACEMENT", "code_information": [{"code": "43212", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP ULTRASOUND EXAM", "code_information": [{"code": "43231", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY BALLOON <30MM", "code_information": [{"code": "43220", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX DX BRUSH", "code_information": [{"code": "43197", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX REMOVE FB", "code_information": [{"code": "43215", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION ABLATE", "code_information": [{"code": "43229", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION REMOVAL", "code_information": [{"code": "43216", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RETRO BALLOON", "code_information": [{"code": "43213", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID BALLOON", "code_information": [{"code": "43195", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID OR FLEX DIAG W/ OR W/O BRUSH/WASH 43200", "code_information": [{"code": "43200", "type": "CPT"}, {"code": "1601525", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID OR FLEXIBLE W/BX SINGLE OR MULTI 43202", "code_information": [{"code": "43202", "type": "CPT"}, {"code": "1587131", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRANSORAL DIAG W/COL. OF SPECIMEN BY BRUSH OR WASH 43191", "code_information": [{"code": "43191", "type": "CPT"}, {"code": "18353986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO", "code_information": [{"code": "43180", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY SNARE LES REMV", "code_information": [{"code": "43217", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY W/US NEEDLE BX", "code_information": [{"code": "43232", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY; FELXIBLE; TRANSORAL WITH CONTROL OF BLEEDING 43227", "code_information": [{"code": "43227", "type": "CPT"}, {"code": "45304870", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.92, "maximum": 8450.0, "gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY; FELXIBLE; TRANSORAL WITH INSERTION OF GUIDE WIRE/DILATORS 43226", "code_information": [{"code": "43226", "type": "CPT"}, {"code": "45304869", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.92, "maximum": 8450.0, "gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP GUIDE WIRE DILAT", "code_information": [{"code": "43196", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO BIOPSY", "code_information": [{"code": "43193", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO INJECT", "code_information": [{"code": "43192", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO REM FB", "code_information": [{"code": "43194", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS ENDOSCOPY/LIGATION", "code_information": [{"code": "43205", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS MOTILITY STUDY", "code_information": [{"code": "91010", "type": "CPT"}], "standard_charges": [{"minimum": 551.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 551.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 866.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 866.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 866.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHGL MOTIL W/STIM/PERFUS", "code_information": [{"code": "91013", "type": "CPT"}], "standard_charges": [{"minimum": 73.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 73.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 114.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 114.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 114.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESPHG DSTL 2/3 W/LAPS MOBLJ", "code_information": [{"code": "43287", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESPHG THRSC MOBLJ", "code_information": [{"code": "43288", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/LAPS MOBLJ", "code_information": [{"code": "43286", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/THRCM", "code_information": [{"code": "43112", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESR", "code_information": [{"code": "85652", "type": "CPT"}, {"code": "1165918", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 63.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 12-19", "code_information": [{"code": "90965", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 2-11", "code_information": [{"code": "90964", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 20+", "code_information": [{"code": "90966", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO <2YRS", "code_information": [{"code": "90963", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO 20+", "code_information": [{"code": "90962", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO <2YRS", "code_information": [{"code": "90953", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VST P MO 12-19", "code_information": [{"code": "90959", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 2-3 VSTS P MO <2YR", "code_information": [{"code": "90952", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VISITS P MO <2YR", "code_information": [{"code": "90951", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VSTS P MO 2-11", "code_information": [{"code": "90954", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 1 VISIT P MO 2-11", "code_information": [{"code": "90956", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 20+", "code_information": [{"code": "90961", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VISITS P MO 20+", "code_information": [{"code": "90960", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VSTS P MO 12-19", "code_information": [{"code": "90957", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 12-19", "code_information": [{"code": "90969", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 2-11", "code_information": [{"code": "90968", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 20+", "code_information": [{"code": "90970", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT <2", "code_information": [{"code": "90967", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESSURE SYSTEM", "code_information": [{"code": "ESS305-MS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO AORTA", "code_information": [{"code": "36160", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO ARTERY", "code_information": [{"code": "36100", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62190", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62192", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62220", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG 1ST WND", "code_information": [{"code": "512T", "type": "CPT"}], "standard_charges": [{"minimum": 1409.04, "maximum": 2214.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1409.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG EA ADDL", "code_information": [{"code": "513T", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 18970.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12072.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18970.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18970.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18970.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW MUSCSKEL SYS NOS", "code_information": [{"code": "101T", "type": "CPT"}], "standard_charges": [{"minimum": 3951.0, "maximum": 18970.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12072.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18970.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18970.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18970.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW PHY ANES LAT HMRL EPCNDL", "code_information": [{"code": "102T", "type": "CPT"}], "standard_charges": [{"minimum": 3951.0, "maximum": 18970.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12072.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18970.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18970.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18970.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHIGUARD 0 VCRL PLS VIOLT 8-18 CTB2 CR VCPB727D", "code_information": [{"code": "VCPB727D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHIGUARD 1 VICRYL PLUS VIO 8-18 CTX VCPB765D", "code_information": [{"code": "VCPB765D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHIGUARD 2-0 VICRL PLUS UNDYD 27 CTB-2 VCPB269H", "code_information": [{"code": "VCPB269H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHMOIDECTOMY INTRANASAL ANTERIOR 31200", "code_information": [{"code": "31200", "type": "CPT"}, {"code": "23179563", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 5886.0, "discounted_cash": 2060.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2848.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHMOIDECTOMY INTRANASAL TOTAL 31201", "code_information": [{"code": "31201", "type": "CPT"}, {"code": "36235649", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EUGLOBULIN LYSIS", "code_information": [{"code": "85360", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 33.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 33.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EV CATH DIR CHEM ABLTJ W/IMG", "code_information": [{"code": "524T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EV FEMPOP ARTL REVSC", "code_information": [{"code": "505T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAC MEIBOMIAN GLND HEAT BI", "code_information": [{"code": "563T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAC RPR A-BIILIAC NDGFT", "code_information": [{"code": "34705", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVACUATION HEMATOMA 11740", "code_information": [{"code": "11740", "type": "CPT"}, {"code": "1480726", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVACUATION OF SUBDURAL HEMATOMA 61108", "code_information": [{"code": "61108", "type": "CPT"}, {"code": "1480727", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVACUATOR 3 SPRING 400 CC DRAIN 1/4 0043620", "code_information": [{"code": "43620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EVACUATOR SILICONE 100CC STERILE 0070740", "code_information": [{"code": "70740", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "EVACUATOR SILICONE 400CC BULB", "code_information": [{"code": "70400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "EVACUATOR SMOKE PENCIL", "code_information": [{"code": "CVPLP2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "EVAL AMNIOTIC FLUID PROTEIN", "code_information": [{"code": "84112", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 250.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 393.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 393.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 393.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 141.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 141.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ 1ST HOUR", "code_information": [{"code": "92626", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ EA ADDL 15", "code_information": [{"code": "92627", "type": "CPT"}], "standard_charges": [{"minimum": 81.06, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 127.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 127.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 127.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL ON FOOT DOCUMENTED", "code_information": [{"code": "G8410", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL ON FOOT NOT PERFORMED", "code_information": [{"code": "G8415", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL RISK VTE CARD 30D PRIOR", "code_information": [{"code": "G9298", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATE PT USE OF INHALER", "code_information": [{"code": "94664", "type": "CPT"}], "standard_charges": [{"minimum": 811.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 811.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATE SPEECH PRODUCTION", "code_information": [{"code": "92522", "type": "CPT"}], "standard_charges": [{"minimum": 413.22, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 413.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 649.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 649.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 649.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATE SWALLOWING FUNCTION", "code_information": [{"code": "92610", "type": "CPT"}], "standard_charges": [{"minimum": 327.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 327.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION CERVICAL MUCUS", "code_information": [{"code": "89330", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 41.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 41.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION HEART DEVICE", "code_information": [{"code": "93640", "type": "CPT"}], "standard_charges": [{"minimum": 826.43, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 826.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1298.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1298.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1298.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF SPEECH FLUENCY", "code_information": [{"code": "92521", "type": "CPT"}], "standard_charges": [{"minimum": 510.19, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 510.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 801.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 801.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 801.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF WHEEZING", "code_information": [{"code": "94060", "type": "CPT"}], "standard_charges": [{"minimum": 208.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 208.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 327.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 327.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 327.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF WHEEZING", "code_information": [{"code": "94070", "type": "CPT"}], "standard_charges": [{"minimum": 138.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT 1ST", "code_information": [{"code": "61650", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT ADD", "code_information": [{"code": "61651", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT", "code_information": [{"code": "34701", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT RPT", "code_information": [{"code": "34702", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-BIILIAC RPT", "code_information": [{"code": "34706", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-ILIAC NDGFT", "code_information": [{"code": "34717", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT", "code_information": [{"code": "34703", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT RPT", "code_information": [{"code": "34704", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC NDGFT", "code_information": [{"code": "34707", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC RPT", "code_information": [{"code": "34708", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR N/A A-ILIAC NDGFT", "code_information": [{"code": "34718", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA ACRS BR", "code_information": [{"code": "33894", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA X CRSG", "code_information": [{"code": "33895", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC VEN ARTLZ TIBL/PRNL VN", "code_information": [{"code": "620T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVISCERATION OF OCULAR CONTENTS;WITH IMPLANT 65093", "code_information": [{"code": "65093", "type": "CPT"}, {"code": "1480728", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVISCERATION OF OCULAR CONTENTS;WITHOUT IMPLANT 65091", "code_information": [{"code": "65091", "type": "CPT"}, {"code": "1480729", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST LIMITED", "code_information": [{"code": "92587", "type": "CPT"}], "standard_charges": [{"minimum": 15.88, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST QUAL", "code_information": [{"code": "92558", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TST COMPLETE", "code_information": [{"code": "92588", "type": "CPT"}], "standard_charges": [{"minimum": 20.68, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOS 2.7MM X 15MM CORTEX SCREW T8 SELF-TAPPING 72402715", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "EVOS 2.7MM X 16MM CORTEX SCREW T8 SELF-TAPPING 72402716", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "EVOS 2.7MM X 18MM CORTEX SCREW T8 SELF-TAPPING 72402718", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "EVOS 2.7MM X 20MM CORTEX SCREW T8 SELF-TAPPING 72402720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "EVOS 4.0MM X 18MM OSTEOPENIA SCREW T8 FULLY THREADED 72424018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "EWK 201", "code_information": [{"code": "E-KIT ADVANCED", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1773.0, "discounted_cash": 620.55, "setting": "both", "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEV RX ADD", "code_information": [{"code": "92618", "type": "CPT"}], "standard_charges": [{"minimum": 149.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEVICE RX", "code_information": [{"code": "92605", "type": "CPT"}], "standard_charges": [{"minimum": 402.1, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 402.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 631.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 631.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 631.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX 1HR", "code_information": [{"code": "92607", "type": "CPT"}], "standard_charges": [{"minimum": 586.44, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 586.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 921.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 921.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 921.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX ADDL", "code_information": [{"code": "92608", "type": "CPT"}], "standard_charges": [{"minimum": 233.64, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 233.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 367.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 367.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 367.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXACTACAINE/CETACAINE TOPICAL ANESTHETIC SPRAY 56 GM", "code_information": [{"code": "MED0080", "type": "CDM"}], "standard_charges": [{"gross_charge": 189.0, "discounted_cash": 66.15, "setting": "both", "billing_class": "facility"}]}, {"description": "EXAM FECES FOR MEAT FIBERS", "code_information": [{"code": "89160", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM UNDER ANESTHESIA ANORECTAL 45990", "code_information": [{"code": "45990", "type": "CPT"}, {"code": "1480730", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1871.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM OVER 10 CM", "code_information": [{"code": "49205", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC BIOPSY OF SALIV GLANDS", "code_information": [{"code": "D7284", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/LYMPHADEC", "code_information": [{"code": "21603", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/O LYMPHADEC", "code_information": [{"code": "21602", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC CHEST WALL TUMOR W/RIBS", "code_information": [{"code": "21601", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FACE TUM DEEP < 2 CM", "code_information": [{"code": "21013", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELV TUM DEEP 5 CM/>", "code_information": [{"code": "27045", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC LESION SPERMATIC CORD SEPARATE PROC 55520", "code_information": [{"code": "55520", "type": "CPT"}, {"code": "1643988", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1274.37, "maximum": 8450.0, "gross_charge": 2633.0, "discounted_cash": 921.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1274.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC MALIGNANT LESION INCLUDING MARGIN TRUNK/ARM/LEG 0.5CM OR LESS 11600", "code_information": [{"code": "11600", "type": "CPT"}, {"code": "1700090", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.92, "maximum": 8450.0, "gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC NEUROMA W/ IMPLNT NV END", "code_information": [{"code": "C7551", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC PAROTID TUMOR OR GLAND LATERAL LOBE TOTAL W/DISSEC. FACIAL NERVE 42420", "code_information": [{"code": "42420", "type": "CPT"}, {"code": "1718542", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC PAROTID TUMOR OR GLAND LATERAL LOBE W/DISSEC. PRESERVE FACIAL NERVE 42415", "code_information": [{"code": "42415", "type": "CPT"}, {"code": "1646743", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC RECTAL TUMOR ENDOSCOPIC", "code_information": [{"code": "184T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC TUMOR SOFT TISSUE FOREARM/WRIST LESS THAN 3CM 25076", "code_information": [{"code": "25076", "type": "CPT"}, {"code": "1700051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC. BENIGN LESION W/MARGINS 0.6CM TO 1.0CM 11422", "code_information": [{"code": "11422", "type": "CPT"}, {"code": "1587163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC. BENIGN LESION W/MARGINS SCALP/NECK/FT/HD/GENT. OVER 4.0CM 11426", "code_information": [{"code": "11426", "type": "CPT"}, {"code": "1954774", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC. LESION OF MUCOSA/SUBMUCOSA MOUTH W/SIMPLE REPAIR 40812", "code_information": [{"code": "40812", "type": "CPT"}, {"code": "1587118", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC. OF SKIN AND SUBCU. TISSUE FOR HIDRADENITIS; PERIANAL/PERINEAL/UMBILICAL W/COMPLEX REPAIR 11471", "code_information": [{"code": "11471", "type": "CPT"}, {"code": "18959518", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1550.25, "maximum": 8450.0, "gross_charge": 3203.0, "discounted_cash": 1121.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1550.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC. OR CURRETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES 25130", "code_information": [{"code": "25130", "type": "CPT"}, {"code": "1900983", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC. OR CURRETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS/ULNA EXC. HEAD/NECK 25120", "code_information": [{"code": "25120", "type": "CPT"}, {"code": "1900986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC.& EXTEN.REPAIR EYELID W/LID MARGIN TARSUS CONJUNCTCANT.W/SKIN GRAFT 67961", "code_information": [{"code": "67961", "type": "CPT"}, {"code": "1480731", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC.OF CHALAZION W/GEN.ANESTHESIA REQUIRING HOSPITALIZATION SINGLE OR MULTI 67808", "code_information": [{"code": "67808", "type": "CPT"}, {"code": "1480732", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCAVATE TOOTH NON-RESTORABL", "code_information": [{"code": "D2989", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCH BIL CATH W/ RMV CALCULI", "code_information": [{"code": "C7545", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCH NEPH CATH W/ DIL STRIC", "code_information": [{"code": "C7548", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGE BILIARY DRG CATH", "code_information": [{"code": "47536", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGE DRAINAGE CATHETER", "code_information": [{"code": "49423", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGE NEPHROSTOMY CATH", "code_information": [{"code": "50435", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGE OF INTRAOCULAR LENS 66986", "code_information": [{"code": "66986", "type": "CPT"}, {"code": "1480733", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGER HEAT MOISTURE 15MM X 22MM NON STRL TREATED OPEN CELL FOAM MEDIA WITHOU", "code_information": [{"code": "2840", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 57.4, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS 250-500", "code_information": [{"code": "96921", "type": "CPT"}], "standard_charges": [{"minimum": 770.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS<250SQCM", "code_information": [{"code": "96920", "type": "CPT"}], "standard_charges": [{"minimum": 770.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS>500SQCM", "code_information": [{"code": "96922", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1409.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIS UPPR JAW CYST W/REPAIR", "code_information": [{"code": "21049", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE BREAST DUCT FISTULA", "code_information": [{"code": "19112", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EPIPHYSEAL BAR", "code_information": [{"code": "20150", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN ARM/HAND", "code_information": [{"code": "15837", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN FAT PAD", "code_information": [{"code": "15838", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN HIP", "code_information": [{"code": "15834", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN LEG", "code_information": [{"code": "15833", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE ILEOANAL RESERVIOR", "code_information": [{"code": "45136", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE INTESTINE LESION(S)", "code_information": [{"code": "44110", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE LWR JAW CYST W/REPAIR", "code_information": [{"code": "21047", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE MAX/ZYGOMA MAL TUMOR", "code_information": [{"code": "21034", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE ORAL MUCOSA FOR GRAFT", "code_information": [{"code": "40818", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42425", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42426", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE SACRAL SPINE TUMOR", "code_information": [{"code": "49215", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE/REPAIR MOUTH LESION", "code_information": [{"code": "40814", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION ADDL BREAST LESION", "code_information": [{"code": "19126", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION AURAL GLOMUS TUMOR TRANSCANAL 69550", "code_information": [{"code": "69550", "type": "CPT"}, {"code": "1480735", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION AURAL GLOMUS TUMOR TRANSMASTOID 69552", "code_information": [{"code": "69552", "type": "CPT"}, {"code": "1480736", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION FACIAL 0.5CM OR LESS 11440", "code_information": [{"code": "11440", "type": "CPT"}, {"code": "1480737", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION FACIAL 0.6CM -1.0CM 11441", "code_information": [{"code": "11441", "type": "CPT"}, {"code": "1480738", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION FACIAL 1.1CM -2.0CM 11442", "code_information": [{"code": "11442", "type": "CPT"}, {"code": "1480739", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION FACIAL 2.1CM -3.0CM 11443", "code_information": [{"code": "11443", "type": "CPT"}, {"code": "1480740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION FACIAL 3.1CM -4.0CM 11444", "code_information": [{"code": "11444", "type": "CPT"}, {"code": "1480741", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION FACIAL 4.0CM OR MORE 11446", "code_information": [{"code": "11446", "type": "CPT"}, {"code": "1480742", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION MARGINS EXCEPT SKIN TAG 2.1CM-3.0CM 11423", "code_information": [{"code": "11423", "type": "CPT"}, {"code": "1582400", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 598.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION TRUNK 0.6CM -1.0CM 11401", "code_information": [{"code": "11401", "type": "CPT"}, {"code": "1480743", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION TRUNK 1.1CM -2.0CM 11402", "code_information": [{"code": "11402", "type": "CPT"}, {"code": "1480744", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION TRUNK 2.1CM -3.0CM 11403", "code_information": [{"code": "11403", "type": "CPT"}, {"code": "1480745", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION TRUNK 3.1CM -4.0CM 11404", "code_information": [{"code": "11404", "type": "CPT"}, {"code": "1480746", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION TRUNK 4.0CM OR MORE 11406", "code_information": [{"code": "11406", "type": "CPT"}, {"code": "1480747", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION W/MAR. HEAD/NECK/HAND/FT/GENI. 0.5CM OR LESS 11420", "code_information": [{"code": "11420", "type": "CPT"}, {"code": "1600099", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 402.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION W/MARGIN SCALP/NECK/HAND/FT/GENT. 3.1 TO 4.0CM 11424", "code_information": [{"code": "11424", "type": "CPT"}, {"code": "1839672", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION W/MARGIN SCALP/NECK/HND/FT/GENT. 0.6 TO 1.0CM 11421", "code_information": [{"code": "11421", "type": "CPT"}, {"code": "1845639", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESIONTRUNK 0.5CM OR LESS 11400", "code_information": [{"code": "11400", "type": "CPT"}, {"code": "1480748", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN TUMOR MANDIBLE 21040", "code_information": [{"code": "21040", "type": "CPT"}, {"code": "1480749", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BONE CYST MAXILLA/ZYGOMA 21030", "code_information": [{"code": "21030", "type": "CPT"}, {"code": "1480750", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1508.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BONE SPUR FIBULA 27641", "code_information": [{"code": "27641", "type": "CPT"}, {"code": "1480752", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BONE TIBIA 27640", "code_information": [{"code": "27640", "type": "CPT"}, {"code": "1480753", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BRACHIAL CLEFT CYST OR VESTIGE CONFINED TO SKIN /SQ TISSUE 42810", "code_information": [{"code": "42810", "type": "CPT"}, {"code": "1646739", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BRACHIAL CLEFT CYST/VESTIGE/FISTULA EXT. BELOW SQ TISSUE AND/OR INTO PHARYNX 42815", "code_information": [{"code": "42815", "type": "CPT"}, {"code": "7616962", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2630.05, "maximum": 9357.0, "gross_charge": 5434.0, "discounted_cash": 1901.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2630.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION CYST BAKERS 27345", "code_information": [{"code": "27345", "type": "CPT"}, {"code": "1480754", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION CYST DERMOID NOSE-COMPLEX UNDER BONE/CARTILAGE 30125", "code_information": [{"code": "30125", "type": "CPT"}, {"code": "1480756", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION CYST DERMOID NOSE-SIMPLE 30124", "code_information": [{"code": "30124", "type": "CPT"}, {"code": "1480757", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION CYST KNEE 27347", "code_information": [{"code": "27347", "type": "CPT"}, {"code": "1480759", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION CYST PILONIDAL COMPLICATED 11772", "code_information": [{"code": "11772", "type": "CPT"}, {"code": "1480761", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION CYST PILONIDAL EXTENSIVE 11771", "code_information": [{"code": "11771", "type": "CPT"}, {"code": "1480762", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION CYST PILONIDAL SIMPLE 11770", "code_information": [{"code": "11770", "type": "CPT"}, {"code": "1480763", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION DISTAL ULNA 25240", "code_information": [{"code": "25240", "type": "CPT"}, {"code": "1480764", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION EXCESS SKIN OTHER 15839", "code_information": [{"code": "15839", "type": "CPT"}, {"code": "1480765", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION EXOTOSIS/ES EXTERNAL AUDITORY CANAL 69140", "code_information": [{"code": "69140", "type": "CPT"}, {"code": "2001902", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR 69110", "code_information": [{"code": "69110", "type": "CPT"}, {"code": "1718540", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION FLEXOR TENDON W/IMPLANT 26390", "code_information": [{"code": "26390", "type": "CPT"}, {"code": "1480766", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION FULL THICKNESS TUMOR BY PROCTOTOMY 45172", "code_information": [{"code": "45172", "type": "CPT"}, {"code": "1480767", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GANGLION RECURRENT 25112", "code_information": [{"code": "25112", "type": "CPT"}, {"code": "1480768", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GANGLION WRIST PRIMARY 25111", "code_information": [{"code": "25111", "type": "CPT"}, {"code": "1480769", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT ABDOMEN", "code_information": [{"code": "35907", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT EXTREMITY", "code_information": [{"code": "35903", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT NECK", "code_information": [{"code": "35901", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT THORAX", "code_information": [{"code": "35905", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GUM EACH QUADRANT", "code_information": [{"code": "41820", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GYNECOMASTIA 19300", "code_information": [{"code": "19300", "type": "CPT"}, {"code": "1480770", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION HAND/FINGER TENDON", "code_information": [{"code": "26415", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION INFERIOR TURBINATE/PARTIAL OR COMPLETE 30130", "code_information": [{"code": "30130", "type": "CPT"}, {"code": "1480771", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION INTERDIGITAL NEUROMA EACH 28080", "code_information": [{"code": "28080", "type": "CPT"}, {"code": "1480772", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION ANUS 46922", "code_information": [{"code": "46922", "type": "CPT"}, {"code": "1480773", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION FLOOR OF MOUTH 41116", "code_information": [{"code": "41116", "type": "CPT"}, {"code": "4040499", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION INTRANASAL-EXTERNAL APPROACH 30118", "code_information": [{"code": "30118", "type": "CPT"}, {"code": "1480774", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION OF PALATE / UVULA WITH LOCAL FLAP 42107", "code_information": [{"code": "42107", "type": "CPT"}, {"code": "4040504", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1589.94, "maximum": 8450.0, "gross_charge": 3285.0, "discounted_cash": 1149.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1589.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION OF PALATE UVULA WITH SIMPLE PRIMARY CLOSURE 42106", "code_information": [{"code": "42106", "type": "CPT"}, {"code": "10710882", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 869.0, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION OF TENDON SHEATH HAND OR FINGER 26160", "code_information": [{"code": "26160", "type": "CPT"}, {"code": "1480775", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION OF TONGUE W/CLOSURE ANTERIOR 2/3 41112", "code_information": [{"code": "41112", "type": "CPT"}, {"code": "1480776", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION OF TONGUE W/CLOSURE POSTERIOR 1/3 41113", "code_information": [{"code": "41113", "type": "CPT"}, {"code": "1480777", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION OF TONGUE W/LOCAL TONGUE FLAP 41114", "code_information": [{"code": "41114", "type": "CPT"}, {"code": "1480778", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION OF TONGUE W/O CLOSURE 41110", "code_information": [{"code": "41110", "type": "CPT"}, {"code": "1480779", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION PALATE UVULA W/O CLOSURE 42104", "code_information": [{"code": "42104", "type": "CPT"}, {"code": "5970870", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION PENIS 54060", "code_information": [{"code": "54060", "type": "CPT"}, {"code": "1480780", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION TENDON SHEATH 25110", "code_information": [{"code": "25110", "type": "CPT"}, {"code": "1480782", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION/TENDON/TENDON SHEATH OR CAPSULE FOOT 28090", "code_information": [{"code": "28090", "type": "CPT"}, {"code": "1480783", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION/TENDON/TENDON SHEATH OR CAPSULE TOE 28092", "code_information": [{"code": "28092", "type": "CPT"}, {"code": "1480784", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA ABDOMINAL WALL 3CM OR MORE 22903", "code_information": [{"code": "22903", "type": "CPT"}, {"code": "1480785", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA ABDOMINAL WALL 5CM OR MORE 22901", "code_information": [{"code": "22901", "type": "CPT"}, {"code": "1480786", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA ABDOMINAL WALL LESS THAN 3CM 22902", "code_information": [{"code": "22902", "type": "CPT"}, {"code": "1480787", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA ABDOMINAL WALL LESS THAN 5CM 22900", "code_information": [{"code": "22900", "type": "CPT"}, {"code": "1480788", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA ARM SUBCUTANEOUS LESS THAN 3CM 24075", "code_information": [{"code": "24075", "type": "CPT"}, {"code": "1480790", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA ARM SUBFASCIAL 5CM OR GREATER 24073", "code_information": [{"code": "24073", "type": "CPT"}, {"code": "1480791", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA ARM SUBFASCIAL LESS THAN 5 CM 24076", "code_information": [{"code": "24076", "type": "CPT"}, {"code": "1480792", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA BACK 3CM OR LESS 21930", "code_information": [{"code": "21930", "type": "CPT"}, {"code": "1480793", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA BACK 3CM OR MORE 21931", "code_information": [{"code": "21931", "type": "CPT"}, {"code": "1480794", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA BACK 5CM OR MORE 21933", "code_information": [{"code": "21933", "type": "CPT"}, {"code": "1480795", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA BACK W/FASCIA 21932", "code_information": [{"code": "21932", "type": "CPT"}, {"code": "1480796", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA BREAST 19120", "code_information": [{"code": "19120", "type": "CPT"}, {"code": "1480797", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA CHEST WALL 19260", "code_information": [{"code": "19260", "type": "CPT"}, {"code": "1480798", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA LEG 27634", "code_information": [{"code": "27634", "type": "CPT"}, {"code": "1480799", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5868.0, "discounted_cash": 2053.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2840.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA LEG OR ANKLE LESS THAN 3 CM 27618", "code_information": [{"code": "27618", "type": "CPT"}, {"code": "1480800", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA NECK I 21552", "code_information": [{"code": "21552", "type": "CPT"}, {"code": "1480801", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA NECK LESS THAN 3 CM 21555", "code_information": [{"code": "21555", "type": "CPT"}, {"code": "1480803", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA NECK LESS THAN 5 CM 21556", "code_information": [{"code": "21556", "type": "CPT"}, {"code": "1480804", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIGNANT LESION FACIAL 0.5CM OR LESS 11640", "code_information": [{"code": "11640", "type": "CPT"}, {"code": "1480805", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIGNANT LESION FACIAL 0.6CM -1.0CM 11641", "code_information": [{"code": "11641", "type": "CPT"}, {"code": "1480806", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIGNANT LESION FACIAL 1.1CM -2.0CM 11642", "code_information": [{"code": "11642", "type": "CPT"}, {"code": "1480807", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIGNANT LESION FACIAL 2.1CM -3.0CM 11643", "code_information": [{"code": "11643", "type": "CPT"}, {"code": "1480808", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIGNANT LESION FACIAL 3.1CM -4.0CM 11644", "code_information": [{"code": "11644", "type": "CPT"}, {"code": "1480809", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIGNANT LESION FACIAL 4.0CM OR MORE 11646", "code_information": [{"code": "11646", "type": "CPT"}, {"code": "1480810", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIGNANT LESION SCALP 0.5CM OR LESS 11620", "code_information": [{"code": "11620", "type": "CPT"}, {"code": "1480811", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIGNANT LESION TRUNK ARMS LEGS 1.1 TO 2.0CM 11602", "code_information": [{"code": "11602", "type": "CPT"}, {"code": "1740089", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 534.82, "maximum": 8450.0, "gross_charge": 1105.0, "discounted_cash": 386.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 534.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 762.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIGNANT LESION W/MARGIN TRUNK/ARMS/LEGS 0.6CM TO 1.0CM 11601", "code_information": [{"code": "11601", "type": "CPT"}, {"code": "1795861", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 534.82, "maximum": 8450.0, "gross_charge": 1105.0, "discounted_cash": 386.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 534.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIGNANT TUMOR MANDIBLE 21044", "code_information": [{"code": "21044", "type": "CPT"}, {"code": "1480812", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2297.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS 46230", "code_information": [{"code": "46230", "type": "CPT"}, {"code": "1836679", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION NAIL & MATRIX 11750", "code_information": [{"code": "11750", "type": "CPT"}, {"code": "1480814", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION NAIL 11765", "code_information": [{"code": "11765", "type": "CPT"}, {"code": "1480813", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BARTHOLIN'S GLAND OR CYST 56740", "code_information": [{"code": "56740", "type": "CPT"}, {"code": "1480819", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT CYST", "code_information": [{"code": "47715", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47711", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47712", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BONE LOWER JAW", "code_information": [{"code": "21025", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL LESION(S)", "code_information": [{"code": "44111", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL POUCH", "code_information": [{"code": "44800", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF CERVICAL STUMP VAGINAL APPROACH 57550", "code_information": [{"code": "57550", "type": "CPT"}, {"code": "1480821", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF CERVICAL STUMP WITH REPAIR OF ENTEROCELE 57556", "code_information": [{"code": "57556", "type": "CPT"}, {"code": "1480824", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF CHALAZION;MULTIPLE DIFFERENT LIDS 67805", "code_information": [{"code": "67805", "type": "CPT"}, {"code": "1480825", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF CHALAZION;MULTIPLE SAME LID 67801", "code_information": [{"code": "67801", "type": "CPT"}, {"code": "1480826", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "gross_charge": 1909.0, "discounted_cash": 668.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 923.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 402.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF CHALAZION;SINGLE 67800", "code_information": [{"code": "67800", "type": "CPT"}, {"code": "1480827", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF CONSTRICTING RING OF FINGER WITH MULTIPLE Z PLASTIES 26596", "code_information": [{"code": "26596", "type": "CPT"}, {"code": "13397457", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF CYST OF THYROID 60200", "code_information": [{"code": "60200", "type": "CPT"}, {"code": "1480828", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF CYST OR TUMOR FEMUR 27355", "code_information": [{"code": "27355", "type": "CPT"}, {"code": "1480829", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF CYST OR TUMOR FEMUR W/GRAFT 27356", "code_information": [{"code": "27356", "type": "CPT"}, {"code": "1480830", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43100", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43101", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF EXTRAPARENCHYMAL LESION OF TESTIS 54512", "code_information": [{"code": "54512", "type": "CPT"}, {"code": "1480831", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF FACIAL BONE(S)", "code_information": [{"code": "21026", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF FRENUM LABIAL OR BUCCAL 40819", "code_information": [{"code": "40819", "type": "CPT"}, {"code": "9761824", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.92, "maximum": 8450.0, "gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM FLAP", "code_information": [{"code": "41821", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41822", "type": "CPT"}], "standard_charges": [{"minimum": 985.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 985.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41823", "type": "CPT"}], "standard_charges": [{"minimum": 1334.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1334.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41825", "type": "CPT"}], "standard_charges": [{"minimum": 763.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41826", "type": "CPT"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41828", "type": "CPT"}], "standard_charges": [{"minimum": 869.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HIP JOINT/MUSCLE", "code_information": [{"code": "27036", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HYDROCELE OF SPERMATIC CORD UNILATERAL 55500", "code_information": [{"code": "55500", "type": "CPT"}, {"code": "1480832", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HYDROCELE;BILATERAL 55041", "code_information": [{"code": "55041", "type": "CPT"}, {"code": "1480833", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HYDROCELE;UNILATERAL 55040", "code_information": [{"code": "55040", "type": "CPT"}, {"code": "1480834", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LACRIMAL GLAND EXCEPT FOR TUMOR PARTIAL 68505", "code_information": [{"code": "68505", "type": "CPT"}, {"code": "44718552", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LACRIMAL GLAND EXCEPT FOR TUMOR TOTAL 68500", "code_information": [{"code": "68500", "type": "CPT"}, {"code": "46254354", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1828.55, "maximum": 8450.0, "gross_charge": 3778.0, "discounted_cash": 1322.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1828.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LACRIMAL GLAND TUMOR;FRONTAL APPROACH 68540", "code_information": [{"code": "68540", "type": "CPT"}, {"code": "1480835", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LACRIMAL GLAND TUMOR;INVOLVING OSTEOTOMY 68550", "code_information": [{"code": "68550", "type": "CPT"}, {"code": "1480836", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LACRIMAL SAC 68520", "code_information": [{"code": "68520", "type": "CPT"}, {"code": "1480837", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION CONJUNCTIVA;OVER 1 CM 68110", "code_information": [{"code": "68110", "type": "CPT"}, {"code": "1480838", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 789.0, "maximum": 8450.0, "gross_charge": 2144.0, "discounted_cash": 750.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1037.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION CONJUNCTIVA;UP TO 1 CM 68115", "code_information": [{"code": "68115", "type": "CPT"}, {"code": "1480839", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1037.69, "maximum": 8450.0, "gross_charge": 2144.0, "discounted_cash": 750.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1037.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION CONJUNCTIVA;WITH ADJACENT SCLERA 68130", "code_information": [{"code": "68130", "type": "CPT"}, {"code": "1480840", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION CORNEA EXCEPT PTERYGIUM 65400", "code_information": [{"code": "65400", "type": "CPT"}, {"code": "1480841", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION OF EYELID WITHOUT CLOSURE OR WITH SIMPLE DIRECT CLOSURE 67840", "code_information": [{"code": "67840", "type": "CPT"}, {"code": "1480842", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION OF MUCOSA AND SUBMUCOSA VESTIBULE OF MOUTH W/O REPAIR 40810", "code_information": [{"code": "40810", "type": "CPT"}, {"code": "10710880", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION OF TENDON SHEATH LEG OR ANKLE 27630", "code_information": [{"code": "27630", "type": "CPT"}, {"code": "1480844", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION OR TUMOR DENTOALVEOLAR W/COMPLEX REPAIR 41827", "code_information": [{"code": "41827", "type": "CPT"}, {"code": "4040502", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 9357.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION SCLERA 66130", "code_information": [{"code": "66130", "type": "CPT"}, {"code": "1480845", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LINGUAL FRENUM / FRENECTOMY 41115", "code_information": [{"code": "41115", "type": "CPT"}, {"code": "4040498", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 231.35, "maximum": 8450.0, "gross_charge": 478.0, "discounted_cash": 167.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 231.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LINGUAL TONSIL", "code_information": [{"code": "42870", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LIP TRANSVERSE WEDGE EXCISION W/PRIMARY CLOSURE 40510", "code_information": [{"code": "40510", "type": "CPT"}, {"code": "1700103", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LOCAL LESION OF EPIDIDYMIS 54830", "code_information": [{"code": "54830", "type": "CPT"}, {"code": "1480846", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MALIGNANT LESION MARGINS/SCALP/NECK/HANDS/FEET/GENITALIA 2.1CM TO 3.0CM 11623", "code_information": [{"code": "11623", "type": "CPT"}, {"code": "1480849", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MALIGNANT LESION SCALP 0.6CM TO 1.0CM 11621", "code_information": [{"code": "11621", "type": "CPT"}, {"code": "1480847", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 514.97, "maximum": 8450.0, "gross_charge": 1064.0, "discounted_cash": 372.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 514.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MALIGNANT LESION SCALP 1.1CM TO 2.0CM 11622", "code_information": [{"code": "11622", "type": "CPT"}, {"code": "1480848", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MALIGNANT LESION SCALP 3.1 CM TO 4.0CM 11624", "code_information": [{"code": "11624", "type": "CPT"}, {"code": "1480850", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MALIGNANT LESION SCALP OVER 4.0 CM 11626", "code_information": [{"code": "11626", "type": "CPT"}, {"code": "1480851", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MALIGNANT LESION TRUNK 3.1 CM TO 4.0CM 11604", "code_information": [{"code": "11604", "type": "CPT"}, {"code": "1480853", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MALIGNANT LESION TRUNK OVER 4.0 CM 11606", "code_information": [{"code": "11606", "type": "CPT"}, {"code": "1480854", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MALIGNANT LESION TRUNK/ARMS/LEGS 2.1CM TO 3.0CM 11603", "code_information": [{"code": "11603", "type": "CPT"}, {"code": "1480852", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MAXILLARY TORUS PALATINUS 21032", "code_information": [{"code": "21032", "type": "CPT"}, {"code": "2025482", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MESENTERY LESION", "code_information": [{"code": "44820", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "40816", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MULLERIAN DUCT CYST 55680", "code_information": [{"code": "55680", "type": "CPT"}, {"code": "1480855", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NEUROMA DIGITAL NERVE EA. ADD. DIGIT 64778", "code_information": [{"code": "64778", "type": "CPT"}, {"code": "1941663", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NEUROMA;CUTANEOUS NERVE SURGICALLY IDENTIFIABLE 64774", "code_information": [{"code": "64774", "type": "CPT"}, {"code": "1480856", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NEUROMA;DIGITAL NERVE 1 OR BOTH SAME DIGIT 64776", "code_information": [{"code": "64776", "type": "CPT"}, {"code": "1480857", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NEUROMA;HAND OR FOOT EXCEPT DIGITAL NERVE 64782", "code_information": [{"code": "64782", "type": "CPT"}, {"code": "1480858", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NEUROMA;MAJOR PERIPHERAL NERVE EXCEPT SCIATIC 64784", "code_information": [{"code": "64784", "type": "CPT"}, {"code": "1480859", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NEUROMA;SCIATIC NERVE 64786", "code_information": [{"code": "64786", "type": "CPT"}, {"code": "1480860", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE) W; GRAFT UP TO 5CM 54111", "code_information": [{"code": "54111", "type": "CPT"}, {"code": "45613846", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 10940.0, "discounted_cash": 3829.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 5294.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF PENILE PLAQUE W/ GRAFT LARGER THAN 5 CM LENGTH 54112", "code_information": [{"code": "54112", "type": "CPT"}, {"code": "45838136", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9906.51, "gross_charge": 20468.0, "discounted_cash": 7163.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 9906.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF PRESSURE ULCER 15946", "code_information": [{"code": "15946", "type": "CPT"}, {"code": "1480861", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL LESION", "code_information": [{"code": "45160", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45130", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45135", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL STRICTURE", "code_information": [{"code": "45150", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SINGLE EXTERNAL PAPILLAE OR TAG ANUS 46220", "code_information": [{"code": "46220", "type": "CPT"}, {"code": "2017926", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKIN AND SQ TISSUE FOR HIDRANDENITIS AXILLARY W/COMPLEX REPAIR 11450", "code_information": [{"code": "11450", "type": "CPT"}, {"code": "2034639", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKIN/TISSUE HIDRADENITIS COMPLEX 11451", "code_information": [{"code": "11451", "type": "CPT"}, {"code": "2401580", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKIN/TISSUE HIDRADENITIS COMPLEX 11463", "code_information": [{"code": "11463", "type": "CPT"}, {"code": "1480862", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKIN/TISSUE HIDRADENITIS INTERMEDIATE 11470", "code_information": [{"code": "11470", "type": "CPT"}, {"code": "1480863", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKIN/TISSUE HIDRADENITIS SIMPLE 11462", "code_information": [{"code": "11462", "type": "CPT"}, {"code": "1480864", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61563", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61564", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL/SUTURES", "code_information": [{"code": "61558", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SPERMATOCELE 54840", "code_information": [{"code": "54840", "type": "CPT"}, {"code": "1480865", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43610", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43611", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SUBLINGUAL GLAND 42450", "code_information": [{"code": "42450", "type": "CPT"}, {"code": "2034638", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SUBLINGUAL SALIVARY CYST RANULA 42408", "code_information": [{"code": "42408", "type": "CPT"}, {"code": "1700108", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS 60280", "code_information": [{"code": "60280", "type": "CPT"}, {"code": "1480866", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS RECURRENT 60281", "code_information": [{"code": "60281", "type": "CPT"}, {"code": "1480867", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONSIL TAGS", "code_information": [{"code": "42860", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TORUS MANDIBULARIS 21031", "code_information": [{"code": "21031", "type": "CPT"}, {"code": "2025481", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TUMOR SOFT TISSUE NECK OR THORAX; 5 CM OR GREATER 21554", "code_information": [{"code": "21554", "type": "CPT"}, {"code": "1480802", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF VAGINAL CYST OR TUMOR 57135", "code_information": [{"code": "57135", "type": "CPT"}, {"code": "1480868", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF VAGINAL SEPTUM 57130", "code_information": [{"code": "57130", "type": "CPT"}, {"code": "1480869", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF VARIOCELE 55530", "code_information": [{"code": "55530", "type": "CPT"}, {"code": "1480870", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF VARIOCELE WITH HERNIA REPAIR 55540", "code_information": [{"code": "55540", "type": "CPT"}, {"code": "1480871", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF VARIOCELE;ABDOMINAL APPROACH 55535", "code_information": [{"code": "55535", "type": "CPT"}, {"code": "1480872", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OPEN INTRABDOMINAL TUMORS 5.1CM-10CM 49204", "code_information": [{"code": "49204", "type": "CPT"}, {"code": "1480817", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OPEN INTRABDOMINAL TUMORS 5CM OR LESS 49203", "code_information": [{"code": "49203", "type": "CPT"}, {"code": "1480818", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OR CURRETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS 23150", "code_information": [{"code": "23150", "type": "CPT"}, {"code": "5709506", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OR DESTRUCTION LESION INTRANASAL 30117", "code_information": [{"code": "30117", "type": "CPT"}, {"code": "1480873", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OR DESTRUCTION OF LESION PHARYNX ANY METHOD 42808", "code_information": [{"code": "42808", "type": "CPT"}, {"code": "1657190", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OR FULGRATION URETHRAL CARUNCLE 53265", "code_information": [{"code": "53265", "type": "CPT"}, {"code": "1480874", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OR FULGURATION SKENES GLANDS 53270", "code_information": [{"code": "53270", "type": "CPT"}, {"code": "44642280", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OR FULGURATION URETHRAL POLYP DISTAL URETHRA 53260", "code_information": [{"code": "53260", "type": "CPT"}, {"code": "22241107", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1190.15, "maximum": 8450.0, "gross_charge": 2459.0, "discounted_cash": 860.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1190.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OR TRANSPOSITION OF PTERYGIUM WITH GRAFT 65426", "code_information": [{"code": "65426", "type": "CPT"}, {"code": "1480875", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OR TRANSPOSITION OF PTERYGIUM WITHOUT GRAFT 65420", "code_information": [{"code": "65420", "type": "CPT"}, {"code": "1480876", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION PARTIAL THICKNESS TUMOR BY PROCTOTOMY 45171", "code_information": [{"code": "45171", "type": "CPT"}, {"code": "1480877", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION SOFT TISSUE LESION EXTERNAL AUDITORY CANAL 69145", "code_information": [{"code": "69145", "type": "CPT"}, {"code": "1480878", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION SUBFACIAL LIPOMA/TUMOR LEG OR ANKLE LESS THAN 5 CM 27619", "code_information": [{"code": "27619", "type": "CPT"}, {"code": "1480879", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION SUBMANDIBULAR GLAND 42440", "code_information": [{"code": "42440", "type": "CPT"}, {"code": "1480880", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TENDON FINGER 26180", "code_information": [{"code": "26180", "type": "CPT"}, {"code": "1480881", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TENDON PALM 26170", "code_information": [{"code": "26170", "type": "CPT"}, {"code": "1480882", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TENDON WRIST 25109", "code_information": [{"code": "25109", "type": "CPT"}, {"code": "1480883", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION THROMBOSED HEMORRHOID EXTERNAL 46320", "code_information": [{"code": "46320", "type": "CPT"}, {"code": "1836678", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE FACE/SCALP GREATER THAN 2CM 21012", "code_information": [{"code": "21012", "type": "CPT"}, {"code": "1480884", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3066.0, "discounted_cash": 1073.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1483.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE FACE/SCALP LESS THAN 2CM 21011", "code_information": [{"code": "21011", "type": "CPT"}, {"code": "1480885", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE FACE/SCALP SUBFASCIAL MORE THAN 2CM 21014", "code_information": [{"code": "21014", "type": "CPT"}, {"code": "1480887", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE FOOT/TOE 1.5CM OR GREATER 28041", "code_information": [{"code": "28041", "type": "CPT"}, {"code": "2401696", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE FOREARM OR WRIST SUBFASCIAL 3CM OR GREATER 25073", "code_information": [{"code": "25073", "type": "CPT"}, {"code": "2580771", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE HIP 3CM OR LESS 27047", "code_information": [{"code": "27047", "type": "CPT"}, {"code": "1480888", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE HIP 5CM OR LESS 27048", "code_information": [{"code": "27048", "type": "CPT"}, {"code": "1480889", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE KNEE LESS THAN 3CM 27327", "code_information": [{"code": "27327", "type": "CPT"}, {"code": "1480890", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE KNEE SUBFASCIAL LESS THAN 3CM 27328", "code_information": [{"code": "27328", "type": "CPT"}, {"code": "1480891", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE OF FOOT OR TOE SUBCUTANEOUS 1.5CM OR MORE 28039", "code_information": [{"code": "28039", "type": "CPT"}, {"code": "2759538", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE OF LEG OR ANKLE AREA 3SQ CM OR GREATER 27632", "code_information": [{"code": "27632", "type": "CPT"}, {"code": "2034640", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE OF PELVIS AND HIP AREA 3CM OR GREATER 27043", "code_information": [{"code": "27043", "type": "CPT"}, {"code": "1480589", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE OF SHOULDER AREA; 5CM OR GREATER 23073", "code_information": [{"code": "23073", "type": "CPT"}, {"code": "4218379", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE OF UPPER ARM OR ELBOW SUBCUTANEOUS 3CM OR GREATER 24071", "code_information": [{"code": "24071", "type": "CPT"}, {"code": "2434567", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE SHOULDER 3CM OR MORE 23071", "code_information": [{"code": "23071", "type": "CPT"}, {"code": "1480892", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE SHOULDER SQ LESS THAN 3CM 23075", "code_information": [{"code": "23075", "type": "CPT"}, {"code": "1480893", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1678.99, "maximum": 8450.0, "gross_charge": 3469.0, "discounted_cash": 1214.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1678.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE SHOULDER SUBFASCIAL", "code_information": [{"code": "23076", "type": "CPT"}, {"code": "1480894", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE THIGH OR KNEE SQ 3CM OR MORE 27337", "code_information": [{"code": "27337", "type": "CPT"}, {"code": "1480895", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE THIGH OR KNEE SUBFASCIAL 5CM OR MORE 27339", "code_information": [{"code": "27339", "type": "CPT"}, {"code": "1480896", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE THIGH OR KNEE-SUBFASCIAL-LESS THAN 5CM 27329", "code_information": [{"code": "27329", "type": "CPT"}, {"code": "1481686", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE WRIST 3CM OR GREATER 25071", "code_information": [{"code": "25071", "type": "CPT"}, {"code": "1480897", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE WRIST LESS THAN 3CM 25075", "code_information": [{"code": "25075", "type": "CPT"}, {"code": "1480898", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR/SOFT TISSUE FOOT/TOE 1.5CM OR GREATER 28045", "code_information": [{"code": "28045", "type": "CPT"}, {"code": "1480899", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR/SOFT TISSUE FOOT/TOE LESS THAN 1.5CM 28043", "code_information": [{"code": "28043", "type": "CPT"}, {"code": "1480900", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR/VASC.HAND SUBCUTANEOUS 1.5CM OR LESS 26115", "code_information": [{"code": "26115", "type": "CPT"}, {"code": "1480901", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR/VASC.HAND SUBCUTANEOUS 1.5CM OR MORE 26111", "code_information": [{"code": "26111", "type": "CPT"}, {"code": "1480902", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1132.56, "maximum": 8450.0, "gross_charge": 2340.0, "discounted_cash": 819.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1132.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR/VASC.HAND SUBFASCIAL 1.5CM OR LESS 26116", "code_information": [{"code": "26116", "type": "CPT"}, {"code": "1480903", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR/VASC.HAND SUBFASCIAL 1.5CM OR MORE 26113", "code_information": [{"code": "26113", "type": "CPT"}, {"code": "1480904", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1413.76, "maximum": 8450.0, "gross_charge": 2921.0, "discounted_cash": 1022.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1413.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION-RADIAL HEAD 24130", "code_information": [{"code": "24130", "type": "CPT"}, {"code": "1482035", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION/CURETTAGE BONE CYST PHALANGES OF FOOT 28108", "code_information": [{"code": "28108", "type": "CPT"}, {"code": "1480906", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION/CURETTAGE BONE CYST TARSAL OR METATARSAL 28104", "code_information": [{"code": "28104", "type": "CPT"}, {"code": "1480907", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION/CURETTAGE BONE CYST TARSAL OR METATARSAL W/ALLOGRAFT II 28107", "code_information": [{"code": "28107", "type": "CPT"}, {"code": "1480908", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION/CURETTAGE BONE CYST TARSAL OR METATARSAL W/AUTOGRAFT 28106", "code_information": [{"code": "28106", "type": "CPT"}, {"code": "1480909", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION/REPAIR EYELID W/MARGIN TARSUS/CONJUNCTIVA/CANTHUS OR FULL THICK. GRAFT OVER 1/4 LID 67966", "code_information": [{"code": "67966", "type": "CPT"}, {"code": "6704838", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPEN ANY METHOD", "code_information": [{"code": "33267", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPN OTH PX ANY METH", "code_information": [{"code": "33268", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCL LAA THRSCP ANY METHOD", "code_information": [{"code": "33269", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXENTERATION OF ORBITREMOVAL OF ORBITAL CONTENTS 65110", "code_information": [{"code": "65110", "type": "CPT"}, {"code": "1480910", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXENTERATION OF ORBITREMOVAL OF ORBITAL CONTENTS AND BONE 65112", "code_information": [{"code": "65112", "type": "CPT"}, {"code": "1480911", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXENTERATION OF ORBITREMOVAL OF ORBITAL CONTENTS AND MUSCLE 65114", "code_information": [{"code": "65114", "type": "CPT"}, {"code": "1480912", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXERCISE TST BRNCSPSM W/ECG", "code_information": [{"code": "94617", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXERCISE TST BRNCSPSM WO ECG", "code_information": [{"code": "94619", "type": "CPT"}], "standard_charges": [{"minimum": 141.93, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 141.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXERCISE W/HEMODYNAMIC MEAS", "code_information": [{"code": "93464", "type": "CPT"}], "standard_charges": [{"minimum": 721.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 721.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1133.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1133.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1133.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS", "code_information": [{"code": "94690", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2", "code_information": [{"code": "94680", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2/CO2", "code_information": [{"code": "94681", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED BREATH CONDENSATE", "code_information": [{"code": "83987", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED NITRIC OXIDE MEAS", "code_information": [{"code": "95012", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOME RE-EVALUATION", "code_information": [{"code": "81417", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1283.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1283.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1283.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 460.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 460.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81415", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 19167.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5975.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19167.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19167.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19167.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6883.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6883.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81416", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 48120.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30600.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48120.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48120.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48120.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17280.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOSTECTOMY OR CHONDYLECTOMY METATARSAL HEAD 28288", "code_information": [{"code": "28288", "type": "CPT"}, {"code": "1480915", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPANDER EXTERNAL CONTINUOUS DERMACLOSE RC", "code_information": [{"code": "204010-K", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2141.0, "discounted_cash": 749.35, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPAREL 1.3% (BUPIVACAINE LIPOSOME INJECTABLE SUSPENSION) 266MG/20ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0666", "type": "HCPCS"}, {"code": "MED0264", "type": "CDM"}, {"code": "259", "type": "RC"}], "standard_charges": [{"gross_charge": 808.0, "discounted_cash": 282.8, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPAREL 1.3% (BUPIVACAINE LIPOSOME INJECTABLE SUSPENSION) 266MG/20ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0666", "type": "HCPCS"}, {"code": "MED0264", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 808.0, "discounted_cash": 282.8, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPAREL BUPIVACAINE LIPOSOME 1.3% 10 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0666", "type": "HCPCS"}, {"code": "MED0837", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPAREL BUPIVACAINE LIPOSOME 1.3% 10 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0666", "type": "HCPCS"}, {"code": "MED0837", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG LXTR ART", "code_information": [{"code": "35703", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG NECK ART", "code_information": [{"code": "35701", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG UXTR ART", "code_information": [{"code": "35702", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION ABDOMINAL WALL 49000", "code_information": [{"code": "49000", "type": "CPT"}, {"code": "1480916", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION BEHIND ABDOMEN", "code_information": [{"code": "49010", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR UNDESCENDED TESTIS 54550", "code_information": [{"code": "54550", "type": "CPT"}, {"code": "1480917", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR UNDESCENDED TESTIS WITH ABDOMINAL EXPLORATION 54560", "code_information": [{"code": "54560", "type": "CPT"}, {"code": "1480918", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ABDOMEN", "code_information": [{"code": "58960", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF BILE DUCTS", "code_information": [{"code": "47700", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "32100", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39000", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39010", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF EPIDIDYMIS 54865", "code_information": [{"code": "54865", "type": "CPT"}, {"code": "1480920", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF KIDNEY", "code_information": [{"code": "50010", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SINUSES", "code_information": [{"code": "31090", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SPINAL FUSION", "code_information": [{"code": "22830", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION W/ OR W/O LYSIS OF ARTERY OTHER VESSELS 35761", "code_information": [{"code": "35761", "type": "CPT"}, {"code": "7616949", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION WOUND 20100", "code_information": [{"code": "20100", "type": "CPT"}, {"code": "1480923", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION WOUND ABDOMEN 20102", "code_information": [{"code": "20102", "type": "CPT"}, {"code": "1480924", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION WOUND EXTREMITY 20103", "code_information": [{"code": "20103", "type": "CPT"}, {"code": "1480925", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2372.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION WRIST 25248", "code_information": [{"code": "25248", "type": "CPT"}, {"code": "1480926", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45562", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45563", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33310", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33315", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": [{"code": "23040", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ABDOMINAL VESSELS", "code_information": [{"code": "35840", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60540", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60545", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST FREE ADHESIONS", "code_information": [{"code": "32124", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST VESSELS", "code_information": [{"code": "35820", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE DEEP NODE(S) NECK", "code_information": [{"code": "38542", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE LIMB VESSELS", "code_information": [{"code": "35860", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE NECK VESSELS", "code_information": [{"code": "35800", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ORBIT/REMOVE LESION", "code_information": [{"code": "61333", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60505", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE SMALL INTESTINE", "code_information": [{"code": "44020", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE TREAT SHOULDER JOINT", "code_information": [{"code": "23107", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND CHEST", "code_information": [{"code": "20101", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/REPAIR CHEST", "code_information": [{"code": "32110", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLR/DECOMPRESS EYE SOCKET", "code_information": [{"code": "67445", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REC SCAN A/R", "code_information": [{"code": "93241", "type": "CPT"}], "standard_charges": [{"minimum": 275.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 275.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 433.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 433.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 433.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D RECORDING", "code_information": [{"code": "93242", "type": "CPT"}], "standard_charges": [{"minimum": 86.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 135.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 135.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 135.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REV&INTERPJ", "code_information": [{"code": "93244", "type": "CPT"}], "standard_charges": [{"minimum": 66.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 104.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 104.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D SCAN A/R", "code_information": [{"code": "93243", "type": "CPT"}], "standard_charges": [{"minimum": 141.93, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 141.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REC SCAN A/R", "code_information": [{"code": "93245", "type": "CPT"}], "standard_charges": [{"minimum": 275.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 275.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 433.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 433.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 433.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D RECORDING", "code_information": [{"code": "93246", "type": "CPT"}], "standard_charges": [{"minimum": 141.93, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 141.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REV&INTERPJ", "code_information": [{"code": "93248", "type": "CPT"}], "standard_charges": [{"minimum": 72.6, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 72.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D SCAN A/R", "code_information": [{"code": "93247", "type": "CPT"}], "standard_charges": [{"minimum": 285.47, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 285.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 448.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 448.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 448.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT TRNSCRANL MAG STIMJ MEAS", "code_information": [{"code": "858T", "type": "CPT"}], "standard_charges": [{"minimum": 810.56, "maximum": 1273.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 810.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1273.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1273.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1273.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDED CULTURE OF OOCYTES", "code_information": [{"code": "89272", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDED VISUAL FIELD XM", "code_information": [{"code": "92083", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDER BTN SUT TIGHTROPE IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1589RT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION ELECTRODE 34.3 CM BOVIE TIP STRAIGHT REUSE", "code_information": [{"code": "E1504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION IV SM 4IN CORE T PORT", "code_information": [{"code": "471950", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION KIT 50CM LEAD", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "MN10550-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 432.6, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION LEAD 25 CM FOR PRECISION SPINAL CORD SIMULATOR SYSS PHASE III", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "SC-3138-25", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2184.0, "discounted_cash": 764.4, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION PERCUTANEOUS 9009", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "9009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.72, "discounted_cash": 98.25, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION SET 7IN MACROBORE OPTION LOK LF SLIDE CLAMP NON DEHP TUBING 50EA/CS", "code_information": [{"code": "12654-28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.98, "discounted_cash": 3.84, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION SET W REMOVABLE NEEDLELESS CONNECTOR 18CM MP4314-C", "code_information": [{"code": "MP4314-C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.21, "discounted_cash": 3.57, "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": [{"setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR CANAL SURGERY", "code_information": [{"code": "69150", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR/NECK SURGERY", "code_information": [{"code": "69155", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HAND SURGERY", "code_information": [{"code": "26250", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE JAW SURGERY", "code_information": [{"code": "21045", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69530", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "982", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15430.14, "maximum": 26489.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15430.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22068.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24275.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26489.71, "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": 28070.0, "maximum": 48189.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28070.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40146.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 44160.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48189.22, "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": 10050.94, "maximum": 17254.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10050.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14375.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15812.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17254.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55862", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55865", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE REMOVAL OF LIVER", "code_information": [{"code": "47122", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21630", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21632", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42842", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42844", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42845", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTERNAL CANNULA DECLOTTING", "code_information": [{"code": "36860", "type": "CPT"}], "standard_charges": [{"minimum": 763.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTERNAL OCULAR PHOTOGRAPHY", "code_information": [{"code": "92285", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTERNAL PULSE GENERATOR 2 PORT HEADER 3032", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "3032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTND COLOR VISION XM", "code_information": [{"code": "92283", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "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 WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRACAPSULAR CATARACT REM. W/INSERT INTRAOCULAR LENS COMPLEX MAN. OR MECH. TECH. ONE OR MORE 66989", "code_information": [{"code": "66989", "type": "CPT"}, {"code": "46008062", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3075.82, "maximum": 9357.0, "gross_charge": 6355.0, "discounted_cash": 2224.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3075.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACAPSULAR CATARACT REM. W/INSERTION INTRAOCULAR LENS MAN. OR MECH. TECH. ONE OR MORE 66991", "code_information": [{"code": "66991", "type": "CPT"}, {"code": "46008063", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACAPSULAR CATARACT REMOVAL W/INSERTION OF INTRAOCULAR LENS PROSTHESIS COMP. 66982", "code_information": [{"code": "66982", "type": "CPT"}, {"code": "1480927", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACAPSULAR CATARACT REMOVAL W/INSERTION OF INTRAOCULAR LENS PROSTHESIS REG. 66984", "code_information": [{"code": "66984", "type": "CPT"}, {"code": "1480928", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL BILAT STUDY", "code_information": [{"code": "93880", "type": "CPT"}], "standard_charges": [{"minimum": 724.74, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 724.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1138.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1138.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1138.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "38", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10090.48, "maximum": 17322.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10090.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14431.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15874.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17322.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "37", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19937.64, "maximum": 34227.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19937.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28515.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31366.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34227.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "39", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6929.15, "maximum": 11895.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6929.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9910.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10901.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11895.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL UNI/LTD STUDY", "code_information": [{"code": "93882", "type": "CPT"}], "standard_charges": [{"minimum": 465.65, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 465.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 731.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 731.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 731.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACTION POUCHES / RETRIEVAL NETS EnTrap Polyp Retrieval Net 133-5543 30 230 2.8", "code_information": [{"code": "NT54511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 178.0, "discounted_cash": 62.3, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTION POUCHES / RETRIEVAL NETS EnTrap Polyp Retrieval Net 1356057 30 230 2.8", "code_information": [{"code": "54515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 179.0, "discounted_cash": 62.65, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR NAIL 3.25MM TRIGEN", "code_information": [{"code": "71631320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1193.0, "discounted_cash": 417.55, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR NITINOL STONE 8MM NGE-017115", "code_information": [{"code": "NGE-017115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 933.67, "discounted_cash": 326.78, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STAPLE PSX PROXIMATE PSX", "code_information": [{"code": "PSX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE 115 CM X 2.2FR 1 CM BASKET TIPLESS N CIRCLE", "code_information": [{"code": "G18778", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 776.0, "discounted_cash": 271.6, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE 2.2FR X 115 CM TIPLESS N CIRC", "code_information": [{"code": "NTSE-022115-UDH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 543.0, "discounted_cash": 190.05, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE 2.4FR 115 CM X 1 CM 4/16 WIRE UNIDEX HANDLE PARTIAL CLOSURE NITI", "code_information": [{"code": "NCT4-024115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 992.34, "discounted_cash": 347.32, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE NCIRCLE TIPLESS 1.5FR X 115CM DISP", "code_information": [{"code": "G46206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 980.24, "discounted_cash": 343.08, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [{"code": "115", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8860.5, "maximum": 15211.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8860.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12672.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13939.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15211.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [{"code": "790", "type": "MS-DRG"}], "standard_charges": [{"minimum": 988.0, "maximum": 988.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTREMITY SHEET TIBURON", "code_information": [{"code": "29415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTREMITY STUDY", "code_information": [{"code": "93970", "type": "CPT"}], "standard_charges": [{"minimum": 721.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 721.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1133.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1133.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1133.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTREMITY STUDY", "code_information": [{"code": "93971", "type": "CPT"}], "standard_charges": [{"minimum": 441.84, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 441.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 694.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 694.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 694.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRNL COUNTERPULSE, PER TX", "code_information": [{"code": "G0166", "type": "HCPCS"}], "standard_charges": [{"minimum": 480.82, "maximum": 1723.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE ALLERGY TESTS", "code_information": [{"code": "95060", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE MVMT ALYS W/O CALBRJ I&R", "code_information": [{"code": "615T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 437.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE PACK", "code_information": [{"code": "DYNJ31662B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 33.95, "setting": "both", "billing_class": "facility"}]}, {"description": "EYE PADS C-EYP22S", "code_information": [{"code": "C-EYP22S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "EYE PHOTODYNAMIC THER ADD-ON", "code_information": [{"code": "67225", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE PROTECTORIGUARD CLEAR FOAM CUSION STERILE 301-AEG100EA", "code_information": [{"code": "301-AEG100EA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.84, "discounted_cash": 7.99, "setting": "both", "billing_class": "facility"}]}, {"description": "EYE SURGERY FOLLOW-UP ADD-ON", "code_information": [{"code": "67331", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE SUTURE DURING SURGERY", "code_information": [{"code": "67335", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EZH2 GENE COMMON VARIANTS", "code_information": [{"code": "81237", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 447.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 252.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 252.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EZH2 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81236", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 721.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "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": 131.51, "maximum": 206.65, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 131.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 206.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 206.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 206.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Electrocardiogram (Ekg), Electroencephalogram (Eeg)", "code_information": [{"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 327.0, "maximum": 384.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 384.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 327.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Electrocardiogram (Ekg), Electroencephalogram (Eeg), Other", "code_information": [{"code": "739", "type": "RC"}], "standard_charges": [{"minimum": 327.0, "maximum": 384.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 384.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 327.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Electrocardiogram, algorithmically generated 12-lead ECG from a reduced-lead ECG; interpretation and report only", "code_information": [{"code": "905T", "type": "CPT"}], "standard_charges": [{"minimum": 22.06, "maximum": 34.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Electrocardiogram, algorithmically generated 12-lead ECG from a reduced-lead ECG; tracing only", "code_information": [{"code": "904T", "type": "CPT"}], "standard_charges": [{"minimum": 151.47, "maximum": 238.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 151.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 238.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 238.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 238.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Electrocardiogram, algorithmically generated 12-lead ECG from a reduced-lead ECG; with interpretation and report", "code_information": [{"code": "903T", "type": "CPT"}], "standard_charges": [{"minimum": 44.12, "maximum": 69.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Electrolyte Panel", "code_information": [{"code": "80051", "type": "CPT"}, {"code": "633610", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 23.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Electronic analysis of implanted integrated neurostimulation system, vagus nerve; with simple programming by physician or other qualified health care professional", "code_information": [{"code": "912T", "type": "CPT"}], "standard_charges": [{"minimum": 107.53, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 107.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Electronic analysis of implanted integrated neurostimulation system, vagus nerve; without programming by physician or other qualified health care professional", "code_information": [{"code": "911T", "type": "CPT"}], "standard_charges": [{"minimum": 278.03, "maximum": 437.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "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": 1279.0, "maximum": 4868.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3095.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4868.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4868.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4868.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "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), separate from initial implantatio", "code_information": [{"code": "931T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 4868.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3095.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4868.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4868.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4868.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "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": 841.34, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 841.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1322.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1322.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1322.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Emergency Room Emtalaemergency Medical Screening Services", "code_information": [{"code": "451", "type": "RC"}], "standard_charges": [{"minimum": 656.0, "maximum": 945.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 656.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 74.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 656.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 945.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 808.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Emergency Room, Beyond Emtala Screening", "code_information": [{"code": "452", "type": "RC"}], "standard_charges": [{"minimum": 656.0, "maximum": 945.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 656.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 74.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 656.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 945.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 808.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Emergency Room, General", "code_information": [{"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 656.0, "maximum": 945.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 656.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 74.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 656.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 945.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 808.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Emergency Room, Other", "code_information": [{"code": "459", "type": "RC"}], "standard_charges": [{"minimum": 656.0, "maximum": 945.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 656.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 74.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 656.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 945.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 808.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Emergency Room, Urgent Care", "code_information": [{"code": "456", "type": "RC"}], "standard_charges": [{"minimum": 656.0, "maximum": 656.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 656.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 74.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 656.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "End-tidal control of inhaled anesthetic agents and oxygen to assist anesthesia care delivery (List separately in addition to code for primary procedure)", "code_information": [{"code": "887T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "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": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Eps stomach plic", "code_information": [{"code": "C9724", "type": "HCPCS"}], "standard_charges": [{"minimum": 5964.0, "maximum": 5964.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "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": 1958.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Estradiol", "code_information": [{"code": "82670", "type": "CPT"}, {"code": "633723", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 43.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 43.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 112.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 112.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 112.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.24, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "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); 20.1 to 30 cm", "code_information": [{"code": "49189", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "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); 5 cm or less", "code_information": [{"code": "49186", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "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); 5.1 to 10 cm", "code_information": [{"code": "49187", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "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); greater than 30 cm", "code_information": [{"code": "49190", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; including recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professi", "code_information": [{"code": "937T", "type": "CPT"}], "standard_charges": [{"minimum": 275.55, "maximum": 433.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 275.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 433.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 433.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 433.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; recording (including connection and initial recording)", "code_information": [{"code": "938T", "type": "CPT"}], "standard_charges": [{"minimum": 141.93, "maximum": 223.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 141.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional", "code_information": [{"code": "940T", "type": "CPT"}], "standard_charges": [{"minimum": 72.6, "maximum": 114.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 72.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; scanning analysis with report", "code_information": [{"code": "939T", "type": "CPT"}], "standard_charges": [{"minimum": 285.47, "maximum": 448.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 285.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 448.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 448.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 448.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Extra-Corporeal Shock Wave Therapy, General", "code_information": [{"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 3700.0, "maximum": 3714.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3700.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3714.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "F2 GENE", "code_information": [{"code": "81240", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 82.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 167.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 263.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 263.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 263.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 94.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 94.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F5 GENE", "code_information": [{"code": "81241", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 94.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 187.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 294.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 294.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 294.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 105.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 105.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F9 FULL GENE SEQUENCE", "code_information": [{"code": "81238", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAB REMOVABLE APPLIANCE", "code_information": [{"code": "D9938", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAB/DEL ORAL APPLIANCE THXPY", "code_information": [{"code": "D9954", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL NERVE FUNCTION TEST", "code_information": [{"code": "92516", "type": "CPT"}], "standard_charges": [{"minimum": 103.33, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 103.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL SHIELD 3/4 LENGTH ANTI-FOG RED", "code_information": [{"code": "H1SHIELD50", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FACILITY SVS DENTAL REHAB", "code_information": [{"code": "G0330", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 11936.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7595.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11936.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11936.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11936.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR INHIBITOR TEST", "code_information": [{"code": "85335", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAM ADAPT BHV TX GDN PHY/QHP", "code_information": [{"code": "97156", "type": "CPT"}], "standard_charges": [{"minimum": 120.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAMILY MEDICINE SS", "code_information": [{"code": "G4005", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAMILY PSYTX W/O PT 50 MIN", "code_information": [{"code": "90846", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAMILY PSYTX W/PT 50 MIN", "code_information": [{"code": "90847", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FANCC GENE", "code_information": [{"code": "81242", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 146.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 146.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 146.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 52.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 52.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIA LATA 101-150SQCM FF PS825FF", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PS825FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8230.0, "discounted_cash": 2880.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FASCIA LATA GRAFT BY STRIPPER 20920", "code_information": [{"code": "20920", "type": "CPT"}, {"code": "42593890", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIA LATA MEDIUM 50-100SQCM 6.0 X 12.0 CM EVP824FF", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "EVP824FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8230.0, "discounted_cash": 2880.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FASCIA LATA X-LG 5.0CM X 15.0CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "EV-93004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8652.0, "discounted_cash": 3028.2, "setting": "both", "billing_class": "facility"}]}, {"description": "FASCIECTOMY HAND 26125", "code_information": [{"code": "26125", "type": "CPT"}, {"code": "1480930", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIECTOMY PLANTAR FACIA PARTIAL 28060", "code_information": [{"code": "28060", "type": "CPT"}, {"code": "1480931", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIECTOMY PLANTAR FACIA RADICAL 28062", "code_information": [{"code": "28062", "type": "CPT"}, {"code": "1480932", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY ALL COMPARTMENTS LEG 27602", "code_information": [{"code": "27602", "type": "CPT"}, {"code": "1480933", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY FOOT AND/OR TOE 28008", "code_information": [{"code": "28008", "type": "CPT"}, {"code": "1480935", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY HIP 27025", "code_information": [{"code": "27025", "type": "CPT"}, {"code": "1480936", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY ILIOTIBIAL OPEN 27305", "code_information": [{"code": "27305", "type": "CPT"}, {"code": "1480937", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY LEG ALL COMPARTMENTS W/DEBRID. 27894", "code_information": [{"code": "27894", "type": "CPT"}, {"code": "1480938", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY LEG ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY 27600", "code_information": [{"code": "27600", "type": "CPT"}, {"code": "1480939", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY LEG POSTERIOR COMPARTMENT ONLY 27601", "code_information": [{"code": "27601", "type": "CPT"}, {"code": "1480940", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY LEG POSTERIOR COMPARTMENT W/DEBRIDEMENT OF NONVIABLE MUSCLE/NERVE 27893", "code_information": [{"code": "27893", "type": "CPT"}, {"code": "1480941", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY PLANTAR ENDOSCOPIC 29893", "code_information": [{"code": "29893", "type": "CPT"}, {"code": "1480942", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY W/DEBRID.OF NONVIABLE THIGH OR KNEE MUSCLE/NERVE MULTI.COMPARTMENT 27499", "code_information": [{"code": "27499", "type": "CPT"}, {"code": "1480943", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY W/DEBRID.OF NOVIABLE THIGH OR KNEE MUSCLE/NERVE SINGLE COMPARTMENT 27497", "code_information": [{"code": "27497", "type": "CPT"}, {"code": "1480944", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAST/DIR LDL >= 190 MG/DL", "code_information": [{"code": "G9663", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASTENER 2.2MM AND 1.2MM 3911-524-731HA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3911-524-731HA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1640.0, "discounted_cash": 574.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FASTENER 2.8MM Q-FIX ASA W/2 MT BL/CB WH 72205860", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "72205860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2635.0, "discounted_cash": 922.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FASTENER 9MM AR-1288QTT-90", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1288QTT-90", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6189.64, "discounted_cash": 2166.37, "setting": "both", "billing_class": "facility"}]}, {"description": "FASTENER ANCHOR 2.3MM WITH 1 STRAND 2.2MM XBRAID 3911-524-730HA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3911-524-730HA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1640.0, "discounted_cash": 574.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FASTENER ANCHOR 2.3MM WITH 3 STRANDS NUMBER 2 XBRAID 3911-524-831HA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3911-524-831HA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FASTENER ANCHOR SUTURE HEALIX 4.5MM PEEK 222027", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "222027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1220.0, "discounted_cash": 427.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FASTENER FIBERSTITCH 1.5 24 DEGREE CURVE AR-4580-24", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "AR-4580-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1305.35, "discounted_cash": 456.87, "setting": "both", "billing_class": "facility"}]}, {"description": "FASTENER FIBERSTITCH IMPLANT, STRAIGHT RC AR-19032S", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "AR-19032S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1192.1, "discounted_cash": 417.24, "setting": "both", "billing_class": "facility"}]}, {"description": "FASTENER FIBERTAG TIGHTROPE IMPLANT WITH FLIP CUTTER III DRILL AND FIBERSNARE SUTURE AR-1288RTT2-FC3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1288RTT2-FC3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2697.5, "discounted_cash": 944.13, "setting": "both", "billing_class": "facility"}]}, {"description": "FASTENER IMPLSYSFT T-RPIIRTT-IBDRILLFBRLINK AR-1288RTT2-IBS", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "AR-1288RTT2-IBS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FASTENER KNEE CAPSULE REPAIR SYSTEM W/GAP GUIDE AR-5875-2", "code_information": [{"code": "AR-5875-2", "type": "CDM"}], "standard_charges": [{"gross_charge": 2764.2, "discounted_cash": 967.47, "setting": "both", "billing_class": "facility"}]}, {"description": "FASTENER ULTRABRIDGE KIT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "72205700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7900.0, "discounted_cash": 2765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FATS/LIPIDS FECES QUAL", "code_information": [{"code": "82705", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FATS/LIPIDS FECES QUANT", "code_information": [{"code": "82710", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FCSD US ABLTJ LEIOMYOM>=200", "code_information": [{"code": "72T", "type": "CPT"}], "standard_charges": [{"minimum": 3951.0, "maximum": 17161.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10916.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17161.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17161.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17161.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL BILIRUBIN TEST", "code_information": [{"code": "82252", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL BLOOD SCRN IMMUNOASSAY", "code_information": [{"code": "G0328", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 72.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL MICROBIOTA PREP INSTIL", "code_information": [{"code": "G0455", "type": "HCPCS"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECES CULTURE AEROBIC BACT", "code_information": [{"code": "87045", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE I&R", "code_information": [{"code": "92617", "type": "CPT"}], "standard_charges": [{"minimum": 187.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 187.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 294.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 294.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 294.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE TEST", "code_information": [{"code": "92616", "type": "CPT"}], "standard_charges": [{"minimum": 451.36, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 451.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 709.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 709.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 709.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM CEMENTED SIZE 2 L-MEDIAL IBAL UKA AR-501-UFLB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-501-UFLB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM COMP SZ 6 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20520.0, "discounted_cash": 7182.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/ARTHR & US", "code_information": [{"code": "C7534", "type": "HCPCS"}], "standard_charges": [{"minimum": 2743.0, "maximum": 6125.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/STENT & US", "code_information": [{"code": "C7535", "type": "HCPCS"}], "standard_charges": [{"minimum": 2743.0, "maximum": 6125.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/ATHER", "code_information": [{"code": "37225", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/TLA", "code_information": [{"code": "37224", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC STNT & ATHER", "code_information": [{"code": "37227", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC W/STENT", "code_information": [{"code": "37226", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [{"code": "748", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8197.45, "maximum": 14072.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8197.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11724.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12896.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14072.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEMORAL CEMENTED W/ COCR HD & R3 XLPE LINER CAP PRICE HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71703312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11330.0, "discounted_cash": 3965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL COCR RT SZ 3 JRNY II BCS 74024213", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74024213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL COMP SC11 SYNERGY POROUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9234.0, "discounted_cash": 3231.9, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT SZ 6 LEFT BI-CRUCIATE STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74024926", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2381.16, "discounted_cash": 833.41, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL ENDOVAS GRAFT ADD-ON", "code_information": [{"code": "34813", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD FROZEN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "14817048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2277.0, "discounted_cash": 796.95, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL HEAD W/O CARTILAGE FD IRR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "92-0495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2777.0, "discounted_cash": 971.95, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL HIP SZ 9 P2 POROUS COATED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "425-96-009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9888.0, "discounted_cash": 3460.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL IMPLANT CR #6 LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL LEFT SZ 5 PRESSFIT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5516-F-501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4952.0, "discounted_cash": 1733.2, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL POROCOAT CRUCIATE RETAINING SIZE 6 RIGHT CEMENTLESS 1504-01-206", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1504-01-206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3700.0, "discounted_cash": 1295.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL SZ 19 ECHELON PRIMARY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71341019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9208.0, "discounted_cash": 3222.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR 4 RM/LL OXINIUM UNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7142-2354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5908.0, "discounted_cash": 2067.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR CRUCIATE RETAINING LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR CRUCIATE RETAINING SZ 3 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR FOUNDATION POROUS W/3D MATRIX LEFT SIZE 4 211-02-104", "code_information": [{"code": "211-02-104", "type": "CDM"}], "standard_charges": [{"gross_charge": 1842.0, "discounted_cash": 644.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR LEFT SZ4 PRESSFIT PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5516-F-401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR SZ 5 CR LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FENTANYL 0.05MG/ML 2ML", "code_information": [{"code": "MED0389", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "FENTANYL 250MCG/5ML AMP", "code_information": [{"code": "MED0461", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FERN TEST", "code_information": [{"code": "Q0114", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 39.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL ANEUPLOIDY TRISOM RISK", "code_information": [{"code": "81507", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 993.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2027.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3187.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3187.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3187.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1144.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1144.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFIL W/O NST", "code_information": [{"code": "76819", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 220.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 346.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 346.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 346.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 119.77, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 127.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFILE W/NST", "code_information": [{"code": "76818", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 299.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 470.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 470.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 470.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 167.19, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 178.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML ANEUPLOIDY", "code_information": [{"code": "81420", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 948.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1935.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1093.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1093.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML MICRODELTJ", "code_information": [{"code": "81422", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 948.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1935.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1093.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1093.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CONTRACT STRESS TEST", "code_information": [{"code": "59020", "type": "CPT"}], "standard_charges": [{"minimum": 85.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CORD PUNCTURE PRENATAL", "code_information": [{"code": "59012", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL FLUID DRAINAGE W/US", "code_information": [{"code": "59074", "type": "CPT"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR W/REPORT", "code_information": [{"code": "59050", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR/INTERPRET ONLY", "code_information": [{"code": "59051", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL NON-STRESS TEST", "code_information": [{"code": "59025", "type": "CPT"}], "standard_charges": [{"minimum": 47.79, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SCALP BLOOD SAMPLE", "code_information": [{"code": "59030", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SHUNT PLACEMENT W/US", "code_information": [{"code": "59076", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [{"code": "864", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5331.75, "maximum": 9153.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5331.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7625.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8388.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9153.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FGT IMPLANT SIZE 20 GREAT TOE FGT-20T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FGT-20T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3762.0, "discounted_cash": 1316.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FHL IMPLANT SYSTEM 7.0MM AR-1570BC-CP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-1570BC-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3241.16, "discounted_cash": 1134.41, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBER 1000UM CORE BARE SURGICAL OPTICAL LASER OAF009901", "code_information": [{"code": "OAF009901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 807.0, "discounted_cash": 282.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBER LASER 230MM X 3MM SNGL BARE 230 MICRON HOLMIUM DISP", "code_information": [{"code": "101130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBER LASER AGILITI SU 940UM", "code_information": [{"code": "8000232", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 807.0, "discounted_cash": 282.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBER LIGHT PATHASSIST", "code_information": [{"code": "LF-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 777.0, "discounted_cash": 271.95, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBER ROBOTIC OMNIGUIDE", "code_information": [{"code": "10751", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3181.0, "discounted_cash": 1113.35, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBER SU 272UM", "code_information": [{"code": "8000229", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.5, "discounted_cash": 167.48, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBER THERAPY LASER MOXY GREENLIGHT", "code_information": [{"code": "Oct-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERFLOW CORTICAL 10CC 455R0100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "455R0100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2720.0, "discounted_cash": 952.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERS CORTICAL CORTIFUSE FLOWABLE 2.5CC 03-00007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-00007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1240.0, "discounted_cash": 434.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERSTITCH IMPLANT 24 DEGREE CURVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4570-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1105.0, "discounted_cash": 386.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERSTITCH MESH ANCHOR 1.5 CURVED AR-4580", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "AR-4580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1192.1, "discounted_cash": 417.24, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAG TIGHTROPE IMPLANT II ABS AR-1588TNT2", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "AR-1588TNT2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 877.5, "discounted_cash": 307.13, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK 1.8MM PERC INSERT KIT FOR AR-3610PK-3", "code_information": [{"code": "AR-3610PK-3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 236.6, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK 2.6 DL KNOTLESS AR-3642SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3642SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1072.5, "discounted_cash": 375.38, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK AR-3638", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 865.0, "discounted_cash": 302.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK DISP KIT KNEE AR-3710", "code_information": [{"code": "AR-3710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 715.14, "discounted_cash": 250.3, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK DISPOSABLES STRAIGHT KIT", "code_information": [{"code": "AR-3638DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK DOUBLE LOADED FW CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3600-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1001.0, "discounted_cash": 350.35, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK DOUBLE LOADED KNOTLESS KNEE AR-3740SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3740SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1137.5, "discounted_cash": 398.13, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK KL RC WH/BLK &TT & (BLU) #2 MTS AR-3653SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3653SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.04, "discounted_cash": 402.16, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK RC DISPOSABLE KIT", "code_information": [{"code": "AR-3650DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.61, "discounted_cash": 199.01, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK RC DOUBLE-LOADED WITH A WHITE/BLUE AND WHITE/BLACK SUTURETAPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1090.0, "discounted_cash": 381.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK SPEEDBRIDGE IMPLANT SYTEM W/ BC SWIVELOCK AR-2600FSB-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2600FSB-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5622.5, "discounted_cash": 1967.88, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAKS 2.9MM DRILL KNEE AR-3712-29", "code_information": [{"code": "AR-3712-29", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 303.05, "discounted_cash": 106.07, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAPE 17IN WITH NDL", "code_information": [{"code": "AR-7237-17LN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADATION PRODUCTS", "code_information": [{"code": "85362", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADE SEMIQUANT", "code_information": [{"code": "85378", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADJ D-DIMER", "code_information": [{"code": "85380", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRIN SEALANT 10ML VISTASEAL VST10", "code_information": [{"code": "VST10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1188.36, "discounted_cash": 415.93, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBRIN SEALANT 4ML VISTASEAL VST04", "code_information": [{"code": "C9250", "type": "HCPCS"}, {"code": "VST04", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 551.0, "discounted_cash": 192.85, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBRIN SEALANT TOPICAL 4 ML KIT FROZEN", "code_information": [{"code": "MED0587", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBRIN SEALANT TOPICAL 4 ML KIT FROZEN (TISSEEL)", "code_information": [{"code": "1501262", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 416.0, "discounted_cash": 145.6, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBRIN SEALENT TISSEEL PRE-FILLED PRIMA SYRINGE FROZEN 4 ML KIT", "code_information": [{"code": "1506079", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBRINOGEN ACTIVITY", "code_information": [{"code": "85384", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN ANTIGEN", "code_information": [{"code": "85385", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN TEST", "code_information": [{"code": "85366", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 100.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 205.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 322.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 322.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 322.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 115.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 115.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN TEST", "code_information": [{"code": "85370", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYSINS SCREEN I&R", "code_information": [{"code": "85390", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC ANTIPLASMIN", "code_information": [{"code": "85410", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMIN", "code_information": [{"code": "85400", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85415", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85420", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85421", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBUAL PLATE 101MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5888403L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3482.0, "discounted_cash": 1218.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBULA BONE GRAFT MICROVASC", "code_information": [{"code": "20955", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBULA SHAFT 14CM EV429FD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EV429FD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBULOCK IMPLANT SYSTEM STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8973DS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1517.6, "discounted_cash": 531.16, "setting": "both", "billing_class": "facility"}]}, {"description": "FILIFORM SURG 3FR 12.5IN URETHRAL WOVEN SPIRAL TIP LF STRL", "code_information": [{"code": "22103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FILIFORM SURG 3FR 12.5IN URETHRAL WOVEN STRAIGHT TIP LF STRL", "code_information": [{"code": "21903", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FILIFORM SURG 5FR 12.5IN WOVEN STRAIGHT TIP URETHRAL LF STRL", "code_information": [{"code": "21905", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLABLE ICE BAG WITH TIES LARGE 4003", "code_information": [{"code": "4003", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.5, "discounted_cash": 1.58, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLER BONE 11GM VERTEPORT", "code_information": [{"code": "306-510-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2253.0, "discounted_cash": 788.55, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLER BONE 1CC PUTTY STARGRAFT DBM", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "92-2001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLER BONE 5.0CCINJECTIONABLE NORIAN", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "7.704.005S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3308.0, "discounted_cash": 1157.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLER CEMENT 1CC BONESYNC FAST-SETTING DRILLABLE CALCIUM PHOSPHATE ABS-3101", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABS-3101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 341.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLER DEVICE RESORBABLE BONEVOID BGAR(10CC)U", "code_information": [{"code": "C9399", "type": "HCPCS"}, {"code": "BGAR(10CC)U", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 6077.0, "discounted_cash": 2126.95, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLER DIRECTCELL ADVANCED BONE GRAFTING SYSTEM KIT 6CC AGILON MOLDABLE BONE GRAFTING BGS-8C-006-AGL", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "BGS-8C-006-AGL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3700.0, "discounted_cash": 1295.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLER RESORBABLE BONEVOID 5CC BGAR(5CC)U", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BGAR(5CC)U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5047.0, "discounted_cash": 1766.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLER VOID 10CC BONE STIMULAN IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "620-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2575.0, "discounted_cash": 901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLER VOID 3CC BONE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "390-0003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLER VOID 5CC BONE CERAMENT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "800-4000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3181.0, "discounted_cash": 1113.35, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLETED FINGER/TOE FLAP", "code_information": [{"code": "14350", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FILM CURX HTL +34HE8 30 X 35", "code_information": [{"code": "402591", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER FLUID .20 MICRON PORE W/MALE LL", "code_information": [{"code": "501030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER FLUID .20MICRON HIGH FLOW MALE FEMALE LUER LOCK FITTING STRL", "code_information": [{"code": "581030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER MEDICATION DISC 5 MICRON LL P 415008", "code_information": [{"code": "415008", "type": "CDM"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER RAPIDVAC ULPA", "code_information": [{"code": "SEA3700", "type": "CDM"}], "standard_charges": [{"gross_charge": 782.0, "discounted_cash": 273.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER REM 3 MON PLMT", "code_information": [{"code": "G9541", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FILTER SMOKE EVACUATOR + 637", "code_information": [{"code": "637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 271.0, "discounted_cash": 94.85, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTERED SPEECH HEARING TEST", "code_information": [{"code": "92571", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIMBRIOPLASTY", "code_information": [{"code": "58760", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINAL REF +/- 1.0 W/IN 90D", "code_information": [{"code": "G9519", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINE NEEDLE ASPIRATION WITHOUT IMAGING; FIRST LESION 10021", "code_information": [{"code": "10021", "type": "CPT"}, {"code": "1480947", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISSURECTOMY ANAL 46200", "code_information": [{"code": "46200", "type": "CPT"}, {"code": "1480948", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULECTOMY/FISTULOTOMY ANAL-INTERSPHINCTERIC 46275", "code_information": [{"code": "46275", "type": "CPT"}, {"code": "1480949", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULECTOMY/FISTULOTOMY ANAL-SUBCUTANEOUS 46270", "code_information": [{"code": "46270", "type": "CPT"}, {"code": "1480950", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULECTOMY/FISTULOTOMY ANAL-TRANSSPHINCTERIC/SUPRASPHENTERIC 46280", "code_information": [{"code": "46280", "type": "CPT"}, {"code": "1480951", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULIZATION OF SCLERA;IRIDENCLEISIS OR IRIDOTASIS 66165", "code_information": [{"code": "1480952", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "billing_class": "facility"}]}, {"description": "FISTULIZATION OF SCLERA;SCLERECTOMY WITH PUNCH OR SCISSORS WITH IRIDECTOMNY 66160", "code_information": [{"code": "66160", "type": "CPT"}, {"code": "1480953", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULIZATION OF SCLERA;THERMOCAUTERIZATION WITH IRIDECTOMY 66155", "code_information": [{"code": "66155", "type": "CPT"}, {"code": "1480954", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULIZATION OF SCLERA;TREPHINATION WITH IRIDECTOMY 66150", "code_information": [{"code": "66150", "type": "CPT"}, {"code": "1480955", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULIZATION SCLERA;TRABECULECTOMY AB EXTERNO IN ABSENCE OF PREVIOUS SURGERY 66170", "code_information": [{"code": "66170", "type": "CPT"}, {"code": "1480956", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULIZATION SCLERA;TRABECULECTOMY AB EXTERNO W/SCARRING PREVI.OCULAR TRAUMA 66172", "code_information": [{"code": "66172", "type": "CPT"}, {"code": "1480957", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MONOFOCL", "code_information": [{"code": "92352", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MULTIFOC", "code_information": [{"code": "92353", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES BIFOCAL", "code_information": [{"code": "92341", "type": "CPT"}], "standard_charges": [{"minimum": 108.09, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MONOFOCAL", "code_information": [{"code": "92340", "type": "CPT"}], "standard_charges": [{"minimum": 84.23, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 84.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MULTIFOCAL", "code_information": [{"code": "92342", "type": "CPT"}], "standard_charges": [{"minimum": 122.38, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 122.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 192.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 192.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 192.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITG C-LENS KERATOCONUS 1ST", "code_information": [{"code": "92072", "type": "CPT"}], "standard_charges": [{"minimum": 451.36, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 451.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 709.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 709.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 709.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LOW VIS 1SYSTEM", "code_information": [{"code": "92354", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LW VIS CMPND LENS", "code_information": [{"code": "92355", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITTING OF DIAPHRAGM/CAP", "code_information": [{"code": "57170", "type": "CPT"}], "standard_charges": [{"minimum": 217.72, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 217.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 342.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 342.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 342.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIX G/COLON TUBE W/DEVICE", "code_information": [{"code": "49460", "type": "CPT"}], "standard_charges": [{"minimum": 789.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIX LINK RETRAC ETHICON", "code_information": [{"code": "FLR01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION ASSEMBLY DSF-A03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-A03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5506.0, "discounted_cash": 1927.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION CONNECTING BLOCK DF-350-M6-B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DF-350-M6-B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 628.0, "discounted_cash": 219.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION FULL RING 180MM DF-R100-180", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DF-R100-180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION HALF RING 180MM DF-R050-180", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DF-R050-180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3018.0, "discounted_cash": 1056.3, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION MINIRAIL LENGTHENER ST 57/5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4174.0, "discounted_cash": 1460.9, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION OF CONTRALATERAL TESTIS 54620", "code_information": [{"code": "54620", "type": "CPT"}, {"code": "1480958", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXATION OF SHOULDER BLADE", "code_information": [{"code": "23400", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXATION PIN 40MM 2.0MM PROVISIONAL 71175092", "code_information": [{"code": "71175092", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.58, "discounted_cash": 446.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION POST 1 HOLE MALE DSF-420-M1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-420-M1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 46.2, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION POST 2 HOLE MALE DSF-420-M2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-420-M2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 182.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION POST 3 HOLE MALE DSF-420-M3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-420-M3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 428.0, "discounted_cash": 149.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION POST SQUARE SUPPORT 120MM DSF-350-120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-350-120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 73.15, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION POST SQUARE SUPPORT 90MM DSF-350-090", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-350-090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 73.15, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION SPRING SHOE SUSPENSION DSF-680-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-680-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION SYSTEM 2.5X16MM ANGLED IMPLANT & INSTRUMENT KIT HAMMER TOE OF20025161", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF20025161", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION SYSTEM CAPSURE PERMANENT 15 COUNT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "113215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 482.6, "discounted_cash": 168.91, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION SYSTEM CAPSURE PERMANENT 30 COUNT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "113230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION SYSTEM POST SQUARE SUPPORT 150MM DSF-350-150", "code_information": [{"code": "DSF-350-150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 388.0, "discounted_cash": 135.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATOR RADIUS ADJ DIST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "394.05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5136.0, "discounted_cash": 1797.6, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXED WING AIR MILEAGE", "code_information": [{"code": "A0435", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXED WING AIR TRANSPORT", "code_information": [{"code": "A0430", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0163 6-7-8 8 180", "code_information": [{"code": "FW24015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0164 8-9-10 8 18", "code_information": [{"code": "FW24025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0165 10-11-12 8", "code_information": [{"code": "FW24035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0166 12-13.5-15", "code_information": [{"code": "FW24045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0167 15-16.5-18", "code_information": [{"code": "FW24055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0168 18-19-20 8", "code_information": [{"code": "FW24065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXER SPECTRA 10 GALLON REPLENISHER", "code_information": [{"code": "253494", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEX 60 ARTICULATING -ORDR QTY 3 EC60A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EC60A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEXBAND DYNAMIC MATRIX 0.5 X 8CM 31053", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "31053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3162.0, "discounted_cash": 1106.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEXOR DIGITORUM LONGUS FF 0.55 X 25.0 CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AT654FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8230.0, "discounted_cash": 2880.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBOW 24330", "code_information": [{"code": "24330", "type": "CPT"}, {"code": "1482208", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBW W/ADVMNT", "code_information": [{"code": "24331", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOGRAFT 2.0ML (XX)", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "FGT-10400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14943.0, "discounted_cash": 5230.05, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOOR ORBITAL SM MEDPOR TITAN 3D OFRIGHT", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "81042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4893.0, "discounted_cash": 1712.55, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOSEAL 5ML HEMOSTATIC MATRIX 5 ML", "code_information": [{"code": "1505288", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 434.0, "discounted_cash": 151.9, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOSEAL 5ML HEMOSTATIC MATRIX 5ML ADS201844", "code_information": [{"code": "ADS201844", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 434.0, "discounted_cash": 151.9, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOSEAL HEMOSTATIC MARTIX 10ML", "code_information": [{"code": "1503352", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 687.0, "discounted_cash": 240.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOSEAL HEMOSTATIC MARTIX 5ML", "code_information": [{"code": "1503350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOSEAL HEMOSTATIC MATRIX", "code_information": [{"code": "MED0082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 431.0, "discounted_cash": 150.85, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOSEAL HEMOSTATIC MATRIX FAST PR 10ML ADS201845", "code_information": [{"code": "ADS201845", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 652.0, "discounted_cash": 228.2, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 2-8", "code_information": [{"code": "88187", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 99.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 156.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 156.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 156.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 49.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 49.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 9-15", "code_information": [{"code": "88188", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 85.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 85.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE", "code_information": [{"code": "81245", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 206.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 422.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 663.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 663.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 663.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 238.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 238.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE ANALYSIS", "code_information": [{"code": "81246", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 103.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 119.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 119.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE ITD VARIANTS QUAN", "code_information": [{"code": "46U", "type": "CPT"}], "standard_charges": [{"minimum": 422.05, "maximum": 663.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 422.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 663.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 663.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 663.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 586.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 586.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU CRY EXAM", "code_information": [{"code": "89060", "type": "CPT"}, {"code": "1231828", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 17.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU IMM NO ADMIN DOC REA", "code_information": [{"code": "M1300", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU IMMUNIZE NO ADMIN", "code_information": [{"code": "M1308", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU IMMUNIZE ORDER/ADMIN", "code_information": [{"code": "M1299", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VAC PANDEM PRSRV FREE IM", "code_information": [{"code": "90666", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VACC IIV3 NO PRESERV ID", "code_information": [{"code": "90654", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VACC IIV4 NO PRESERV ID", "code_information": [{"code": "90630", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUID MANAGEMENT ACCESORY AVETA 205-212", "code_information": [{"code": "205-212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 382.8, "discounted_cash": 133.98, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID PRESSURE MUSCLE", "code_information": [{"code": "20950", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUO BILE DUCT IMAGING W/ICG", "code_information": [{"code": "C9776", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUOCINONIDE 0.05%/15GM CREAM LIDEX", "code_information": [{"code": "MED0081", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUORESCEIN ANGIOSCOPY I&R", "code_information": [{"code": "92230", "type": "CPT"}], "standard_charges": [{"minimum": 2141.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN SODIUM OPHTHALMIC STRIPS/FUL-GLO", "code_information": [{"code": "MED0083", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUORESCEIN&ICG ANGIOGRAPHY", "code_information": [{"code": "92242", "type": "CPT"}], "standard_charges": [{"minimum": 786.7, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 786.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1236.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1236.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1236.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENCE LYMPH MAP W/ICG", "code_information": [{"code": "C9756", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT ANTIBODY SCREEN", "code_information": [{"code": "86255", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT ANTIBODY TITER", "code_information": [{"code": "86256", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORINE-18 FLUORODEOXYGLUCO", "code_information": [{"code": "S8085", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUORO EXAM OF G/COLON TUBE", "code_information": [{"code": "49465", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORO POLARIZE FETAL LUNG", "code_information": [{"code": "83663", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOROMETHOLONE 0.1% OPHTH 5ML DROPS", "code_information": [{"code": "MED0084", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT; SEPARATE PROCEDURE 77002", "code_information": [{"code": "77002", "type": "CPT"}, {"code": "10481802", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2055.0, "discounted_cash": 719.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1040.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 763.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 326.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1058.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1276.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 210.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 223.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMR1 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81243", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 71.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 145.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 228.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 228.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 228.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 82.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 82.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMR1 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81244", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 56.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 180.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 180.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 180.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 64.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 64.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY PHYS/PSYCH", "code_information": [{"code": "70555", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 563.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 886.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 886.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 886.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY TECH", "code_information": [{"code": "70554", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 686.51, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 730.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN 1ST LES", "code_information": [{"code": "10009", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN EA ADDL", "code_information": [{"code": "10010", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN 1ST LES", "code_information": [{"code": "10007", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN EA ADDL", "code_information": [{"code": "10008", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN 1ST LES", "code_information": [{"code": "10011", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN EA ADDL", "code_information": [{"code": "10012", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/O IMG GDN EA ADDL", "code_information": [{"code": "10004", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN 1ST LES", "code_information": [{"code": "10005", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN EA ADDL", "code_information": [{"code": "10006", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOA DOC, CARE PLAN NOT DOC", "code_information": [{"code": "G9227", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOA NOT DOC AS BEING PERF", "code_information": [{"code": "G8540", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOAM ROLL CHEST POSITIONER FP-CHEST", "code_information": [{"code": "FP-CHEST", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "FOAM STABILITY FETAL LUNG", "code_information": [{"code": "83662", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOAM ULNAR NERVE POSITIONER", "code_information": [{"code": "FP-UN1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FOCUS ON WOMEN'S HEALTH MVP", "code_information": [{"code": "M1366", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLEY TRAY SYSTEM A300416A", "code_information": [{"code": "A300416A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.63, "discounted_cash": 20.87, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLLOW UP PULM NOD", "code_information": [{"code": "G9345", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLLOW-UP ANGIOGRAPHY", "code_information": [{"code": "75898", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1720.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4779.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOLLOWER UROLOGIC 20FR SURG STRAIGHT THREAD WOVEN LF STRL", "code_information": [{"code": "21520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLLOWER UROLOGIC 22FR SURG STRAIGHT THREAD WOVEN LF STRL", "code_information": [{"code": "21522", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLLOWUP EVAL OF FOOT PT LOP", "code_information": [{"code": "G0246", "type": "HCPCS"}], "standard_charges": [{"minimum": 511.25, "maximum": 803.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH CC", "code_information": [{"code": "504", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10797.32, "maximum": 18536.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10797.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15442.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16986.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18536.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH MCC", "code_information": [{"code": "503", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16062.77, "maximum": 27575.79, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16062.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22973.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25270.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27575.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "505", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10797.32, "maximum": 18536.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10797.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15442.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16986.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18536.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT RAIL BODY COMPLETE - LONG DNE-6000-100L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-6000-100L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FOOTPLATE 180MM DF-R320-180", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DF-R320-180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2812.0, "discounted_cash": 984.2, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP BIOPSY 2.4 X 115 CM G48240", "code_information": [{"code": "G48240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1344.0, "discounted_cash": 470.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP END GRIP 25G ECKARDT DISP", "code_information": [{"code": "1286.WD05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 169.05, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP END GRIP 27G ECKARDT DISP", "code_information": [{"code": "1286.WD04", "type": "CDM"}], "standard_charges": [{"gross_charge": 471.0, "discounted_cash": 164.85, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP OPTHALMIC INSTRUMENT LENS FRAMENTATION DEVICE MILOOP", "code_information": [{"code": "104 MILOOP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP RADIAL JAW 4 28MM LARGE BIOPSY", "code_information": [{"code": "M00513330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP SHARKSKIN ILM 25G 705.88P", "code_information": [{"code": "705.88P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 449.0, "discounted_cash": 157.15, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS 25 GRIESHABER MAX GRIP REFLEX 805.13", "code_information": [{"code": "805.13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.63, "discounted_cash": 155.62, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS 25+ ILM REFLEX DSP 805.44", "code_information": [{"code": "805.44", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS 25+SHARKSKIN ILM REFLEX DSP 805.88", "code_information": [{"code": "805.88", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 497.73, "discounted_cash": 174.21, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS 25G MAXGRIP REV DSP 705.13", "code_information": [{"code": "705.13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 131.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS 27+ MAXGRIP GRIESHABER 811.13", "code_information": [{"code": "811.13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS APPLYING 15CM CLIP SCALP RANEY EXTENDED TIP", "code_information": [{"code": "20-5115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 677.13, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPOLAR 1590-10", "code_information": [{"code": "1590-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1861.5, "discounted_cash": 651.53, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY 2.2MM X 240 CM X 2.8MM ELECTROSURGERY RADIAL JAW 3 HOTINSTR", "code_information": [{"code": "M00515502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY 2.8MM X 240 CM ENDO LG CAPACITY W/ NDL RADIAL JAW 4 STRLINSTR", "code_information": [{"code": "M00513331", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY 2.8MM X 240 CM ENDO LG CAPACITY W/ NDL RADIAL JAW 4 STRLINSTR DIS", "code_information": [{"code": "M00513332", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY 230 CM 7.2MM BLUE HOT STANDARD OVAL MINIMUM CHANNEL 2.8 MM SS STR", "code_information": [{"code": "FD-230U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR MACRO ENDOPATH EBF01", "code_information": [{"code": "EBF01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.0, "discounted_cash": 59.15, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BX SPK ALGTR JW 1 DRV WRE HNG LNKG 230CM JMB DISP (Single Pack Number is BF41080)", "code_information": [{"code": "BF40181", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS CUTTING 5MM 33 CM HALO PKS", "code_information": [{"code": "HACF0533", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1210.5, "discounted_cash": 423.68, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS CUTTING 5MM X 33MM PK", "code_information": [{"code": "PK-CF0533", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1444.0, "discounted_cash": 505.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS ENDGRASPING 25+ REFLEX DSP 805.43", "code_information": [{"code": "805.43", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 426.0, "discounted_cash": 149.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS ENDO 5MM X 36CM AUTO SUT REPROCESS W/ ON OFF RATCHET SWITCH ENDO CLINCH", "code_information": [{"code": "174317R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 55.65, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS ENDOSCOPIC GRASPING FORCEPS 10MM GRASPING DIAM. 115CM", "code_information": [{"code": "G14677", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 592.0, "discounted_cash": 207.2, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS GRASPING RAT TOOTH STANDARD NGF03-11023230", "code_information": [{"code": "NGF03-11023230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS GRIESHABER 23G REVOLUTION ILM", "code_information": [{"code": "706.44", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 368.0, "discounted_cash": 128.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS GRIESHABER ADVANCED DSP MAXGRIP 25GA", "code_information": [{"code": "725.13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS GRIESHABER REVOLUTION DSP ILM 25GA PLUS", "code_information": [{"code": "705.44P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS ILM 25G", "code_information": [{"code": "725.44P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 132.3, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS MAXGRIP 23G ADV DSP", "code_information": [{"code": "723.13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REVOLUTION 25G ENDGRASPING 705.43", "code_information": [{"code": "705.43", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 382.0, "discounted_cash": 133.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SURG 115 CM 3FR ENDO BITE PRCH DISP", "code_information": [{"code": "M0065051600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 782.82, "discounted_cash": 273.99, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SURG 120 CM 3FR URETERAL STONE 3 PRONG STRTH TRCP", "code_information": [{"code": "M0063701230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SURG 230 CM 2.4MM RED SERRATED CPTR BX FEN DISP", "code_information": [{"code": "M005133340", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SURG 4 ENDO HOT RJ", "code_information": [{"code": "M00515032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FOREFOOT IMPLANT SYS PEEK AR-1530P-CP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1530P-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3024.36, "discounted_cash": 1058.53, "setting": "both", "billing_class": "facility"}]}, {"description": "FOREHEAD FLAP W/VASC PEDICLE", "code_information": [{"code": "15731", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORENSIC AUTOPSY (NECROPSY)", "code_information": [{"code": "88040", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3581.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5631.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5631.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5631.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 829.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 829.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORENSIC CYTOPATHOLOGY", "code_information": [{"code": "88125", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 24.41, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 26.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING 54450", "code_information": [{"code": "54450", "type": "CPT"}, {"code": "1480960", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORMULAINJECT 10CC BONE SUBSTITUTE OSTEOVATION", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "390-2010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6963.0, "discounted_cash": 2437.05, "setting": "both", "billing_class": "facility"}]}, {"description": "FRACTIONATION KETOSTEROIDS", "code_information": [{"code": "83593", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 40.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 72.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 114.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 114.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 114.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 41.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 41.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTURE ASSESSMENT VIA DXA", "code_information": [{"code": "77086", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 63.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 67.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTURE NASAL TURBINATES THERAPEUTIC 30930", "code_information": [{"code": "30930", "type": "CPT"}, {"code": "1643986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "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": 8587.98, "maximum": 14743.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8587.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12282.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13510.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14743.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [{"code": "563", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5305.59, "maximum": 9108.38, "estimated_discounted_cash": 19486.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5305.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7588.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8346.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9108.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITH MCC", "code_information": [{"code": "533", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8614.74, "maximum": 14789.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8614.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12320.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13553.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14789.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [{"code": "534", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4806.79, "maximum": 8252.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4806.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6874.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7562.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8252.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [{"code": "535", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7499.12, "maximum": 12874.13, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7499.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10725.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11797.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12874.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [{"code": "536", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4694.25, "maximum": 8058.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4694.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6713.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7385.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8058.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRANCISELLA TULARENSIS", "code_information": [{"code": "86668", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE ASSAY (FT-3)", "code_information": [{"code": "84481", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE FASCIAL FLAP MICROVASC", "code_information": [{"code": "15758", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE FLAP FORMATION 15570", "code_information": [{"code": "15570", "type": "CPT"}, {"code": "1480961", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1037.69, "maximum": 8450.0, "gross_charge": 2144.0, "discounted_cash": 750.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1037.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE JEJUNUM FLAP MICROVASC", "code_information": [{"code": "43496", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE MYO/SKIN FLAP MICROVASC", "code_information": [{"code": "15756", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE OMENTAL FLAP MICROVASC", "code_information": [{"code": "49906", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE SKIN FLAP MICROVASC", "code_information": [{"code": "15757", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE/REMOVE CHEST LINING", "code_information": [{"code": "32320", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRENOPLASTY 41520", "code_information": [{"code": "41520", "type": "CPT"}, {"code": "1740087", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 9357.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRENULOTOMY OF PENIS 54164", "code_information": [{"code": "54164", "type": "CPT"}, {"code": "13152603", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRONTAL 5 X 17MM 70DEGREE NUVENT", "code_information": [{"code": "1830517FRT70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1979.0, "discounted_cash": 692.65, "setting": "both", "billing_class": "facility"}]}, {"description": "FROZEN BLOOD FREEZE/THAW", "code_information": [{"code": "86932", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD PREP", "code_information": [{"code": "86930", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD THAW", "code_information": [{"code": "86931", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN CELL PREPARATION", "code_information": [{"code": "88241", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN PLASMA, POOLED, SD", "code_information": [{"code": "P9023", "type": "HCPCS"}], "standard_charges": [{"minimum": 204.36, "maximum": 321.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 204.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 321.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 321.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 321.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FS NO ODI 9-15MO", "code_information": [{"code": "M1043", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FS NO OKS", "code_information": [{"code": "M1141", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FS ODI 6-20WK POSTOP <= 22", "code_information": [{"code": "G2144", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FS ODI 9-15MO > 22", "code_information": [{"code": "G2143", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FS ODI 9-15MO POSTOP<= 22", "code_information": [{"code": "G2142", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FS OKS 9-15MO < 37 < 71", "code_information": [{"code": "M1046", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FS OKS 9-15MO >= 37 >= 71", "code_information": [{"code": "M1045", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FS WTH SCR NO ODI PRE AND P", "code_information": [{"code": "M1049", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FSODI 6-20WK >22 OR CHG 30PT", "code_information": [{"code": "G2145", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "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": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR N/E/E/L EACH ADDL", "code_information": [{"code": "15261", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK EACH ADDL", "code_information": [{"code": "15201", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUP DNA SEQ CMPR ALYS", "code_information": [{"code": "341U", "type": "CPT"}], "standard_charges": [{"minimum": 2027.25, "maximum": 3187.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2027.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3187.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3187.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3187.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2736.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2736.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY STR ALYS DNA", "code_information": [{"code": "252U", "type": "CPT"}], "standard_charges": [{"minimum": 1093.03, "maximum": 3043.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1935.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1093.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1093.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY TRSMY DNA SEQ", "code_information": [{"code": "327U", "type": "CPT"}], "standard_charges": [{"minimum": 1144.8, "maximum": 3187.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2027.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3187.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3187.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3187.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1144.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1144.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR 3 PROTEINS", "code_information": [{"code": "81509", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1859.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2141.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2141.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FIVE ANAL", "code_information": [{"code": "81512", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 86.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 100.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 100.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FOUR ANAL", "code_information": [{"code": "81511", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 191.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 221.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 221.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR THREE ANAL", "code_information": [{"code": "81510", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 69.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 79.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 79.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR TWO PROTEINS", "code_information": [{"code": "81508", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 67.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 78.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 78.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL FIELD ERG W/I&R", "code_information": [{"code": "92273", "type": "CPT"}], "standard_charges": [{"minimum": 432.31, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 432.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 679.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 679.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 679.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL MOUTH X-RAY OF TEETH", "code_information": [{"code": "70320", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 104.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 111.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [{"code": "793", "type": "MS-DRG"}], "standard_charges": [{"minimum": 988.0, "maximum": 988.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "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": [{"setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [{"code": "934", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS GRAFT 20SQ CM OR LESS 15220", "code_information": [{"code": "15220", "type": "CPT"}, {"code": "1480963", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS GRAFT FREE INC. DIRECT CLOSURE OF DONOR SITE SCALP/ARM/LEG EA. ADD. 20SQ CM 15221", "code_information": [{"code": "15221", "type": "CPT"}, {"code": "2042285", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS GRAFT TRUNK 20SQ CM OR LESS 15200", "code_information": [{"code": "15200", "type": "CPT"}, {"code": "1480964", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS GRAFT-FREE-CLOSURE DONOR SITE-FACIAL-NECK-AXILLAE-GENITALIA-HANDS-FEET 15240", "code_information": [{"code": "15240", "type": "CPT"}, {"code": "1482119", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS GRAFT-FREE-INCLUDING CLOSURE OF DONOR SITE-NOSE-EARS-EYELIDS-LIPS 15260", "code_information": [{"code": "15260", "type": "CPT"}, {"code": "1482118", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL-WEDGE AUGMENT BASEPLATE 29MM 15 DEG DWJ515", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "FULLGUARD HIGH-TOP SHOE COVER SIZE XL 8458", "code_information": [{"code": "8458", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "FUNCT STATUS PAST 12 MONTHS", "code_information": [{"code": "G9916", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNCTIONAL BRAIN MAPPING", "code_information": [{"code": "96020", "type": "CPT"}], "standard_charges": [{"minimum": 742.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 742.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1166.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1166.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1166.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNDOPLICATION LAPAROSCOPIC 43280", "code_information": [{"code": "43280", "type": "CPT"}, {"code": "1480965", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 7854.0, "discounted_cash": 2748.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3801.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNDUS PHOTOGRAPHY W/I&R", "code_information": [{"code": "92250", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGI IDENTIFICATION MOLD", "code_information": [{"code": "87107", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGI IDENTIFICATION YEAST", "code_information": [{"code": "87106", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGUS ISOLATION CULTURE", "code_information": [{"code": "87102", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 33.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 33.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGUS NES ANTIBODY", "code_information": [{"code": "86671", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNNEL MED OPAQUE MICRONIZED CARTILAGE MATRIX BIOCARTILAGE DISP", "code_information": [{"code": "ABS-1003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47760", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47780", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47785", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43340", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43341", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & STOMACH", "code_information": [{"code": "43320", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47720", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47740", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47741", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE HEADLESS 2.5MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX-HD-2516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCT & INTESTINE", "code_information": [{"code": "47802", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCTS & BOWEL", "code_information": [{"code": "47765", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS AND BOWEL", "code_information": [{"code": "48548", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48520", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48540", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE UPPER GI STRUCTURES", "code_information": [{"code": "47721", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE/GRAFT ADDED JOINT", "code_information": [{"code": "26863", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSEFORCE NITINOL STAPLE KIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFNS1816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2927.0, "discounted_cash": 1024.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION MODULUS ALIF FIXATION BOLT 5.0 X 20MM 1450200", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1450200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1407.0, "discounted_cash": 492.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION OF ELBOW JOINT", "code_information": [{"code": "24800", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64866", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64868", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JOINTS", "code_information": [{"code": "C7506", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNEE", "code_information": [{"code": "27580", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF SKULL ARTERIES", "code_information": [{"code": "61711", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43810", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43820", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43825", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25300", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25301", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & BOWEL", "code_information": [{"code": "50810", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50740", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50750", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETERS", "code_information": [{"code": "50760", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION SPINE LUMBAR POSTERIOR 22612", "code_information": [{"code": "22612", "type": "CPT"}, {"code": "1480968", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION SPINE LUMBAR TRANSFORAMINAL INTERBODY 22630", "code_information": [{"code": "22630", "type": "CPT"}, {"code": "1480970", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "gross_charge": 18808.0, "discounted_cash": 6582.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 9103.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION SYSTEM 8DEG X 8-10MM EXPANDING POSTERIOR LUMBAR INTERBODY 1282-1001-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1282-1001-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11536.0, "discounted_cash": 4037.6, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF ELBOW JOINT", "code_information": [{"code": "24802", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUT1 GNOTYP FUT1 EXON 4", "code_information": [{"code": "185U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 266.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUT2 GNOTYP FUT2 EXON 2", "code_information": [{"code": "186U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 266.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR 1ST 100 SQ CM", "code_information": [{"code": "479T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR EA ADDL 100SQCM", "code_information": [{"code": "480T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE ANALYSIS", "code_information": [{"code": "233U", "type": "CPT"}], "standard_charges": [{"minimum": 395.76, "maximum": 1102.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE CHARAC ALLELES", "code_information": [{"code": "81285", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE DETC ABNOR ALLELES", "code_information": [{"code": "81284", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE FULL GENE SEQUENCE", "code_information": [{"code": "81286", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE KNOWN FAMIL VARIANT", "code_information": [{"code": "81289", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 472.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FY GNOTYP ACKR1 EXONS 1-2", "code_information": [{"code": "187U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 395.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Facility-based respite, 24-hour unit, for use in CMMI model", "code_information": [{"code": "G0531", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ferritin", "code_information": [{"code": "82728", "type": "CPT"}, {"code": "633726", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 114.0, "discounted_cash": 39.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 42.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Filled at least two prescriptions during the performance period for any combination of the qualifying oral antipsychotic medications listed under \"denominator note\" or the long-acting injectable antipsychotic medications listed under \"denominator note\"", "code_information": [{"code": "M1380", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "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": 568.32, "maximum": 893.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 568.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 893.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 893.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 893.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Flow cytometry, cell surface, cytoplasmic, or nuclear marker, each add'l marker 88185", "code_information": [{"code": "88185", "type": "CPT"}, {"code": "42590800", "type": "CDM"}, {"code": "311", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 119.0, "discounted_cash": 41.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 44.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 99.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 99.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 99.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker", "code_information": [{"code": "88184", "type": "CPT"}, {"code": "34093807", "type": "CDM"}, {"code": "311", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 134.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Flow cytometry, interpretation; 16 or more markers 88189", "code_information": [{"code": "88189", "type": "CPT"}, {"code": "34093808", "type": "CDM"}, {"code": "311", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 311.0, "discounted_cash": 108.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 225.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 354.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 354.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 354.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 115.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 115.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Flu", "code_information": [{"code": "87804", "type": "CPT"}, {"code": "1099832", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 218.0, "discounted_cash": 76.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 80.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 66.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 66.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 66.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Follicle Stimulating Hormone", "code_information": [{"code": "83001", "type": "CPT"}, {"code": "633730", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 27.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Free Thyroxine Index", "code_information": [{"code": "84436", "type": "CPT"}, {"code": "633731", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 23.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Fresh Frozen Plasma", "code_information": [{"code": "P9017", "type": "HCPCS"}, {"code": "1093824", "type": "CDM"}, {"code": "383", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "Fungal Stain/AFB Smear 87206", "code_information": [{"code": "87206", "type": "CPT"}, {"code": "633878", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "G-ESOPH REFLX TST W/ELECTROD", "code_information": [{"code": "91035", "type": "CPT"}], "standard_charges": [{"minimum": 1795.93, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1795.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2822.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2822.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2822.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "G6PC GENE", "code_information": [{"code": "81250", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 73.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 234.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 234.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 234.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 84.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 84.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "G6PD FULL GENE SEQUENCE", "code_information": [{"code": "81249", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "G6PD GENE ALYS CMN VARIANT", "code_information": [{"code": "81247", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 445.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "G6PD KNOWN FAMILIAL VARIANT", "code_information": [{"code": "81248", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 469.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 956.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GABAPENTIN NON-BLOOD", "code_information": [{"code": "80355", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GADOTERATE MEGLUMINE(DOTAREM) 376.9 MG/ML (0.5 MMOL/ML) SOLN 5 ML", "code_information": [{"code": "MED0211", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GALACTOSE TRANSFERASE TEST", "code_information": [{"code": "82776", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 47.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GALECTIN-3", "code_information": [{"code": "82777", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 55.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 112.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 177.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 177.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 177.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 63.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 63.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA AMP PROBE", "code_information": [{"code": "87511", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA DIR PROBE", "code_information": [{"code": "87510", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA QUANT", "code_information": [{"code": "87512", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 60.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 60.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAS ISPAN SF6 CONSTELLATION 125GM 8065797005", "code_information": [{"code": "8065797005", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2206.0, "discounted_cash": 772.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GASTRIC ANALY W/PH EA SPEC", "code_information": [{"code": "82930", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS FOR OBESITY", "code_information": [{"code": "43846", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS INCL SMALL I", "code_information": [{"code": "43847", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78264", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1346.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2116.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2116.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2116.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 625.41, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 665.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78265", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1544.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2428.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2428.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2428.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 741.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 789.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78266", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1900.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2988.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2988.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2988.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 840.84, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 894.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC MOTILITY STUDIES", "code_information": [{"code": "91020", "type": "CPT"}], "standard_charges": [{"minimum": 775.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 775.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1218.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1218.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1218.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC MUCOSA IMAGING", "code_information": [{"code": "78261", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 789.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1240.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1240.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1240.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 372.17, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 396.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIN TEST", "code_information": [{"code": "82938", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 70.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 70.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 70.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROCNEMIUS RECESSION 27687", "code_information": [{"code": "27687", "type": "CPT"}, {"code": "1480981", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROENTEROLOGY SS", "code_information": [{"code": "G4006", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROESOPHAGEAL REFLUX EXAM", "code_information": [{"code": "78262", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 946.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1487.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1487.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1487.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 459.8, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 489.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROESOPHAGEAL REFLUX TEST", "code_information": [{"code": "91034", "type": "CPT"}], "standard_charges": [{"minimum": 626.18, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 626.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 983.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 983.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 983.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL FAT ABSORPT", "code_information": [{"code": "S3708", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.2, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [{"code": "378", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6043.46, "maximum": 10375.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6043.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8643.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9507.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10375.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [{"code": "377", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10956.7, "maximum": 18809.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10956.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15670.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17237.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18809.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "379", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3876.09, "maximum": 6654.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3876.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5543.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6098.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6654.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [{"code": "389", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5007.53, "maximum": 8596.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5007.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7161.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7878.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8596.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [{"code": "388", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9213.31, "maximum": 15816.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9213.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13177.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14494.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15816.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC", "code_information": [{"code": "390", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3547.0, "maximum": 6089.31, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3547.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5072.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5580.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6089.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43360", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43361", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY DUODENAL SWITCH", "code_information": [{"code": "43845", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY W/O V-BAND", "code_information": [{"code": "43843", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATED HEART MULTIPLE", "code_information": [{"code": "78473", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 992.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1559.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1559.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1559.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 469.46, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 499.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATED HEART PLANAR SINGLE", "code_information": [{"code": "78472", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 822.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1292.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1292.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1292.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 389.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 414.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAUGE DEPTH / COUNTERSINK 2.5MM (YELLOW) IS1103", "code_information": [{"code": "IS1103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1195.0, "discounted_cash": 418.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE MONSTER DEPTH", "code_information": [{"code": "P20-951-2027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE SYRNG 60 MLK ASSEMBLY DISP", "code_information": [{"code": "M00550600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.53, "discounted_cash": 32.04, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE BANDAGE ROLL 4.5INX4.1YD 6PLY ST", "code_information": [{"code": "C-FR446S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE BANDAGE ROLL-LIGHT 3X4.1YD 3PLY ST", "code_information": [{"code": "C-CBL3S", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE BANDAGE ROLL-LIGHT 4X4.1YD 3PLY ST", "code_information": [{"code": "C-CBL4S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE BORDERED DRESSING WOUND MSC3236", "code_information": [{"code": "MSC3236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE DRESSING 3IN X 8IN OIL EMULSION ADAPTIC", "code_information": [{"code": "CUR250381", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE ROLL DERMACEA STRTCH 2X4.1YD STRL 441504", "code_information": [{"code": "441504", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE SPONGES-PREMIUM 4INX4IN 8-PLY, NS", "code_information": [{"code": "C-NSG448", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE VASELINE 3X9 FOIL PK STERILE 8884413605", "code_information": [{"code": "8884413605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZEROLL DERMACEASTRTCH3X4.1YDSTRL 441505", "code_information": [{"code": "441505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GBA GENE", "code_information": [{"code": "81251", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 59.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 68.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 68.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GC CHL SYP DOCUMENTED", "code_information": [{"code": "G9228", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GE GNOTYP GYPC EXONS 1-4", "code_information": [{"code": "188U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 395.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GEL INJECTIONS PROLARYN 1.0CC", "code_information": [{"code": "C1878", "type": "HCPCS"}, {"code": "8602MOK5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 414.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL PORT (ETHICON)", "code_information": [{"code": "HAP02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 754.0, "discounted_cash": 263.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFILM 25X50MM", "code_information": [{"code": "MED0085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 196.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFILM FL 6 STRL OPTH 2.5X12IN", "code_information": [{"code": "9-0297-03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFOAM POWDER", "code_information": [{"code": "MED0438", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFOAM SIZE 100 (ABSORBABLE GELATIN)", "code_information": [{"code": "MED0086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFOAM SIZE 50", "code_information": [{"code": "MED0087", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFOAM SPONGE 12-7MM (ABSORBABLE GELATIN)", "code_information": [{"code": "MED0088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GEMINUS HOOK PLATE GMN-HP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-HP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1132.0, "discounted_cash": 396.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GEMINUS HOOK PLATE SCREW GMN-HP-SCRW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-HP-SCRW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GENE PROFILE PANEL BREAST", "code_information": [{"code": "S3854", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1764.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1122.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1764.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1764.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1764.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST ALPHA-THALASSEMIA", "code_information": [{"code": "S3845", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST BETA-THALASSEMIA", "code_information": [{"code": "S3846", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST HIPPEL-LINDAU", "code_information": [{"code": "S3842", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST MYO MUSCLR DYST", "code_information": [{"code": "S3853", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST NIEMANN-PICK", "code_information": [{"code": "S3849", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST RETINOBLASTOMA", "code_information": [{"code": "S3841", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST SICKLE CELL", "code_information": [{"code": "S3850", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TESTING NOT PERFORMED", "code_information": [{"code": "G9841", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TESTING PERFORMED", "code_information": [{"code": "G9840", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENERAL HEALTH PANEL 80050", "code_information": [{"code": "80050", "type": "CPT"}, {"code": "45923143", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 87.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 90.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 57.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 57.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENERAL SURGERY SS", "code_information": [{"code": "G4007", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENERATOR DEMIPULSE 103HP UDI", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "10-0009-5503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34192.0, "discounted_cash": 11967.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERATOR DRG EXTERNAL PULSE 2 PORT HEADER 7032", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "7032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 650.0, "discounted_cash": 227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERATOR IMPLANTABLE PULSE MODEL 3150 INSPIRE 5 3150", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43200.0, "discounted_cash": 15120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERATOR IMPLANTABLE PULSE W/CHARGING KIT", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1032B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35638.0, "discounted_cash": 12473.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERATOR INTELLIS ADAPT.", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "97715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28960.0, "discounted_cash": 10136.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERATOR KIT PULSE WAVEWRITER ALPHA IMPLANTABLE M365SC12320", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "M365SC12320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37698.0, "discounted_cash": 13194.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERATOR PULSE IMPLANTABLE", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 58267.0, "discounted_cash": 20393.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERATOR PULSE IMPLANTABLE RESTORE NEUROSTIMULATOR", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "97714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32548.0, "discounted_cash": 11391.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GENET VIRUS ISOLATE HSV", "code_information": [{"code": "87255", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 135.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 135.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 135.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENETIC COUNSELING 30 MIN", "code_information": [{"code": "96040", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENETIC TEST BRUGADA", "code_information": [{"code": "S3861", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENETIC TESTING ALS", "code_information": [{"code": "S3800", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENETIC TSTG SEVERE INH COND", "code_information": [{"code": "81443", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 9818.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6243.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3525.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3525.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENIOPLASTY 21120", "code_information": [{"code": "21120", "type": "CPT"}, {"code": "1480988", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOM RPD SEQ ALYS EA CMPRTR", "code_information": [{"code": "425U", "type": "CPT"}], "standard_charges": [{"minimum": 12829.56, "maximum": 20175.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12829.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOME RAPID SEQUENCE ALYS", "code_information": [{"code": "94U", "type": "CPT"}], "standard_charges": [{"minimum": 10918.37, "maximum": 20175.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12829.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10918.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10918.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOME RE-EVALUATION", "code_information": [{"code": "81427", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 9373.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5961.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9373.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9373.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9373.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3366.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3366.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOME SEQUENCE ANALYSIS", "code_information": [{"code": "81425", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 20175.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12829.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7244.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7244.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOME SEQUENCE ANALYSIS", "code_information": [{"code": "81426", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 10866.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6910.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10866.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10866.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10866.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3902.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3902.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOME ULTRA-RAPID SEQ ALYS", "code_information": [{"code": "426U", "type": "CPT"}], "standard_charges": [{"minimum": 12829.56, "maximum": 20175.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12829.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENTAMICIN 80 MG/100 ML-NS 0.9% IV SOLN", "code_information": [{"code": "MED0247", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GENTAMICIN 80MG/2 ML VIAL/GARAMYCIN", "code_information": [{"code": "MED0089", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GENTAMICIN OPHTHALMIC SOLUTION 3MG/ML 5ML", "code_information": [{"code": "MED0091", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GENTAMICIN PEDIATRIC 20MG/2ML", "code_information": [{"code": "MED0221", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GENTAMICIN TOP 0.1% OINT 15 GM", "code_information": [{"code": "MED0090", "type": "CDM"}], "standard_charges": [{"gross_charge": 111.0, "discounted_cash": 38.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GERIATRICS SS", "code_information": [{"code": "G4008", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GFRG AUTOL FAT LIPO EA ADDL", "code_information": [{"code": "15774", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI BARET ESPH DNA MTHYLN ALY", "code_information": [{"code": "407U", "type": "CPT"}], "standard_charges": [{"minimum": 1368.0, "maximum": 3809.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2422.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1368.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI BARET ESPH DNA MTHYLN ALY", "code_information": [{"code": "409U", "type": "CPT"}], "standard_charges": [{"minimum": 4204.22, "maximum": 15037.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9562.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI BARRETT ESOPH 9 PRTN BMRK", "code_information": [{"code": "108U", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 7128.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7128.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI BARRETTS ESOPH VIM&CCNA1", "code_information": [{"code": "114U", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 2790.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2790.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2790.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI BIPOLAR HEMOSTASIS PRO", "code_information": [{"code": "CD-B620LA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GI ENDOSCOPIC ULTRASOUND", "code_information": [{"code": "76975", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI IBS IA ANTI-CDTB&VINCULIN", "code_information": [{"code": "164U", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 161.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 161.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 161.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI MALABS AAT CALPRO PNCRTC", "code_information": [{"code": "430U", "type": "CPT"}], "standard_charges": [{"minimum": 58.57, "maximum": 92.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI MARKER BLUE BEACON GI Marker 5ml Syringe Indigo Carmine 0.4% Sterile 128-5667", "code_information": [{"code": "IC62021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.0, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GI MYOELECTRICAL ACTV STUDY", "code_information": [{"code": "779T", "type": "CPT"}], "standard_charges": [{"minimum": 2112.59, "maximum": 3321.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2112.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3321.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3321.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3321.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI PROTEIN LOSS EXAM", "code_information": [{"code": "78282", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1544.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2428.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2428.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2428.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI TRC IMG INTRAL COLON I&R", "code_information": [{"code": "91113", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3688.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5798.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5798.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5798.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI TRC IMG INTRAL ESOPH-ILE", "code_information": [{"code": "91110", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3358.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5277.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5277.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5277.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI TRC IMG INTRAL ESOPHAGUS", "code_information": [{"code": "91111", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3358.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5277.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5277.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5277.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI WIRELESS CAPSULE MEASURE", "code_information": [{"code": "91112", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5198.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8169.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8169.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8169.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GIA 60-3.8 SINGLE USE LOADING UNIT GIA6038L", "code_information": [{"code": "GIA6038L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 261.0, "discounted_cash": 91.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GIARDIA AG IA", "code_information": [{"code": "87329", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GIARDIA AG IF", "code_information": [{"code": "87269", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GIARDIA LAMBLIA ANTIBODY", "code_information": [{"code": "86674", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GJB2 GENE FULL SEQUENCE", "code_information": [{"code": "81252", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 126.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 257.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 405.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 405.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 405.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 145.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 145.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GJB2 GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81253", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 156.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 246.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 246.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 246.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 88.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 88.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GJB6 GENE COM VARIANTS", "code_information": [{"code": "81254", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GL0VE 6.0 PROT HYDRO LTX PF SURG", "code_information": [{"code": "2D72LS60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLAUCOMA PLAN OF CARE DOC", "code_information": [{"code": "M1223", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA PLN OF CARE NOT DOC", "code_information": [{"code": "M1222", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SCRN HGH RISK DIREC", "code_information": [{"code": "G0117", "type": "HCPCS"}], "standard_charges": [{"minimum": 251.11, "maximum": 394.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 251.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 394.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 394.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 394.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SCRN HGH RISK DIREC", "code_information": [{"code": "G0118", "type": "HCPCS"}], "standard_charges": [{"minimum": 187.56, "maximum": 294.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 187.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 294.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 294.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 294.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID 50MM-STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "414.842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID ANATOMIC AUGMENTED 25 DEG RIGHT DWK406RA25S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWK406RA25S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID AUGMENT AEQUALIS PERFORM CORTILOC DWK405RA35S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWK405RA35S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID AUGMENT AEQUALIS PERFORM SMALL LEFT 15DEG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWK403LA15S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID AUGMENT UHMWPE PLUS COCR LARGE LEFT 15 CORTILOC DWK405LA15S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWK405LA15S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID CORTILOC MODEL L40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID CORTILOC MODEL M35", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6901.0, "discounted_cash": 2415.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID CORTILOCPEGGED L50", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID E-PLUS 42MM SZ 42 ALL-POLY PEGGED 521-07-242", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "521-07-242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2358.0, "discounted_cash": 825.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID PEGGED E-PLUS 46MM ALL-POLY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "521-07-246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2358.0, "discounted_cash": 825.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID PEGGED SZ 40 AFFINITI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "20060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6582.0, "discounted_cash": 2303.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID PEGGED SZ 46", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-01-246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID S30 PEFFED MODEL TORNIER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2200.0, "discounted_cash": 770.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID S35 PEFFED MODEL TORNIER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4439.0, "discounted_cash": 1553.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID TURON 46MM PEGGED ALL POLY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "521-01-246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID UNIVERSAL MED BASEPLATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9120-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5047.0, "discounted_cash": 1766.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID VAULTLOCK SMALL UNIV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9106-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3245.0, "discounted_cash": 1135.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSHERE CANNULATED COCR STANDARD 39MM DWJ1017302", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ1017302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSHPERE LATERLIZED 3MM X 36MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE 3MM LAT 42MM PERFORM REVERSED LATERAL DWJ024", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE AQUALIS PERFORM REVERSED STANDARD GLENOSPHERE 36MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE CANNULATED COCR LATERALIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ1017306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE CANNULATED COCR LATERALIZED (+3MM) 36MM DWJ1017305", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ1017305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE CANNULATED COCR LATERALIZED +3MM 42MM DWJ1017307", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ1017307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE CANNULATED COCR LATERALIZED 33MM DWJ1017304", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ1017304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 1540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE CANNULATED COCR STANDARD 36MM DWJ1017301", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ1017301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE CANNULATED COCR STANDARD SHOULDER IMPLANT DWJ1017303", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ1017303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE IMPLANT ECCENTRIC CANN 36MM +2MM DWJ1017701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ1017701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE LATERAL PERFORM 3MM LAT39MM DWJ023", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE LATERALIZED DWP4426", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP4426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE REVERSED STANDARD 39MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE SHOULDER 36MM +3MM REVERSE COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "115313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2050.0, "discounted_cash": 717.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE UNIVERS REVERS 39", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9504M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIDESHEETS IOL 5 X 35MM 2.5MM RADIUS", "code_information": [{"code": "9204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIDEWIRE RADIFOCUS .035 630-100", "code_information": [{"code": "630-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOBAL AP PC STEM 8 MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113008200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7189.0, "discounted_cash": 2516.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOSSECTOMY LESS THAN ONE HALF TONGUE 41120", "code_information": [{"code": "41120", "type": "CPT"}, {"code": "2334796", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 9357.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ORTHO PRO SIZE 7.0 47670", "code_information": [{"code": "47670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ORTHO PRO SIZE 7.5 47675", "code_information": [{"code": "47675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ORTHO PRO SIZE 8.5 47685", "code_information": [{"code": "47685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRA TOUCH M SZ 6.5 42665", "code_information": [{"code": "42665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRA TOUCH M SZ 7.0 42670", "code_information": [{"code": "42670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRA TOUCH M SZ 7.5 42675", "code_information": [{"code": "42675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRA TOUCH M SZ 8.5 42685", "code_information": [{"code": "42685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRATOUCH G 7.0 LF 42170", "code_information": [{"code": "42170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRATOUCH G 8.5 LF 42185", "code_information": [{"code": "42185", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PLULTRATOUCHG SZ 6.5 LF 42165", "code_information": [{"code": "42165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE ENCRE PRRY STYL 42 PF BEAD 8.0 5711105PF", "code_information": [{"code": "5711105PF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE ESSENTIAL LATEX POWDER SZ 7 MSG5970", "code_information": [{"code": "MSG5970", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.46, "discounted_cash": 1.21, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE EXAM XL 12IN BLUE BEADED CUFF TEXTURED FINGERTIPS LTX EUDERMIC MP PF", "code_information": [{"code": "485604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE EXAM XL BEADED CUFF TEXTURED HND SPECIFIC P2 BRAND HI RISK PF", "code_information": [{"code": "SA932486-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE ORTHO SURGICAL PROTEXIS LTX S 2D72LT90", "code_information": [{"code": "2D72LT90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LATEX BLU NEU-THERA S", "code_information": [{"code": "2D72LU60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LATEX BLU NEU-THERA S 2D72LU65", "code_information": [{"code": "2D72LU65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LATEX BLU NEU-THERA S 2D72LU70", "code_information": [{"code": "2D72LU70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LATEX BLU NEU-THERA S 2D72LU80", "code_information": [{"code": "2D72LU80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LATEX BLU NEU-THERA S 2D72LU85", "code_information": [{"code": "2D72LU85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LATEX BLU NEU-THERA S 2D72LU90", "code_information": [{"code": "2D72LU90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LATEX HYDROGEL SZ 7 2D72LS70", "code_information": [{"code": "2D72LS70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LATEX HYDROGEL SZ 7.5 2D72LS75", "code_information": [{"code": "2D72LS75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LATEX HYDROGEL SZ 8 2D72LS80", "code_information": [{"code": "2D72LS80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LATEX HYDROGEL SZ 8.5 2D72LS85", "code_information": [{"code": "2D72LS85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LATEX HYDROGEL SZ 9 2D72LS90", "code_information": [{"code": "2D72LS90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LTX ORTHO SURGICAL SZ 7.5 2D72LT75", "code_information": [{"code": "2D72LT75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LTX ORTHO SURGICAL SZ 8 2D72LT80", "code_information": [{"code": "2D72LT80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS LTX ORTHO SURGICAL SZ 8.5 2D72LT85", "code_information": [{"code": "2D72LT85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS MICRO SZ 6.0 PO", "code_information": [{"code": "2D73PM60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS ORTHO SURGICAL LTX SZ 2D72LT70", "code_information": [{"code": "2D72LT70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS SURGICAL ORTHO LTX SZ 6 2D72LT60", "code_information": [{"code": "2D72LT60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS SURGICAL ORTHO LTX SZ 6.5 2D72LT65", "code_information": [{"code": "2D72LT65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS SZ 8.0 LATEX NEU THERA LATEX PF", "code_information": [{"code": "2D73TP80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE PROTEXIS SZ 8.5 LATEX NEU THERA LATEX PF", "code_information": [{"code": "2D73TP85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE RADIATION SZ 8", "code_information": [{"code": "RR2-8.0", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE RADIATION SZ 8.5", "code_information": [{"code": "RR2- 8.5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SENSICARE PI SLT 8 1/2 MSG1585", "code_information": [{"code": "MSG1585", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SRG ORTHO HDRGL PF LF STRL 7.5 2D73HT75", "code_information": [{"code": "2D73HT75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.13, "discounted_cash": 2.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SRG PROTXIS PI CLASSC 6.0PF SY 2D72PL60X", "code_information": [{"code": "2D72PL60X", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SRGCL BIOGEL ULTRATOUCH PF 6.5 41165", "code_information": [{"code": "41165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SRGCL LTX BIOGEL ECLIPSE PF 7 75270", "code_information": [{"code": "75270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE STRETCH SYNTH ALOE ULTRA IC L", "code_information": [{"code": "MDS195076", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE STRETCH SYNTH ALOE ULTRA IC M", "code_information": [{"code": "MDS195075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE STRETCH SYNTH ALOE ULTRA IC S", "code_information": [{"code": "MDS195074", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG 7 BROWN ORTHO PERRY STYLE SMOOTH POWDERED LATEX STRL", "code_information": [{"code": "5721313", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG 7 TRIUMPH LF PF", "code_information": [{"code": "MSG2270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG 7.5 LATEX SMOOTH POWDERED STRL", "code_information": [{"code": "5711104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG 7.5 TRIUMPH LF PF", "code_information": [{"code": "MSG2275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG 8 BEIGE NAT RUBBER TEXTURED STRL PF", "code_information": [{"code": "20873080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG 8 BROWN ORTHO PERRY STYLE SMOOTH POWDERED LATEX STRL", "code_information": [{"code": "5721315", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG 8.5 LATEX POWDERED SMOOTH STRL", "code_information": [{"code": "5711106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG 8.5 ORANGE RADIATION ATTENUATION PF", "code_information": [{"code": "20873085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG 8.5 ORTHO MAXXUS STRL", "code_information": [{"code": "5721316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG 8.5 TRIUMPH LF PF", "code_information": [{"code": "MSG2285", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LATEX BIOGEL INDICATOR PF 31265", "code_information": [{"code": "31265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LATEX BIOGEL INDICATOR PF 31280", "code_information": [{"code": "31280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LATEX BIOGEL INDICATOR PF 6 31260", "code_information": [{"code": "31260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LATEX BIOGEL INDICATOR PF 7.5 31275", "code_information": [{"code": "31275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LATEX BIOGEL INDICATOR PF 8.5 31285", "code_information": [{"code": "31285", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LATEX BIOGEL SURGICAL PF 6 30460", "code_information": [{"code": "30460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LATEX BIOGEL SURGICAL PF 8.5 30485", "code_information": [{"code": "30485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LATEX BIOGEL SURGICAL PF 9 30490", "code_information": [{"code": "30490", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LATX BIOGEL INDICTOR PF 7 31270", "code_information": [{"code": "31270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LATX ENCRE MCROPTC PF 6.5 5787002", "code_information": [{"code": "5787002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LATX ENCRE MCROPTC PF 8.5 5787006", "code_information": [{"code": "5787006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LTX BIOGEL SUPER-SENSITIVE 6 82560", "code_information": [{"code": "82560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LTX ENCORE MICROPTIC PF 7 5787003", "code_information": [{"code": "5787003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.13, "discounted_cash": 1.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG LTX ENCORE MICROPTIC PF 8 5787005", "code_information": [{"code": "5787005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.44, "discounted_cash": 1.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG NEOPRENE SYNTH LF PF 6.5 8513", "code_information": [{"code": "8513", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG ORTHO HDROGEL PF LF STRL 2D73HT70", "code_information": [{"code": "2D73HT70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.18, "discounted_cash": 2.86, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG ORTHO HDROGEL PF LF STRL 8.0 2D73HT80", "code_information": [{"code": "2D73HT80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.13, "discounted_cash": 2.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PF SYN NEOPR PROTEXIS 7.0 2D73DP70", "code_information": [{"code": "2D73DP70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG POLYISOPRENE ESTEEM PF 7 2D73EB70", "code_information": [{"code": "2D73EB70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG POLYISOPRENE ESTEEM PF 8 2D73EB80", "code_information": [{"code": "2D73EB80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG POLYISOPRENE ESTEEM PF 9 2D73EB90", "code_information": [{"code": "2D73EB90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.14, "discounted_cash": 10.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG POLYISOPRNE ESTEEM PF 6.5 2D73EB65", "code_information": [{"code": "2D73EB65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.37, "discounted_cash": 2.23, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS LATEX 8.5 PF 2D72NS85X", "code_information": [{"code": "2D72NS85X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS LATEX CLASSIC 7.0 PF 2D72N70X", "code_information": [{"code": "2D72N70X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS LATEX CLASSIC 8.5 PF 2D72N85X", "code_information": [{"code": "2D72N85X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS LTX CLSSC 6.5 PF 2D72N65X", "code_information": [{"code": "2D72N65X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS PI 5.5 PF SYN 2D72PT55X", "code_information": [{"code": "2D72PT55X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS PI 6.0 PF SYN 2D72PT60X", "code_information": [{"code": "2D72PT60X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.86, "discounted_cash": 2.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS PI 6.5 PF SYN 2D72PT65X", "code_information": [{"code": "2D72PT65X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.86, "discounted_cash": 2.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS PI 7.0 PF SYN 2D72PT70X", "code_information": [{"code": "2D72PT70X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.92, "discounted_cash": 2.42, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS PI 7.5 PF SYN 2D72PT75X", "code_information": [{"code": "2D72PT75X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.86, "discounted_cash": 2.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS PI 8.0 PF SYN 2D72PT80", "code_information": [{"code": "2D72PT80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS PI 8.5 PF SYN 2D72PT85X", "code_information": [{"code": "2D72PT85X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXIS PI 9.0 PF SYN 2D72PT90X", "code_information": [{"code": "2D72PT90X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PROTEXISLATEXMICRO 8.0 PF 2D72NT80X", "code_information": [{"code": "2D72NT80X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG PRTXS LATEX CLSSC7.5PF 2D72N75X", "code_information": [{"code": "2D72N75X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SIGNATURE LTX ESS LTX PF 8 MSG5980", "code_information": [{"code": "MSG5980", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 5.5 12IN IVORY BEADED CUFF SMTH HND SPECIFIC POLYISOPRENE PROTEXIS", "code_information": [{"code": "2D72NT55X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 6 BIOGEL PIINDICATOR", "code_information": [{"code": "41660", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 6 BIOGEL PL ULTRATOUCH G LF", "code_information": [{"code": "42160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 6.0 POLYISOPRENE ESTEEM PF", "code_information": [{"code": "2D73EB60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.31, "discounted_cash": 2.21, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 6.5 BIOGEL PRO PI ORTHO", "code_information": [{"code": "47665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 7 LATEX ALOETOUCH ORTHO PF", "code_information": [{"code": "MSG2670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 7.5 BROWN ORTHO BEADED CUFF HND SPECIFIC LATEX POWERED PERRY DISP", "code_information": [{"code": "5721314", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 7.5 LATEX ALOETOUCH ORTHO PF", "code_information": [{"code": "MSG2675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 7.5 POLYISOPRENE ESTEEM PF", "code_information": [{"code": "2D73EB75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.31, "discounted_cash": 2.21, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 8 BIOGEL PL ORTHO PRO", "code_information": [{"code": "47680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 8 BIOGEL PL ULTRATOUCH G LF STRL", "code_information": [{"code": "42180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 8 IVORY SMTH CHEMO RATED BEADED CUFF SMOOTH SYNTH ESTEEM STRL PF", "code_information": [{"code": "2D72PT80X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.86, "discounted_cash": 2.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 8 LATEX ALOETOUCH ORTHO PF", "code_information": [{"code": "MSG2680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 8 LATEX BIOGEL ORTHO PF", "code_information": [{"code": "31080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 8.5 LATEX ALOETOUCH ORTHO PF", "code_information": [{"code": "MSG2685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 8.5 POWDERED SMTH BEADED CUFF LATEX NEUTRALON STRL DISP", "code_information": [{"code": "5385", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 9 BIOGEL PL ULTRATOUCH G LF", "code_information": [{"code": "42190", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG SZ 9 ORTHO BIOGEL", "code_information": [{"code": "31090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURG TRIUMPH LTX PF 8 MSG2280", "code_information": [{"code": "MSG2280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL 5.5 PROTEXIS LATEX BLUE", "code_information": [{"code": "2D72LU55", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL 5.5 PROTEXIS LATEX HYDROGEL", "code_information": [{"code": "2D72LS55", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL BIOGEL LF PF 6.5 40865", "code_information": [{"code": "40865", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL BIOGEL LF PF 7 40870", "code_information": [{"code": "40870", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL BIOGEL PI IND SZ 7.5 41675", "code_information": [{"code": "41675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL BIOGEL ULTRATOUCH PF 41160", "code_information": [{"code": "41160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL BIOGEL ULTRATOUCH PF 41170", "code_information": [{"code": "41170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL BIOGEL ULTRATOUCH PF 41175", "code_information": [{"code": "41175", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL BIOGEL ULTRATOUCH PF 41180", "code_information": [{"code": "41180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL BIOGEL ULTRATOUCH PF 41185", "code_information": [{"code": "41185", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LATEX BIOGEL M PF 6.5 30565", "code_information": [{"code": "30565", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LATEX BIOGEL M PF 7.5 30575", "code_information": [{"code": "30575", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LATEX BIOGEL M PF 8.0 30580", "code_information": [{"code": "30580", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LATEX BIOGEL PF 6.5 30465", "code_information": [{"code": "30465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LATEX BIOGEL PF 7 30470", "code_information": [{"code": "30470", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LATEX BIOGEL PF 7.5 30475", "code_information": [{"code": "30475", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LATEX BIOGEL PF 8 30480", "code_information": [{"code": "30480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LTX BIOGEL ECLIPSE PF 6.5 75265", "code_information": [{"code": "75265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LTX BIOGEL ECLIPSE PF 7.5 75275", "code_information": [{"code": "75275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LTX BIOGEL ECLIPSE PF 8 75280", "code_information": [{"code": "75280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LTX BIOGEL ECLIPSE PF 8.5 75285", "code_information": [{"code": "75285", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL LTX BIOGEL SENSOR PF 30685", "code_information": [{"code": "30685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL ORTHO SYNTH PF 8 2D73ET80", "code_information": [{"code": "2D73ET80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL ORTHO SYNTH PF 8.5 2D73ET85", "code_information": [{"code": "2D73ET85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL PF LATEX COATED SZ 6.5 2D72LS65", "code_information": [{"code": "2D72LS65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL PI ORTHO SZ 6.5", "code_information": [{"code": "2D73HT65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.56, "discounted_cash": 66.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL PI ORTHO SZ 8.5", "code_information": [{"code": "2D73HT85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.13, "discounted_cash": 2.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL POLY MICRO PF 7.5 2D73PM75", "code_information": [{"code": "2D73PM75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL POLYISOPRENE MICRO 2D73PM85", "code_information": [{"code": "2D73PM85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL POLYISOPRENE MICRO PF 2D73PM70", "code_information": [{"code": "2D73PM70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL POLYISOPRENE MICRO PF 2D73PM80", "code_information": [{"code": "2D73PM80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL POLYISOPRENE MICRO PF 9", "code_information": [{"code": "2D73PM90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL PROTEXIS 6.0 NEU-THERA PF STRL", "code_information": [{"code": "2D73TP60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL PROTEXIS LATEX BLUE 2D72LU75", "code_information": [{"code": "2D72LU75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL PROTEXIS LATEX CLASSI", "code_information": [{"code": "2D72N55X", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL PROTEXIS NEOPRENE", "code_information": [{"code": "2D73DP55", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL TRIUMPH SZ 7 LF", "code_information": [{"code": "MDS108070LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL TRIUMPH SZ 7.5 LF", "code_information": [{"code": "MDS108075LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL TRIUMPH SZ 8 LF", "code_information": [{"code": "MDS108080LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE SURGICAL TRIUMPH SZ 8.5 LF", "code_information": [{"code": "MDS108085LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVES EXAM LARGE DECONTAMINATION NITRILE CS16L", "code_information": [{"code": "CS16L", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVES EXAM MEDIUM DECONTAMINATION NITRILE CS16M", "code_information": [{"code": "CS16M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVES LATEX POWDER FREE SZ 8 MSG5980Z", "code_information": [{"code": "MSG5980Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVES POWDER FREE 8.5 LATEX SURGICAL MSG5985", "code_information": [{"code": "MSG5985", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.46, "discounted_cash": 1.21, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVES SENSICARE PI SHIELD RADIATION PROTECTION SIZE 8 MSG3980", "code_information": [{"code": "MSG3980", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.41, "discounted_cash": 41.44, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVES SENSICARE PI SHIELD RADIATION PROTECTION SIZE 8.5 MSG3985", "code_information": [{"code": "MSG3985", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.41, "discounted_cash": 41.44, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVES SIZE 9 SENSICARE PI SHIEL RADIATION PROTECTION MSG3990H", "code_information": [{"code": "MSG3990H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.41, "discounted_cash": 41.44, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVES SURGICAL PROTEXIS LATEX WITH NEU-THERA NEU-THERA COATING POWDER FREE SIZE 6 1/2", "code_information": [{"code": "2D73TP65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVES SURGICAL PROTEXIS LATEX WITH NEU-THERA NEU-THERA COATING POWDER FREE SIZE 7 1/2", "code_information": [{"code": "2D73TP75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GLUCAGON 1MG INJ", "code_information": [{"code": "MED0314", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 141.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLUCAGON TOLERANCE PANEL", "code_information": [{"code": "80422", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 71.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 117.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 184.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 184.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 184.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 66.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 66.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLUCAGON TOLERANCE PANEL", "code_information": [{"code": "80424", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 77.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 128.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 202.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 202.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 202.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 72.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 72.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLUCAGON TOLERANCE TEST", "code_information": [{"code": "82946", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 71.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 71.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLUCOSE OTHER FLUID", "code_information": [{"code": "82945", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLUCOSE TEST", "code_information": [{"code": "82950", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLUCOSE TOLERANCE TEST (GTT)", "code_information": [{"code": "82951", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLY RCPTR ALPHA1 IGG SRM/CSF", "code_information": [{"code": "431U", "type": "CPT"}], "standard_charges": [{"minimum": 30.73, "maximum": 48.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLYCA NUC MR SPECTRSC QUAN", "code_information": [{"code": "24U", "type": "CPT"}], "standard_charges": [{"minimum": 49.24, "maximum": 137.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 49.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 49.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GONADOTROPIN HORMONE PANEL", "code_information": [{"code": "80426", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 229.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 378.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 595.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 595.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 595.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 213.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 213.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GONAK OPTH 2.5% 15 ML", "code_information": [{"code": "MED0092", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GONIOSCOPY", "code_information": [{"code": "92020", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GONIOTOMY 65820", "code_information": [{"code": "65820", "type": "CPT"}, {"code": "1480989", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GOWN 2XL SURGICAL STERILE NONREINFORCED WITH SET IN SLEEVES AND TOWEL", "code_information": [{"code": "DYNJP2003S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN COVER YELLOW 2101PG", "code_information": [{"code": "2101PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN FABRIC-REINFORCED STRL-BACK 2XL 9571", "code_information": [{"code": "9571", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN IMPERVIOUS KNIT CUFFS", "code_information": [{"code": "4203PG", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN IMPERVIOUS KNIT CUFFS 4201PG", "code_information": [{"code": "4201PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN IMPERVIOUS THMBHOKS UNIV 4211PG", "code_information": [{"code": "4211PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN IMPERVIOUS THMBHOKS XXL", "code_information": [{"code": "4213PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISO AAMI 2 TAPE TAB XL YLW", "code_information": [{"code": "AT4437-XL", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISO IMP WHTE UNIV KNIT CUFF 7300PG", "code_information": [{"code": "7300PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISO IMP YELLOW KNIT CUFF XL 7101PG", "code_information": [{"code": "7101PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISO POLYCOATED KNTCUFF UNV YLW", "code_information": [{"code": "7100PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISO POLYCOATED KNTCUFF XL WHT", "code_information": [{"code": "7301PG", "type": "CDM"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISOLATION AAMI 3 TAPE TAB UNIV BLUE", "code_information": [{"code": "AT6200", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISOLATION AAMI 3 TAPE TAB UNIV YLW", "code_information": [{"code": "AT6100", "type": "CDM"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISOLATION FULL COVERAGE LVL 3 XL YELLOW", "code_information": [{"code": "AT6100-XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISOLATION LTWT W/TIES XL YLW", "code_information": [{"code": "1101PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISOLATION SMS W/TIES XL BLUE", "code_information": [{"code": "2201PG", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISOLATION YELLOW 1100PG", "code_information": [{"code": "1100PG", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN ISOLATION YELLOW ELAST CUFF AT4437-BD", "code_information": [{"code": "AT4437-BD", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN NON-REINFORCED 49\" 2 XL DYNJP2003SL", "code_information": [{"code": "DYNJP2003SL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN PLASTIC FILM THMBHKS UNIV BLUE", "code_information": [{"code": "5210PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN PLASTIC FILM THMBHKS XL BLUE", "code_information": [{"code": "5213PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN PLASTIC FILM W/THUMBHOOKS UNIV BLUE", "code_information": [{"code": "5211PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN PROCEDURE NON-STERILE XL BLUE", "code_information": [{"code": "3201PG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SMRTSLEVE X-LONG XXL 9071EL", "code_information": [{"code": "9071EL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN STER XLRG W/TOWEL/SLEEVE", "code_information": [{"code": "9541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG EXTRA LARE 47IN BLUE NON REINFORCED AAMI LEVEL 2 PROTECTION W/ TOWEL E", "code_information": [{"code": "DYNJP2002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG EXTRA XL 49IN BLUE NON REINFORCED HOOK AND LOOP CLOSURE ECLIPSE STRL", "code_information": [{"code": "DYNJP2003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG EXTRA XL 50IN BLUE FABRIC REINFORCED RAGLAN SLEEVE HOOK AND LOOP CLOSU", "code_information": [{"code": "DYNJP2503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG EXTRA XL BLUE IMPERVIOUS BREATHABLE AAMI LEVEL 4 PREVENT PLUS LF STRL", "code_information": [{"code": "DYNJP2303P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG EXTRA XL BLUE REINFORCED HOOK AND LOOP CLOSURE SMS FABRIC SIRUS LF STR", "code_information": [{"code": "DYNJP2103S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG EXTRA XL EXTRA LNG BLUE REINFORCED HOOK AND LOOP CLOSURE POLYETHYLENE", "code_information": [{"code": "DYNJP2206S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG XL BLUE IMPERVIOUS BREATHABLE AAMI LEVEL 4 PREVENT PLUS LF STRL", "code_information": [{"code": "DYNJP2302P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG XL BLUE REINFORCED HOOK AND LOOP CLOSURE SMS FABRIC SIRUS LF STRL", "code_information": [{"code": "DYNJP2102S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG XL NON REINFORCED HOOK AND LOOP CLOSURE SMS FABRIC W/ SETIN SLEEVE SIR", "code_information": [{"code": "DYNJP2002S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG XL ZIPPER TOGA STRL DISP", "code_information": [{"code": "400851000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.0, "discounted_cash": 55.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN WARMING STANDARD 51IN FLEX CLINICAL OR COMFORT WARMING 2INSERTS BAIR PAWS", "code_information": [{"code": "81003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GR 2 OR> DIA OR GR2 OR> COL", "code_information": [{"code": "M1181", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT 10 X 14 MM DECELLURARIZED DERMIS AFLEX822", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AFLEX822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 514.8, "discounted_cash": 180.18, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT 10/10MM PATELAR TENDON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "463002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5999.0, "discounted_cash": 2099.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT 2MM X 15MM AVANCE NERVE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "211215 Graft", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4738.0, "discounted_cash": 1658.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT 8 X 8 X 20.6MM SI CORTICAL S88-20", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "S88-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7109.0, "discounted_cash": 2488.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ACELLULAR DERMIS 4 X 4CM; 0.90MM ACD.070.0404", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ACD.070.0404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4934.0, "discounted_cash": 1726.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ACHILLES STRIP SIZE 25.7CM EVP189FF", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "EVP189FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8652.0, "discounted_cash": 3028.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ACHILLES TENDON PRESHAPED 9MM ATP-091", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ATP-091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6400.0, "discounted_cash": 2240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ACHILLES TENDON W/S TRUT F2 02B002", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "2B002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5800.0, "discounted_cash": 2030.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ACHILLLES TENDON W/BONE BLOCK 200 X 10MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "311004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT AGILON MODABLE 12CC BGS-8C-012-AGL", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "BGS-8C-012-AGL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT AGILON VOLUME 12CC 012-AGL", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "12-AGL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2900.0, "discounted_cash": 1015.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT AGILON VOLUME 3CC 003-AGL", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3-AGL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 850.0, "discounted_cash": 297.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ALLODERM EXTRA THICK 2 X 4", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "982011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT AMNIOFIX 2.0 X 12CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "APS-5212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2050.0, "discounted_cash": 717.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT AMNIOTIC MEMBRANE 4 X 4CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AAS-5440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8034.0, "discounted_cash": 2811.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ANTERIOR TENDON", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PS801FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8755.0, "discounted_cash": 3064.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ANTERIOR TIB SINGLE STRAND", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "SAT-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ANTERIOR TIBIALIS 31106", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "31106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5590.0, "discounted_cash": 1956.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ANTERIOR TIBIALIS TENDON FREEZE DRIED", "code_information": [{"code": "C9356", "type": "HCPCS"}, {"code": "400335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5552.0, "discounted_cash": 1943.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT AUGMENT BONE 3CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "K2003010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7200.0, "discounted_cash": 2520.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT AVANCE NERVE 311250 311250", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "311250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11382.0, "discounted_cash": 3983.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE .5CC SM NUCEL IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "NC-1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1362.0, "discounted_cash": 476.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 1.25CCINJECTION AMNIOFIX", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "AI-5125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8355.0, "discounted_cash": 2924.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 1.7MM TO 10MM 15ML CANCELLOUS CHIP FREEZE DRIED IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "400145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 527.0, "discounted_cash": 184.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 10CC GRANULES", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "12700501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5099.0, "discounted_cash": 1784.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 10CC GRFT MORSELIZED ALLOGRAFT CANC W/ VIABLE CELLS TRINITY EVOLUTION", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "410110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9799.0, "discounted_cash": 3429.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 110 MG MIN NT DENOVO", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "-5606-000-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9620.0, "discounted_cash": 3367.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 12MM X 19MM X 9MM ALLOGRAFT IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "77102094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 1CC MED NUCEL IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "NC-1001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3327.0, "discounted_cash": 1164.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 1CC PUTTY", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "HG-01P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 742.0, "discounted_cash": 259.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 2.5CC ALLOGRAFT SUBSITUTE VITOSS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "2102-1402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1821.0, "discounted_cash": 637.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 2.5CC PUTTY", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "HG-02P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 2.5ML PUTTY DBM NON STRL IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "38025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 936.0, "discounted_cash": 327.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 30ML 1.7MM TO 10MM CANCELLOUS CHIP FREEZE DRIED IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "400150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 928.0, "discounted_cash": 324.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 40GM CEMENT RADIOPAQUE VERSABOND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71271340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 40GM CEMENT VERSABOND AB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71271440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 4CM X 4CM ALLOGRAFT AMNIOFIX", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "APS-5440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 500 MG ALLOGRAFT COLLAGEN WOUND DRESSING MATRISTEM MICROMATRIX", "code_information": [{"code": "Q4118", "type": "HCPCS"}, {"code": "MM0500", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2398.0, "discounted_cash": 839.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 5CC DBM CRUSH ALLOGRAFT IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "EHG-05C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 5CC MORSELIZED ALLOGRAFT CANC W/ VIABLE CELLS TRINITY EVOLUTION", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "410105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5131.0, "discounted_cash": 1795.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 5CC PUTTY DBM", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "14100401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2476.0, "discounted_cash": 866.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 5ML PASTE DBM DBX LF STRL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "38050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1715.0, "discounted_cash": 600.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 5ML PASTE DBM DBX LF STRL", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "38050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1784.0, "discounted_cash": 624.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 6MM 4DEG ALLOGRAFT AUTOGRAFT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "77102064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE 6MM X 6MM PAVICAVDUN IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "723E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2699.0, "discounted_cash": 944.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE ACHILLES TENDON ALLOGRAFT W/ LG CANCELLOUS BLOCK IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "453042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5974.0, "discounted_cash": 2090.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE AGILON VOLUME 6CC 006-AGL", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "6-AGL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE ALLOGRAFT WEDGE 8 X 22 X 20MM EVANS IMMUNE PRIVILEGED DOUBLE SIDED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3102-1908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5597.0, "discounted_cash": 1958.95, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE BIOACTIVE VITOSS BBTRAUMA", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "2102-2205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4169.0, "discounted_cash": 1459.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE CEMENT CMW 2 GENTAMICIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "545032500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE CRUSH CANCELLOUS CHIPS 15ML 1-8MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PCAN15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE CRUSH CANCELLOUS CHIPS 30ML 1-8MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PCAN30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE FOAM VITOSS BB IMPLANT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "2102-2210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6537.26, "discounted_cash": 2288.04, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE LG BLOCK TRICORTICAL ALLOGRAFT IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "OP101024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4728.0, "discounted_cash": 1654.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE MAJOR 20902", "code_information": [{"code": "20902", "type": "CPT"}, {"code": "1480992", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BONE MALAR AREA 21210", "code_information": [{"code": "21210", "type": "CPT"}, {"code": "1480993", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BONE MANDIBLE 21215", "code_information": [{"code": "21215", "type": "CPT"}, {"code": "1480994", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BONE MEDIAL MENISCUS BONE BLOCK RIGHT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "28225001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9785.0, "discounted_cash": 3424.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE MINOR 20900", "code_information": [{"code": "20900", "type": "CPT"}, {"code": "1480995", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BONE OSTEOCHONDRAL 10MM PLUG", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "RFP10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4893.0, "discounted_cash": 1712.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE SPINE 20930", "code_information": [{"code": "20930", "type": "CPT"}, {"code": "1480996", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BONE SPINE W/HARVEST 20936", "code_information": [{"code": "20936", "type": "CPT"}, {"code": "1480997", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BONE STAGRAFT 2CC CANCELLOUS PUTTY BIOABSORBABLE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "92-2002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 760.0, "discounted_cash": 266.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE SUBSTITUTE MORPHEUS 12CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "12-MOR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2856.0, "discounted_cash": 999.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE SUBSTITUTE MORPHEUS 6CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "6-MOR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE VITOSS 1.2ML 2X BIOACTIVE SUBSTITUTE FOAM PACK", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "2102-2101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BONE VITOSS BIMODAL 10CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2102-1910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5476.0, "discounted_cash": 1916.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT BURN MATRIX 5 X 5 CM BMM0505", "code_information": [{"code": "Q4166", "type": "HCPCS"}, {"code": "BMM0505", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1471.0, "discounted_cash": 514.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT CANNULATED REVISION DOWEL; PRESERVON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PCDXL18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2364.0, "discounted_cash": 827.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT CARTILAGE EAR 21235", "code_information": [{"code": "21235", "type": "CPT"}, {"code": "1480998", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT CARTIMAX LIVE CARTILAGE 401210", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "401210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4500.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT CORNEA 1/2 SPLIT IN GLYCERIN", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "IT9705C1C141", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GRAFT CORNEA PRE-LOADED V0092000", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "V0092000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 10190.0, "discounted_cash": 3566.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GRAFT CORNEA WHOLE LEBT-BCM LT", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "15-0752-200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 7622.0, "discounted_cash": 2667.7, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GRAFT CORNEA WHOLE LFBT-BCM", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "15-0752-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 7715.0, "discounted_cash": 2700.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GRAFT CORNEA WHOLE PRE-CUT DSAEK LEBT-BCM", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "15-0788-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 7622.0, "discounted_cash": 2667.7, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GRAFT CORNEA WHOLE PRE-CUT FOR DSAEK", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "15-0749-200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 7622.0, "discounted_cash": 2667.7, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GRAFT CORNEA WHOLE TISSUE", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "I-15-0062 100", "type": "CDM"}, {"code": "810", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 8652.0, "discounted_cash": 3028.2, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GRAFT CORNEAWHOLE PRE CUT FOR ALK", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "V0091000", "type": "CDM"}, {"code": "810", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 10455.0, "discounted_cash": 3659.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GRAFT DBM 1CC PUTTY BIO", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "7775001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT DBM 2.5CC PUTTY BIO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7775025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT DBM 5CC PUTTY BIO", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "7775005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1564.4, "discounted_cash": 547.54, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT DERMA FAT FASCIA 15770", "code_information": [{"code": "15770", "type": "CPT"}, {"code": "1480999", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT DERMAL 4 CM TO 8 CM ACELLULAR DERMASPAN IMP", "code_information": [{"code": "Q4126", "type": "HCPCS"}, {"code": "48-0700408", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT DERMIS DECELLULARIZED", "code_information": [{"code": "Q4125", "type": "HCPCS"}, {"code": "AFLEX100", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4584.0, "discounted_cash": 1604.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT EPIPATCH MEDIUM 10X10MM 0.1MM FREEZE DRIED BE2110FD", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "BE2110FD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT FASCIA LATA 50-100SQCM 6.0 X 15.0 CM PS824FF", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PS824FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8230.0, "discounted_cash": 2880.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT FASCIA LATA MEDIUM 4 X8", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "EV93006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2884.0, "discounted_cash": 1009.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT FASCIA LATA MEDIUM 50 X 80", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "EV93002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2730.0, "discounted_cash": 955.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT FASCIA LATA X-LARGE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "EV93008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3492.0, "discounted_cash": 1222.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT FORTIFY TRG TISSUE REPAIR 1X10CM FTRG-1X10", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "FTRG-1X10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2447.0, "discounted_cash": 856.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT HAND OR FINGER TENDON", "code_information": [{"code": "26416", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT HARVESTER 8MM BONE G05 S1008", "code_information": [{"code": "G05 S1008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1241.73, "discounted_cash": 434.61, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT HUMAN FLOABLE NUSHIELD 2 X 3CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "NO-1230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT HUMAN FLOABLE NUSHIELD 4 X 6CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "NO-1460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3605.0, "discounted_cash": 1261.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT JACKET 4X4CM 1-2MM THICK", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "86204X04", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4283.0, "discounted_cash": 1499.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT JACKET 5X5CM MAX FORCE 1.40-1.91MM", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "86MX-5X05", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4283.0, "discounted_cash": 1499.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT JACKET MAX FORCE EXTREME 4CM X 7CM", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "86UM-4X07", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 8415.0, "discounted_cash": 2945.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT JACKET NOW THICK 4 X 4 86304X04", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "86304X04", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 5002.46, "discounted_cash": 1750.86, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT JACKET NOW THIN 4X8CM 0.4-1MM THICK", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "86104X08", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4924.52, "discounted_cash": 1723.58, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT JACKET TISSUE MATRIX 2 X 4", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "8600-2X04", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2734.0, "discounted_cash": 956.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MATRI FIB 6.0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FIB 6.0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 793.22, "discounted_cash": 277.63, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MATRIX 8 LAYER 6 X 2CM PURAFORCE 550-002", "code_information": [{"code": "C9356", "type": "HCPCS"}, {"code": "550-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 937.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MATRIX HD 5 X 8CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "TD0508", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MATRIX IQ DERMIS 10CM X 5CM X 1.0MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "362003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7416.0, "discounted_cash": 2595.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MATRIX IQ DERMIS 5CM X 4CM X 1.0MM 362001", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "362001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MATRIX STRIP 50 X 20 X 7MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "442007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MEDIAL MENISCUS W/ BONE BLOCK LEFT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "28225002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9785.0, "discounted_cash": 3424.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MEMBRANE .5ML AMNIOTIC ALLOGRAFT AMNIOFIX IMP", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "AI-5050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "gross_charge": 1539.0, "discounted_cash": 538.65, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT MESH HERNIA 25 X 20CM COMPOSITE SYMBOTEX 3D MONO POLY ABSORB COLLAGEN FILM RECTANGLE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "SYM2520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2463.0, "discounted_cash": 862.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MESH HERNIA 6 X 3.5IN REPAIR PARIATEX PROGRIP INGUINAL RECTANGULAR", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "TEM1509G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 642.0, "discounted_cash": 224.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MESH HERNIA 6.6CM PARIETEX PATCH REPAIR", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PCO6VP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MESH PARIETEX 4.6CM HERNIA PATCH REPAIR PCO4VP", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PCO4VP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9.64, "discounted_cash": 3.37, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT MESH PARIETEX 8.6CM HERNIA PATCH REPAIR", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PCO8VP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1323.0, "discounted_cash": 463.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT NASAL SEPTUM 20912", "code_information": [{"code": "20912", "type": "CPT"}, {"code": "1481002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT OMEGA PLACENTAL MEMBRANE 4 X 4 CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "OSW-0404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3914.0, "discounted_cash": 1369.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ONE SURG AMNIO 3 X 5", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "OSW-0305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3914.0, "discounted_cash": 1369.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT OSTEOAMP 1CC GRANULES 2MM 12600201", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "12600201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 711.0, "discounted_cash": 248.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT OSTEOSTRAND PLUS MEDIUM 56730050", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "56730050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2587.0, "discounted_cash": 905.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PATELLA HEMI", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PERCARDIUM PORCINE 6 X 6 93-8266", "code_information": [{"code": "C9364", "type": "HCPCS"}, {"code": "93-8266", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3597.0, "discounted_cash": 1258.95, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PERONEUS LONGUS 7 X 28.5 CM", "code_information": [{"code": "150058-007", "type": "CDM"}], "standard_charges": [{"gross_charge": 3698.0, "discounted_cash": 1294.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PERONEUS LONGUS 7 x 30 CM", "code_information": [{"code": "140210-011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3698.0, "discounted_cash": 1294.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PERONEUS LONGUS 8.5 X 290MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5511.0, "discounted_cash": 1928.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PLACENTAL TISSUE 3X6CM STRAVIX CRYOPRESERVED", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "PS60008", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PLUG CANCELLOUS 10MM W/O CARTILAGE PRESERVON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PCPD10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PRE-SHAPED PATELLA LIGAMENT 10MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "18017000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PRESHAPED BTB 10 X 28MM", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "8922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7612.0, "discounted_cash": 2664.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PURAPLY ANTIMICROBIAL WOUND MATRIX 2CM X 4CM PURAPLYAM-COM 2X4", "code_information": [{"code": "Q4196", "type": "HCPCS"}, {"code": "PURAPLYAM-COM 2X4", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PURAPLY ANTIMICROBIAL WOUND MATRIX 5 X 5CM 515-008", "code_information": [{"code": "Q4196", "type": "HCPCS"}, {"code": "515-008", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 5356.0, "discounted_cash": 1874.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT PUTTY CRUSH MIX 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "PH6-05C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3403.0, "discounted_cash": 1191.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT REPAIR OF SPINE DEFECT", "code_information": [{"code": "63710", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT SEMI TENDINOSIS TENDON 225 CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "311006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5758.0, "discounted_cash": 2015.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SEMITENDINOSIS TENDON 9 X 28MM DOUBLED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "311008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.0, "discounted_cash": 1438.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SEMITENDINOSUS TENDON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SKIN 12 X 6 CM DERMAL MATRIX TISSUE REPLIFORM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "M0068202460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3712.0, "discounted_cash": 1299.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SKIN 4 CM X 2 CM DERMAL MATRIX REGENERATIVE THICK ACCELERATOR ALLODERM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "102012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 913.0, "discounted_cash": 319.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SKIN 4 CM X 2 CM THIN RIGHT ACELLULAR DERMAL MATRIX ALLODERM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "102010 (LIFECELL)", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 913.0, "discounted_cash": 319.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SKIN 4 X 7 CM DERMAL MATRIX TISSUE REPLIFORM.", "code_information": [{"code": "C9363", "type": "HCPCS"}, {"code": "M0068202430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1733.0, "discounted_cash": 606.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SKIN 7 X 3 CM DERMAL MATRIX TISSUE REPLIFORM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "M0068202420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1448.0, "discounted_cash": 506.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SKIN 8CM X 12CM BLADDER FASCIA LATA DEHYDRATED GAMMA IRRIGATION AXIS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "939812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5953.0, "discounted_cash": 2083.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SKIN 8CM X 6CM BLADDER FASCIA LATA DEHYDRATED GAMMA IRRIGATION AXIS TUTOPL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "93-9268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4349.0, "discounted_cash": 1522.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SOFT TISSUE 5CM X 5CM X .8MM TO 1.7MM ACELLULAR HUMAN DERMIS THICK IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "471505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2515.0, "discounted_cash": 880.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SPEEDTRAP PREPARATION SYSTEM GREEN/WHITE MULTI-PACK 30 MM 223750", "code_information": [{"code": "223750", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 95.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SPREADER AR-19007GS", "code_information": [{"code": "AR-19007GS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1093.49, "discounted_cash": 382.72, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT ST TIS 12X8CM AXIS TTPLST DERM ALGRF DEHYDRATE GMA", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "93-9812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5800.0, "discounted_cash": 2030.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TENDON 10MM ACHILES ALLOGRAFT IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "453006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5768.0, "discounted_cash": 2018.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TENDON ALL SZS ACHILLES FROZEN SOFT TISSUE W/ BONE BLOCK STRL IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "10017000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4221.0, "discounted_cash": 1477.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TENDON ALL SZS SEMI TENDINOSUS FROZEN DOUBLE STRAND STRL IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "18717000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4965.0, "discounted_cash": 1737.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TENDON PERONEUS LONGUS 6.5MM X 275MM", "code_information": [{"code": "C9356", "type": "HCPCS"}, {"code": "EV95006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TENDON PLANTARIS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "990", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TENDON PRE-SHAPED PATELLA FPL-10", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "FPL-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5931.74, "discounted_cash": 2076.11, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TENDON PRE-SUTURED PILOTGRAFT BTB PSP-101", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PSP-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7120.0, "discounted_cash": 2492.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TENDON SEMITENDINOSUS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "453015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 937.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TENDON TENSIX 5 X 10CM DBM ACELLULAR DERMAL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "TSD-50100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10702.0, "discounted_cash": 3745.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TENDON TIBIALIS ANTERIOR FROZEN", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "7804203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5552.0, "discounted_cash": 1943.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TIBIAL TENDON POSTERIOR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "53721-PTT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5346.0, "discounted_cash": 1871.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TIBIALIS 8.5MM X 262MM ANT ALLOGRAFT IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "443017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TIBIALIS TENDON ANTERIOR FROZEN", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "41522000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4017.0, "discounted_cash": 1405.95, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TIBIASLIS TENDON POS. FZ/A 41622000", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "41622000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4017.0, "discounted_cash": 1405.95, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE .6MM X 22MM PERONEUS IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "10015-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3203.0, "discounted_cash": 1121.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE .6MM X 24MM PERONEUS IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "120136-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3203.0, "discounted_cash": 1121.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE 1.0CC VIAFLOW MATRIX AMBIENT PLACENTAL FLOWABLE AMAF-0010", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "AMAF-0010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3677.0, "discounted_cash": 1286.95, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE 2ML ALLOGRAFT AMNIOTIC MEMBRANE IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AI-5200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13369.0, "discounted_cash": 4679.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE 2X4 3.4 X 0.6MM X-THICK 142208", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "142208", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1304.0, "discounted_cash": 456.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE 5CM X 5CM ACELLULAR HUMAN DERMIS GRFT THIN ALLOPATCH HD IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "470505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2785.0, "discounted_cash": 974.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE ACHILLES IMPLANT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "453206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5999.0, "discounted_cash": 2099.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE ALL SZS PERONOUS LONGOS DOUBLE STRAND FROZEN ALLOWASH STRL IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "43917000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2148.0, "discounted_cash": 751.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE CARTILAGE 3.0 TSC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "2019-0097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 983.0, "discounted_cash": 344.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE CORNEA WHOLE RIGHT BCM", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "15-0615 100", "type": "CDM"}, {"code": "810", "type": "RC"}], "standard_charges": [{"minimum": 3960.0, "maximum": 3960.0, "gross_charge": 6077.0, "discounted_cash": 2126.95, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "standard_charge_dollar": 3960.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GRAFT TISSUE GRAFT JACKET 4 X 7CM MATRIX REGEN ULCER MESHED", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "86ST-4X07", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 3978.0, "discounted_cash": 1392.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE LG STEM CELL CELLULAR REPAIR MATRIX OVATION IMP", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "PS31001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5603.0, "discounted_cash": 1961.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE MATRIGRAFT ALLOGRAFT SEMI TENDINOSUS 150 TO 160MM 5.5 X 15MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "FPSST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2738.0, "discounted_cash": 958.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE MAXSTRIP 1 X 12CM JACKET HIGH SUTURE RETENTION STRENGTH REGEN", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "86MX-1X12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE TENDON SCAFFOLD 0.3 X 8CM SYNTH DEGR REINF ARTIMPLANT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "31051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2589.0, "discounted_cash": 906.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISSUE XENMATRIX 20 x 20CM COLLAGEN PORCINE ACELLULAR SQUARE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "1162020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25647.0, "discounted_cash": 8976.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TISUE LASCIA LATA MED 16.5CM X 80MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "400270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1288.0, "discounted_cash": 450.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TRI-CORTICAL BLOCK", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "92-0053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TRICORTICAL BLK 8-15MM FD EV305FD", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "EV305FD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4841.0, "discounted_cash": 1694.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT TRICORTICAL BLOCK 24-26MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "421026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.0, "discounted_cash": 1438.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT VERSAGRAFT TENDON PRESUTURED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "VRG-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2657.0, "discounted_cash": 929.95, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT WEDGE 9MM+ ILIACCREST", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "92-0054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFTFUN UNIVERSAL CARTRIDGE KIT GG-K-1000", "code_information": [{"code": "GG-K-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1345.0, "discounted_cash": 470.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFTING TROCAR BONE MARROW GRAFTING", "code_information": [{"code": "SMI-TROC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3947.0, "discounted_cash": 1381.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFTJACKET NOW THIN 2X4CM", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "86102X04", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2253.1, "discounted_cash": 788.59, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFTJACKET RTM STD THICKNESS", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "86ST4X07", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 3978.0, "discounted_cash": 1392.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFTON DBF 1CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "T50101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 740.0, "discounted_cash": 259.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRANULES 2-4MM", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "12710101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1689.0, "discounted_cash": 591.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GRANULES 2.5CC OSTEOAMP GROWTH FACTOR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "12610101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1502.0, "discounted_cash": 525.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GRANULES <2MM 5CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "12600401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2064.0, "discounted_cash": 722.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPER BABCOCK 5MM 33CM", "code_information": [{"code": "5BB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPER ENDO 33 CM 10MM RATCHET HANDLE ANVIL ENDOPATH STRL DISP", "code_information": [{"code": "10AG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 83.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPER ENDOPATH 5 MM -ORDR QTY 6 5DSG", "code_information": [{"code": "5DSG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.36, "discounted_cash": 30.58, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPER LAPSCR ROT", "code_information": [{"code": "174233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 225.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPING FORCEPS Grasping Forceps Blue Alligator Rat Tooth 131-2209 Alligator-Rat Blue 230 2.8", "code_information": [{"code": "GF61061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPING FORCEPS Grasping Forceps Blue Alligator Tooth 131-2208 Alligator Blue 230 2.8", "code_information": [{"code": "GF61041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPING FORCEPS Grasping Forceps Blue Rat Tooth 131-2207 Rat Blue 230 2.8", "code_information": [{"code": "GF61021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAVITY PLANTAR PLATE REPAIR IMPLANT SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "86PPS1N0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2914.0, "discounted_cash": 1019.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GREAT TOE-HAND TRANSFER", "code_information": [{"code": "26551", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFAT AMNIOFIX 2.0X6.0CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "APS-5260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1028.0, "discounted_cash": 359.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 25 CC/<", "code_information": [{"code": "15773", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 50 CC/<", "code_information": [{"code": "15771", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO EA ADDL", "code_information": [{"code": "15772", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL SOFT TISS DIR EXC", "code_information": [{"code": "15769", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRIESHABER MAXGRIP 27G", "code_information": [{"code": "727.13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 166.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GROUND MILEAGE", "code_information": [{"code": "A0425", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROUND PAD WITH CORD SINGLE PIECE", "code_information": [{"code": "DGP-PM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GROUP CAREGIVER TRAINING", "code_information": [{"code": "97552", "type": "CPT"}], "standard_charges": [{"minimum": 100.11, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROUP HEALTH EDUCATION", "code_information": [{"code": "99078", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROUP MNT 2 OR MORE 30 MINS", "code_information": [{"code": "G0271", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.53, "maximum": 112.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROUP PSYCHOTHERAPY", "code_information": [{"code": "90853", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROUP THERAPEUTIC PROCEDURES", "code_information": [{"code": "97150", "type": "CPT"}], "standard_charges": [{"minimum": 82.64, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 82.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 129.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 129.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 129.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE ANTIBODY", "code_information": [{"code": "86277", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 63.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 63.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE PANEL", "code_information": [{"code": "80428", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 102.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 170.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 267.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 267.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 267.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 96.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 96.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE PANEL", "code_information": [{"code": "80430", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 161.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 329.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 518.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 518.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 518.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 186.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 186.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROWTH STIMULATION GENE 2", "code_information": [{"code": "83006", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 192.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 303.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 303.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 303.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 108.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 108.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRP ADAPT BHV TX BY PHY/QHP", "code_information": [{"code": "97158", "type": "CPT"}], "standard_charges": [{"minimum": 120.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRP ADAPT BHV TX BY TECH", "code_information": [{"code": "97154", "type": "CPT"}], "standard_charges": [{"minimum": 120.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GSTR EMPTG 7 TIMED BRTH SPEC", "code_information": [{"code": "106U", "type": "CPT"}], "standard_charges": [{"minimum": 61.48, "maximum": 1259.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1259.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1259.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GTT-ADDED SAMPLES", "code_information": [{"code": "82952", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUAGE 150MM MICA DEPTH", "code_information": [{"code": "57S000DG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 421.08, "discounted_cash": 147.38, "setting": "both", "billing_class": "facility"}]}, {"description": "GUEDEL COLOR CODED AIRWAY SIZE 6 CLEAR LF", "code_information": [{"code": "1226110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDANCE FOR RADJ TX DLVR", "code_information": [{"code": "77387", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 515.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 809.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 809.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 809.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GUIDE AIMING PLS 0.9MM X 10DEG", "code_information": [{"code": "PDG-AIM-0910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE DEPLOYMENT FRONTAL SINUS RELIEVA STRATUS", "code_information": [{"code": "GC090RS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE DRILL 18MM ENCOMPASSINSTR", "code_information": [{"code": "386-1018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 859.0, "discounted_cash": 300.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE DRILL 4.0MM PARALLEL", "code_information": [{"code": "395.965", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 404.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE K-WIRE 1.1 CK11115", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CK11115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 88.8, "discounted_cash": 31.08, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE NERV DESTR ELEC STIM", "code_information": [{"code": "95873", "type": "CPT"}], "standard_charges": [{"minimum": 247.93, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 247.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 389.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 389.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 389.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE NERV DESTR NEEDLE EMG", "code_information": [{"code": "95874", "type": "CPT"}], "standard_charges": [{"minimum": 255.87, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 255.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE NERVE 1.5MM X 3 CM PERIPHERAL NERVE REPAIR SURG NEURAGEN", "code_information": [{"code": "C9352", "type": "HCPCS"}, {"code": "PNG130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3307.0, "discounted_cash": 1157.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE NERVE 2 CM X 2MM PERIPHERAL NERVE REPAIR SURG NEURAGEN", "code_information": [{"code": "C9352", "type": "HCPCS"}, {"code": "PNG-220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2553.0, "discounted_cash": 893.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE NERVE 3 CM X 2MM PERIPHERAL NERVE REPAIR SURG NEURAGEN", "code_information": [{"code": "C9352", "type": "HCPCS"}, {"code": "PNG230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5663.0, "discounted_cash": 1982.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE NERVE 3 CM X 3MM PERIPHERAL NERVE REPAIR SURG NEURAGEN", "code_information": [{"code": "C9352", "type": "HCPCS"}, {"code": "PNG330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5772.0, "discounted_cash": 2020.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE NERVE 3 CM X 4MM PERIPHERAL NERVE REPAIR SURG NEURAGEN", "code_information": [{"code": "C9352", "type": "HCPCS"}, {"code": "PNG430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5772.0, "discounted_cash": 2020.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE OSTEOTOMY LNG ARM ACCU-CUT", "code_information": [{"code": "19510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 197.0, "discounted_cash": 68.95, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PACK TARGET 57S10013", "code_information": [{"code": "57S10013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.7, "discounted_cash": 216.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 1.1MM KIRSCHNER WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSDS1011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 1.5MM X 150MM 0109-150", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "109-150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 791.0, "discounted_cash": 276.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 2.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "230787004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 2MM BIOBLOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "50017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 3.2MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-440041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 527.0, "discounted_cash": 184.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 3.2MM LG CANNULATED SCREW SYS THREADED TIMAX DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14012-9", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 132.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 3.2MM X 343MM BRAD POINT TIP", "code_information": [{"code": "71674130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN BREAKAWAY 2.5 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2230-00-019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN DEPUY ORTHO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "230796000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN GAITWAY SYS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GTW-1002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN KIRSCHNER WIRE 0.9 MM", "code_information": [{"code": "DSDS1009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN KIRSCHNER WIRE 1.4MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSDS1014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN THREADED 3.2 X 300MM", "code_information": [{"code": "71177201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN THREADED 3.2MM", "code_information": [{"code": "71751147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 746.0, "discounted_cash": 261.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN TRO PT 1.3 X 140", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "128047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN WARSAW APG+ BREAKWAY 2.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223000019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE REAMER 2MM X 2.7MMINSTR", "code_information": [{"code": "XDG2027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE SUTURE BARIATRIC 15MM 4 HOLE DISPOSABLE", "code_information": [{"code": "PMI154D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE .025IN X 150 CM 3 CM NITIONOL STANDARD BODY HI WIREINSTR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "HW025150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE .035 X 6IN SINGLE TROCAR 80-1524", "code_information": [{"code": "80-1524", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE .035IN X 145 CM 3 CM TIP STANDARD BODY STR SLIP COAT ROADRUNNERINSTR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "RFSPC-035145-0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE .035IN X 145 CM PC STANDARD BODY ANGLED TIP ROADRUNNERINSTR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "RFSPC-035145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE .035IN X 150CM 3CM ANGLED TIP STIFF BODY NITINOL CORE HI-WIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "HW035150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE .035IN X 150CM 3CM ANGLED TIP STIFF BODY NITINOL CORE HIWIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "HWA035150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 416.0, "discounted_cash": 145.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE .038IN X 145 CM 3 CM PC ANGLED TIP STANDARD BODY SLIP COAT ROADRUNN", "code_information": [{"code": "RFSPC-038145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.4, "discounted_cash": 66.99, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE .038IN X 145 CM 3 CM PC STRAIGHT TIP STANDARD BODY SLIP COAT ROADRUNN", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "RFSPC-038145-0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE .038IN X 150 CM 3 CM TIP NITINOL CORE STR STANDARD BODY HI WIREINSTR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "HW-038150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE .062IN X 6IN P06 S2333", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "P06 S2333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 67.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 0.7 X 150MM SINGLE TROCAR 35-0025", "code_information": [{"code": "35-0025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.88, "discounted_cash": 58.06, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 0.7X150MM DOUBLE TROCAR 35-0026", "code_information": [{"code": "35-0026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 197.78, "discounted_cash": 69.22, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 0.9 x 150MM NON-THREADED TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "MSG09150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 0.9 x 150MM THREADED TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSK09150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.1MM X 150MM DOUBLE TROCAR 35-0030", "code_information": [{"code": "35-0030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 50.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.25MM 150MM NON THREADED", "code_information": [{"code": "900.721", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.6MM", "code_information": [{"code": "101-00006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.8MM X 200MM SGL TROCAR K200-18S", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "K200-18S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 2.0MM X 150MM UNTHREADED", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "705234S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 2.5MM X 220MM AEQUALIS PERFORM COCR", "code_information": [{"code": "DWD017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 3.0 TROCAR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "707003002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 3.0MM DISP", "code_information": [{"code": "K100-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.72, "discounted_cash": 56.95, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE COCR 0.8MM X 160MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "GWK-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE DBL TROCAR 0.035 IN X 6IN", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "80-1525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE KIT 3.0MM--4.5MM", "code_information": [{"code": "GWK-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 410.0, "discounted_cash": 143.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE LAPIFUSE 1.4MM ORTHOLOC 2 LAPIDUS W/ROTATION LAP-040-14", "code_information": [{"code": "LAP-040-14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.0, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE NITINOL 2.0MM MWJ10461", "code_information": [{"code": "MWJ10461", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE NITINOL CORE STANDARD ANGLED HI WIREINSTR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "HWA025150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 416.0, "discounted_cash": 145.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE OLIVE 1.4MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "P99-201-1406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 79.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE PARAGON 1.6MM X 150MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "P99-192-1615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE SUBTALAR 8 17230", "code_information": [{"code": "17230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 271.15, "discounted_cash": 94.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE TROCAR TIP 0.86MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-8737-39", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 125.43, "discounted_cash": 43.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE TROCAR TIP 1.1MM", "code_information": [{"code": "AR-8737-41", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.85, "discounted_cash": 28.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE TROCAR TIP 1.35MM AR-8943-01", "code_information": [{"code": "AR-8943-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.5, "discounted_cash": 25.73, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE WITH TROCAR TIP DIA 1.35MM AR-8737-01", "code_information": [{"code": "AR-8737-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE-WIRE COLAG SINGLE TROCAR .062X5 - 4.0/5.0 SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P06 N0331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEBLOCK PALISADE 10MM SPACING 18G", "code_information": [{"code": "PG-1018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEBLOCK PALISADE 10MM SPACING 20G SINGLE PIECE", "code_information": [{"code": "PG-1020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEPIN 2.5 NEXA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NCS-GP25", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE .025 UWR1025", "code_information": [{"code": "UWR1025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.33, "discounted_cash": 47.37, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE .035MM ULTRA TRACK STRAIGHT", "code_information": [{"code": "GWH3505R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE .038MM ULTRA TRACK ANGLED TIP", "code_information": [{"code": "GWH3805RA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.99, "discounted_cash": 43.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE .045X6IN ST", "code_information": [{"code": "WS-1106ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE .86MM LASER LINE SS", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-8737-21", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.1 X 152MM 76308831", "code_information": [{"code": "76308831", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 199.06, "discounted_cash": 69.67, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.1MM DISPENSER HEADLESS SCREW SYSTEM T001000052", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "T001000052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 247.0, "discounted_cash": 86.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.25MM NON THREADED", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "292.626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.2MM X 100MM SINGLE ENDED P99-192-1210", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "P99-192-1210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.2X100MM SGL TROCAR K100-12S", "code_information": [{"code": "K100-12S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.8, "discounted_cash": 31.08, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.4MM 3.5MM BEVELED FT AR-8741-14", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-8741-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.6 X 150MM CAPITAL FRAG AR-8741-16", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-8741-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 50.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.6MM 4MM BEVELED FT AR-8741-15", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-8741-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.6MM JONES NITINOL P99-172-1620", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "P99-172-1620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.6MM X 150MM SGL TROCAR K150-16S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K150-16S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 17100-18-1", "code_information": [{"code": "17100-18-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 18IN NITI MPS 01-01G1-18", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "1-01G1-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 2.0MM ACUMED", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "WS-2018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 2.0MM X 240MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3.010.025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 8\" STERILE SUBTALAR 19590", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "19590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE ACUTRAK FUSION DOUBLE TIP 1.6MM (0.062\")", "code_information": [{"code": "WS-1606DT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.77, "discounted_cash": 51.02, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE AMPLATZ SUPERSTIFF PTFE COATED .035in x 145cm 3.5cm Flexible M0066401081", "code_information": [{"code": "M0066401081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE AMPLATZ SUPERSTIFF PTFE COATED .035in x 145cm 7cm Bentson-Type M0066401041", "code_information": [{"code": "M0066401041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE BONE 0.062 X 5.91IN TROCAR TIP SS", "code_information": [{"code": "AR-8941K", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE BONE HYPROCURE S7 FOOT .073 X 9.75IN", "code_information": [{"code": "HYP-GW", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE DIA 1.4MM CSS-040-14", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "CSS-040-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE DRILL TIP 1.1MM X 150MM", "code_information": [{"code": "71101413", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 452.98, "discounted_cash": 158.54, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE NITINOL BLUNT 150MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "20-0123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE NON-THREADED 1.1 X 150MM MSG11150", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "MSG11150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE NON-THREADED 1.4 X 150MM MSG14150", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "MSG14150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE NON-THREADED 1.6 X 150MM MSG16150", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "MSG16150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE PACK LAT ACCESS", "code_information": [{"code": "AC01-90064-G4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.6, "discounted_cash": 47.46, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE SINGLE TROCAR .045 X 5INCH - 3.0 COLAG P06 N0321", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "P06N0321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE SIZE 01.4MM NITI 5101-90058", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "5101-90058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 56.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE STYLET 35MMALPHATEC 17166-035", "code_information": [{"code": "17166-035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 874.25, "discounted_cash": 305.99, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE TEMP FIX PIN XBR001000", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "XBR001000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 301.0, "discounted_cash": 105.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE THREADED 1.4MM X 150MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "705233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE THREADED ASNIS III 2.0MM X 150MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "702460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.01, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE THREADED ASNIS III 3.2MM X 300MM", "code_information": [{"code": "702463", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 185.02, "discounted_cash": 64.76, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE TROCAR .045X6 P06 N0322", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "P06 N0322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE TROCAR TIP 2.0MM X 200MM", "code_information": [{"code": "AR-8956K-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE ULTRA-TRACK 0.035 ANGLED TIP", "code_information": [{"code": "GWH3505RA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE ULTRA-TRACK 0.038 STRAIGHT TIP", "code_information": [{"code": "GWH3805R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE UNTHREADED 0.32MM X 230MM", "code_information": [{"code": "705235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 273.0, "discounted_cash": 95.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE UNTHREADED 2.0MM X 150MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "705234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 183.0, "discounted_cash": 64.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE UROLOGICAL 150CM .038IN ZEBRA STRAIGHT TIP", "code_information": [{"code": "M0066701141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 895.0, "discounted_cash": 313.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE VILEX 1.1MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "K150-11S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE W TROCAR TIP 0.062IN X 9.25IN", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-8750K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE ZIPWIRE .035 X 150MM", "code_information": [{"code": "630-205B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE ZIPWIRE .035ANG", "code_information": [{"code": "M006630206B1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRES 0.8MM X 160MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "GWK 108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDWIRE W/TROCAR TIP THREADED 1.6MM X 235MM", "code_information": [{"code": "AR-8750KT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GUM GRAFT", "code_information": [{"code": "41870", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUN DEL CORTOSS", "code_information": [{"code": "2110-0008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1237.0, "discounted_cash": 432.95, "setting": "both", "billing_class": "facility"}]}, {"description": "GUN GRAFTUNIVERSAL GRAFT DELIVERY SYSTEM GG-U-1000", "code_information": [{"code": "GG-U-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1971.0, "discounted_cash": 689.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GYPA GNOTYP NTRNS 1 5 EXON 2", "code_information": [{"code": "189U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 395.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GYPB GNOTYP NTRNS 1 5 SEUX 3", "code_information": [{"code": "190U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 395.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Gait Training Charges", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "752350", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 136.67, "maximum": 8450.0, "gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 210.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 136.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Gait Training Charges - PTA", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "45575342", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 136.67, "maximum": 8450.0, "gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 210.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 136.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Gastroenterology (Barrett's esophagus), esophageal cells, DNA methylation analysis by next-generation sequencing of at least 89 differentially methylated genomic regions, algorithm reported as likelihood for Barrett's esophagus", "code_information": [{"code": "506U", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Gastroenterology (irritable bowel disease [IBD]), immunoassay for quantitative determination of adalimumab (ADL) levels in venous serum in patients undergoing adalimumab therapy, results reported as a numerical value as micrograms per milliliter (\u00b5g/mL)", "code_information": [{"code": "514U", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Gastroenterology (irritable bowel disease [IBD]), immunoassay for quantitative determination of infliximab (IFX) levels in venous serum in patients undergoing infliximab therapy, results reported as a numerical value as micrograms per milliliter (\u00b5g/mL)", "code_information": [{"code": "515U", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Gastroenterology care MIPS value pathway", "code_information": [{"code": "M1422", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Gastrointestinal (Gi) Services General", "code_information": [{"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 3700.0, "maximum": 3714.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3700.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3714.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Gene Analysis (Thyroid Cancer)", "code_information": [{"code": "81545", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4500.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Glial fibrillary acidic protein (GFAP), chemiluminescent enzyme immunoassay, using plasma", "code_information": [{"code": "548U", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Glucose Point of Care", "code_information": [{"code": "82948", "type": "CPT"}, {"code": "1093832", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 27.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Glucose Random", "code_information": [{"code": "82947", "type": "CPT"}, {"code": "633594", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 27.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use 82962", "code_information": [{"code": "82962", "type": "CPT"}, {"code": "5324825", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 114.0, "discounted_cash": 39.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 42.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Gonorrhea Culture", "code_information": [{"code": "87081", "type": "CPT"}, {"code": "633895", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 33.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Gram Stain", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "633910", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 377.0, "discounted_cash": 131.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 140.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Gram Stain.", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "45343408", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 377.0, "discounted_cash": 131.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 140.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Group caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, an", "code_information": [{"code": "G0543", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.8, "maximum": 75.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H PYLORI (C-13) BLOOD", "code_information": [{"code": "83009", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 103.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 270.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 270.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 270.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H PYLORI (C-13) BREATH", "code_information": [{"code": "83013", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 103.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 270.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 270.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 270.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H PYLORI AG IA", "code_information": [{"code": "87339", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H PYLORI DRUG ADMIN", "code_information": [{"code": "83014", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H and H", "code_information": [{"code": "85018", "type": "CPT"}, {"code": "1231832", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 218.0, "discounted_cash": 76.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 80.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HA COATED REVERSED METAPHYSIS 36 MM CALL FOR AVAILABILITY DWE001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9038.0, "discounted_cash": 3163.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HAB PREVO WAIVER PER 15", "code_information": [{"code": "T2047", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAD SMOKE B/4 ANES DAY SURG", "code_information": [{"code": "G9645", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAIR ANALYSIS", "code_information": [{"code": "P2031", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 19.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAIR REMOVAL BY ELECTROLYSIS", "code_information": [{"code": "17380", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAIR TRNSPL 1-15 PUNCH GRFTS", "code_information": [{"code": "15775", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAIR TRNSPL >15 PUNCH GRAFTS", "code_information": [{"code": "15776", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALF PIN 2.5 X 60MM SHORT 500-060-25S", "code_information": [{"code": "500-060-25S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HALF PIN 3.0 X 90MM 500-090-30", "code_information": [{"code": "500-090-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HALF PIN 3.0 X 90MM SHORT 500-090-30S", "code_information": [{"code": "500-090-30S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HALF RING TL HEX 180MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "56-11650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1264.0, "discounted_cash": 442.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HALLUX RIGIDUS CORRECTION W. CHEILECTOMY FIRST MT. JT. ANY METHOD 28291", "code_information": [{"code": "28291", "type": "CPT"}, {"code": "44660516", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALLUX RIGIDUS CORRECTION W/CHEILECTOMY DEBRID/CAP. REL. METATARSOPHAL. JT W/O IMPLANT 28289", "code_information": [{"code": "28289", "type": "CPT"}, {"code": "1481565", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAMMERFUZE IMPLANT 3.0 X 25MM ANGLED TH30-25T-1110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TH30-25T-1110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERLOCK PROXIMAL 15MMX 5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HL2M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2390.0, "discounted_cash": 836.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMEROTE FIXATION 2.5 X 16MM STRAIGHT 0 DEGREE OSSIO FIBER OF20025160", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF20025160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2994.0, "discounted_cash": 1047.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERTOE 2.8MM X 19MM 10DEGREE PRESERVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "P01-H10-2319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4223.0, "discounted_cash": 1478.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERTOE 2.8MMX 21MM 10DEGREE PRESERVE", "code_information": [{"code": "P01-H10-2821", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3609.0, "discounted_cash": 1263.15, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERTOE FIXATION SYSTEM 3.2MM X 21MM ANGLED 10D OF20032211", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF20032211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3084.0, "discounted_cash": 1079.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERTOE IMPLANT FIXATION DEVICE OF10025161", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF10025161", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERTUBE DRILL CANNULATED 3.50MM", "code_information": [{"code": "P40-920-3507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 574.0, "discounted_cash": 200.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERTUBE DRILL TROCAR 1.6 X 70MM", "code_information": [{"code": "P99-195-1607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERTUBE SYSTEM 2.75MM X 14MM 0 DEG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "P40-001-0275-SK", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2732.0, "discounted_cash": 956.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERTUBE SYSTEM 3.50MM X 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "P40-001-0350-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2734.0, "discounted_cash": 956.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMOCK SUBFASCIAL SLING MONARC", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "72403830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1640.0, "discounted_cash": 574.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HAND INNOVATIONS DISTAL VOLAR PLATE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DVRA-R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.0, "discounted_cash": 412.65, "setting": "both", "billing_class": "facility"}]}, {"description": "HAND INNOVATIONS PEG FULLY THREADED 2.5 X 24 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 46.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HAND INNOVATIONS PEG FULLY THREADED 2.5 X 28 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 46.2, "setting": "both", "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": 9562.48, "maximum": 16416.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9562.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13676.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15044.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16416.4, "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": 6077.53, "maximum": 10433.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6077.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8692.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9561.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10433.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND PIECE OMNIGUIDE SET ENT- ELEVATE", "code_information": [{"code": "10825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1372.0, "discounted_cash": 480.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HAND PROCEDURES FOR INJURIES", "code_information": [{"code": "906", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10972.52, "maximum": 18837.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10972.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15693.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17262.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18837.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND TENDON/MUSCLE TRANSFER", "code_information": [{"code": "26494", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HANDLE AO CANNULATED", "code_information": [{"code": "57S1HNDL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.06, "discounted_cash": 82.62, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE CATH SINUS GUIDE FOR RELIEVA FLEX SINUS GUIDE CATH RELIEVA SIDEKICK STRL", "code_information": [{"code": "SDKKLP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 183.0, "discounted_cash": 64.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE COUNTERSINK MINI QUICK COUPLING FOR USE W/ TAPS COUNTERSINKS AND SCREWDRI", "code_information": [{"code": "311.43", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 816.0, "discounted_cash": 285.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE ENDO GIA 4 STANDARD EGIAUSTND", "code_information": [{"code": "EGIAUSTND", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE LARYNGOSCOPE FIBEROPTIC SINGLE 77700", "code_information": [{"code": "77700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.43, "discounted_cash": 13.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE SUCT YANKAUER NON VENTED OPEN TIP WITHOUT TUBING FLEXIBLE ARGYLE STRL", "code_information": [{"code": "8888501007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE T SM TORQUE LIMITING T15INSTR", "code_information": [{"code": "2142-15-070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1293.0, "discounted_cash": 452.55, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE THUNDERBEAR 9CM OPEN JAW TB-0009OFX", "code_information": [{"code": "TB-0009OFX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1159.61, "discounted_cash": 405.86, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE THUNDERBEAT 9CM OPEN JAW", "code_information": [{"code": "TB-0009OF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE WITH MAC 3 DISPOSABLE COMBO MEDIUM DUAL LED 1023.C2015.C", "code_information": [{"code": "1023.C2015.C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.21, "discounted_cash": 28.77, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE WITH MILLER 2 DISPOSABLE COMBO MEDIUM DUAL LED 1032.C2015.C", "code_information": [{"code": "1032.C2015.C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.21, "discounted_cash": 28.77, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE YANKAUER STERILE FLEXIBLE OR61", "code_information": [{"code": "OR61", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE ABLATION ENDO MINERVA", "code_information": [{"code": "MIN3PAK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE ABLATION ENDOMETRIAL MINERVA", "code_information": [{"code": "MIN9770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1917.0, "discounted_cash": 670.95, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE BIPOLAR AQUAMAN 3 6.0", "code_information": [{"code": "83-305-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1405.0, "discounted_cash": 491.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE NANOSCOPE AR-3210-0040", "code_information": [{"code": "AR-3210-0040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1487.0, "discounted_cash": 520.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE TIP", "code_information": [{"code": "1910-2011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.0, "discounted_cash": 148.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE VOYANT FINE FUSION DEVICE SEALER & DIVIDER EB230", "code_information": [{"code": "EB230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1081.0, "discounted_cash": 378.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDSET AVETA DISPOSABLE RESECTING 213-029", "code_information": [{"code": "213-029", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDSET AVETA DISPOSABLE RESECTING 213-060", "code_information": [{"code": "213-060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDSET HYDROSURGERY SYSTEM VERSAJET II 15D 14MM PLUS 66800043", "code_information": [{"code": "66800043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1624.0, "discounted_cash": 568.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HARDWARE ASSEMBLY DSF-A02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-A02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9099.0, "discounted_cash": 3184.65, "setting": "both", "billing_class": "facility"}]}, {"description": "HARVEST ALLOGENEIC STEM CELL", "code_information": [{"code": "38205", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST AUTO STEM CELLS", "code_information": [{"code": "38206", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST CULTURED SKIN GRAFT", "code_information": [{"code": "15040", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST EYE TISSUE ALOGRAFT", "code_information": [{"code": "68371", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST FEMOROPOPLITEAL VEIN", "code_information": [{"code": "35572", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST STEM CELL CONCENTRTE", "code_information": [{"code": "38215", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST VEIN FOR BYPASS", "code_information": [{"code": "35500", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVESTER 9MM QUADPRO AR-2386-09", "code_information": [{"code": "AR-2386-09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1178.0, "discounted_cash": 412.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HAST W/OXYGEN TITRATE", "code_information": [{"code": "94453", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAST W/REPORT", "code_information": [{"code": "94452", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HB GLYCOSYLATED A1C HOME DEV", "code_information": [{"code": "83037", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 FULL GENE SEQUENCE", "code_information": [{"code": "81259", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE", "code_information": [{"code": "81257", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 127.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 260.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 410.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 410.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 410.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 147.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 147.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE DUP/DEL VRNTS", "code_information": [{"code": "81269", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 516.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 811.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 811.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 811.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 291.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 291.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE FAM VRNT", "code_information": [{"code": "81258", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 469.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 956.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBB FULL GENE SEQUENCE", "code_information": [{"code": "81364", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 405.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 827.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 467.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 467.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBB GENE COM VARIANTS", "code_information": [{"code": "81361", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 445.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBB GENE DUP/DEL VARIANTS", "code_information": [{"code": "81363", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 516.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 811.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 811.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 811.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 291.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 291.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBB GENE KNOWN FAM VARIANT", "code_information": [{"code": "81362", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 469.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 956.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1504.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBOT, FULL BODY CHAMBER, 30M", "code_information": [{"code": "G0277", "type": "HCPCS"}], "standard_charges": [{"minimum": 507.41, "maximum": 797.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 507.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 797.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 797.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 797.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBV STATUS ASSESED AND INT", "code_information": [{"code": "G9912", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HC PRO PHONE CALL 11-20 MIN", "code_information": [{"code": "98967", "type": "CPT"}], "standard_charges": [{"minimum": 114.44, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HC PRO PHONE CALL 21-30 MIN", "code_information": [{"code": "98968", "type": "CPT"}], "standard_charges": [{"minimum": 171.64, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HC PRO PHONE CALL 5-10 MIN", "code_information": [{"code": "98966", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HCG FREE BETACHAIN TEST", "code_information": [{"code": "84704", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 61.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 61.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 61.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HCS DRIVER 2.5MM DRVR-HCS-0915", "code_information": [{"code": "DRVR-HCS-0915", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1058.0, "discounted_cash": 370.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HCS DRIVER 3.5MM DRVR-HCS-1420", "code_information": [{"code": "DRVR-HCS-1420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 672.5, "discounted_cash": 235.38, "setting": "both", "billing_class": "facility"}]}, {"description": "HDR ELCTR NTRST/NTRCV BRCHTX", "code_information": [{"code": "395T", "type": "CPT"}], "standard_charges": [{"minimum": 3236.07, "maximum": 5087.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3236.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5087.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5087.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5087.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR ELCTR NTRST/NTRCV BRCHTX", "code_information": [{"code": "400U", "type": "CPT"}], "standard_charges": [{"minimum": 6243.83, "maximum": 9818.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6243.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HDR ELCTRNC SKN SURF BRCHYTX", "code_information": [{"code": "394T", "type": "CPT"}], "standard_charges": [{"minimum": 1032.89, "maximum": 1623.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1032.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1623.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1623.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1623.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR ELCTRNC SKN SURF BRCHYTX", "code_information": [{"code": "395U", "type": "CPT"}], "standard_charges": [{"minimum": 5176.5, "maximum": 8140.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5176.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77770", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1249.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1017.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1599.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1599.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1599.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 594.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 632.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77771", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1249.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1795.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2822.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2822.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2822.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 990.33, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1055.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77772", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1249.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2809.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4417.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4417.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4417.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1520.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1620.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL SKN SURF BRACHYTX", "code_information": [{"code": "77767", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 384.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 792.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1245.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1245.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1245.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 470.27, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 500.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL SKN SURF BRACHYTX", "code_information": [{"code": "77768", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 384.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1266.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1990.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1990.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1990.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 709.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 755.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEA CARE PRACT TX IN PLACE", "code_information": [{"code": "G2021", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD 20S LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "MRH-350-20S-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4285.0, "discounted_cash": 1499.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD 36MM BIOLOX DELTA S 01.29.208", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1.29.208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD 43/18 ARTHREX ECLISPR HUMERAL AR-9343-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9343-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD 50MMX18MM OFFSET HUMERAL 520-50-318", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-50-318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD ACTBLR 22.2MM +8MM COBALT CHROME V40 LFIT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6260-9-322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD ACTBLR 22.2MM COBALT CHROME V40 LFIT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6260-9-122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1231.0, "discounted_cash": 430.85, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD CHIN STRAP SCHUREMED (BERCHTOLD)", "code_information": [{"code": "OZ7518375", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD COCR 48MM 21MM STB HUMERAL SIMPLICITI 7122885", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7122885", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD DARCO ED CLEANING STYLETTE 2.7/3.5/4.0MM CANNULATED IW170212", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IW170212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD ED NAIL - 3/4 6541-4-575", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6541-4-575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 83.52, "discounted_cash": 29.23, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD EVOLVE 22MM 496H022", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "496H022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3212.0, "discounted_cash": 1124.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEM CEM STD RIGHT SZ 5 42-5046-058-02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5046-058-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13211.0, "discounted_cash": 4623.85, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL -3MM OPTION TYPE IINSERT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "650-1065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 880.0, "discounted_cash": 308.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 12 BY 14 28MM POSITIVE 0 NECK LEN OXINIUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71342800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3837.0, "discounted_cash": 1342.95, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 12 BY 14 28MM POSITIVE 0MM NECK LEN COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71302800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1902.0, "discounted_cash": 665.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 12 BY 14 36MM NEGATIVE 3 OXINIUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71343603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3836.0, "discounted_cash": 1342.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 28MM +7.0MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "497-28-700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 28MM -4MM OFFSET BIOLOX DELTA V40 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6570-0-028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1420.0, "discounted_cash": 497.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 28MM NEGATIVE 3MM COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71302803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1846.0, "discounted_cash": 646.1, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 28MM NEGATIVE 3MM OXINIUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71342803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4272.0, "discounted_cash": 1495.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 28MM POSITIVE 4MM COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71302804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1959.0, "discounted_cash": 685.65, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 28MM POSITIVE 4MM OXINIUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71342804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 1540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32.0MM CERAMIC BIOLOXD OPTION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "650-1056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM +0MM 12/14 TAPER COBALT CHROME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71303200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2151.0, "discounted_cash": 752.85, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM +0MM 12/14 TAPER OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71343200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 1540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM +12 NECK LEN 12/14 TAPER OXINIUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71343212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3835.0, "discounted_cash": 1342.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM +4MM 12/14 TAPER COBALT CHROME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71303204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1686.0, "discounted_cash": 590.1, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM -3MM 12/14 TAPER OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71343203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3836.0, "discounted_cash": 1342.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM -4MM OFFSET BIOLOX DELTA V40 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6570-0-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1463.0, "discounted_cash": 512.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM NEGATIVE 3MM COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71303203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2088.0, "discounted_cash": 730.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM POSITIVE 8MM OXINIUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71343208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 1540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM POSITIVE 9 COBALT CHROME ARTICULEZE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-23-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1537.0, "discounted_cash": 537.95, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36 MM DELTA CERAMIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "400-03-361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3183.0, "discounted_cash": 1114.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM +0MM 12/14 TAPER COBALT CHROME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71303600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2467.0, "discounted_cash": 863.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM +0MM 12/14 TAPER OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71343600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 1540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM +2.5MM V40 TAPER BIOLOX CERAMIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6570-0-536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1463.0, "discounted_cash": 512.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM +4MM 12/14 TAPER OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71343604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3836.0, "discounted_cash": 1342.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM +5MM BIOLOX DELTA CERAMIC V40 STERILE DISPOSABLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6570-0-236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3700.0, "discounted_cash": 1295.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM +8MM 12/14 TAPER COBALT CHROME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71303608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2701.0, "discounted_cash": 945.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM -2.5MM OFFSET V40 BIOLOX DELTA IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6570-0-436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1463.0, "discounted_cash": 512.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM -3MM 12/14 TAPER COBALT CHROME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71303603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2349.0, "discounted_cash": 822.15, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM -5MM OFFSET BIOLOX DELTA V40 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6570-0-036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1463.0, "discounted_cash": 512.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM -7.5MM OFFSET BIOLOX DELTA V40 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6570-0-736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1463.0, "discounted_cash": 512.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM 0MM OFFSET BIOLOX DELTA V40 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6570-0-136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1463.0, "discounted_cash": 512.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM CERAMIC BIOLOX IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "400-03-362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3183.0, "discounted_cash": 1114.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM NEGATIVE 5MM OFFSET C TAPER", "code_information": [{"code": "18-36-5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM POSITIVE 12MM COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71303612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2622.0, "discounted_cash": 917.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM POSITIVE 12MM XL OXINIUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71343612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3688.0, "discounted_cash": 1290.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40.0MM CERAMIC BIOLOXD OPTION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "650-1058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8961.0, "discounted_cash": 3136.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40MM X 15MM ECCENTRIC IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "MHH-0920-010-4015E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4862.0, "discounted_cash": 1701.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 44MM X 15MM ECCENTRIC EPIPHYSIS GLOBAL UNITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110044600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2765.0, "discounted_cash": 967.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 48MM X 18MM ECCENTRIC EPIPHYSIS GLOBAL UNITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110048610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2765.0, "discounted_cash": 967.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL BIOLOX DELTA 12/14S 36MM X 4MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "H3-53699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3461.0, "discounted_cash": 1211.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL COCR 22MM +0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71302200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1959.0, "discounted_cash": 685.65, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL NEGATIVE 4MM OFFSET 28MM DIA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6260-9-028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1231.0, "discounted_cash": 430.85, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL OXINIUM 12/14 TAPER +8 36MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7134-3608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3668.0, "discounted_cash": 1283.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL POSITIVE LARGE OXINIUM 8MM X 36MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71343608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3688.0, "discounted_cash": 1290.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD GLENOID 36MM W/ NEUTRAL SCREW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "508-36-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1540.0, "discounted_cash": 539.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD GLENOID SIZE 42 GLENOSPHERE UNIVERSAL POSITIVE 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9504L-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 15MM X 19MM X 1.5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "502350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8570.0, "discounted_cash": 2999.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 18 X19 X 3.5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "502448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9105.0, "discounted_cash": 3186.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 32MM W/ RETAINING SCREW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "508-32-103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1391.0, "discounted_cash": 486.85, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 42MM 16MM THICK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-42-116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 44MM X 15MM GLOBAL AP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113044500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2905.0, "discounted_cash": 1016.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 44MM X 18MM STANDARD GLOBAL UNITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110044510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2765.0, "discounted_cash": 967.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 44X17X3.50MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "502444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9105.0, "discounted_cash": 3186.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 46 MM X 16MM NEUTRAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-46-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 46 MM X 20MM NEUTRAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-46-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 46 MM X 20MM OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-46-120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 50MM X 19MM X 4.0MM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "502450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9105.0, "discounted_cash": 3186.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 51X17 LOW OFFSET ASCEND FLEX STB DWG051", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWG051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6026.0, "discounted_cash": 2109.1, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 52MM X 21MM GLOBAL AP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113052520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2905.0, "discounted_cash": 1016.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL AEQUALIS OFFSET 19MM X 52MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10084.0, "discounted_cash": 3529.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL ASCEND SZ 46", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10084.0, "discounted_cash": 3529.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL ECCENTRIC GLOBAL 48MM X 18MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1100-48-610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2765.0, "discounted_cash": 967.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL NECK NEUTRAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-00-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL OFFSET ALTIVATE 46 X 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-46-316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL PYROCARBON TORNIER LOW .43MM/16MM DWH043", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWH043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14400.0, "discounted_cash": 5040.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL STND 48MM X 18MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1100-48-510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2765.0, "discounted_cash": 967.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL SZ 52 X 18 ECCENTRIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1100-52-610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2765.0, "discounted_cash": 967.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL SZ44MMX15MM ECCENTRIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1100-44-600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2765.0, "discounted_cash": 967.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL TURON STANDARD 54 X 22MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-54-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD K-WIREDARCO ED 2.5MM QTY1 270MM LONG SMOOTH TIP 707092502", "code_information": [{"code": "707092502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD MATCH 2.5MM 14 CM ANGLED", "code_information": [{"code": "MR8-T14MH25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.0, "discounted_cash": 190.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD METATARSAL 11MM FOR LESSER DIGIT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "MMCI-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9466.0, "discounted_cash": 3313.1, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD MODULAR 52MM BHR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74122552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14172.0, "discounted_cash": 4960.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD OFFSET 46MM X 18M IMPLANT HUMERAL 520-46-318", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-46-318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD OPTION 36MM 16/18 TAPER CERAMIC DELTA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "650-1057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6709.0, "discounted_cash": 2348.15, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD RADIAL 10MM X 22MM MODULAR EXPLOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-210031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD RADIAL 10MM X 24MM MODULAR EXPLOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-210041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD RADIAL 12MM X 24MM EXPLOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-210042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3702.0, "discounted_cash": 1295.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD RADIAL 12MM X 32MM MODULAR EXPLOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-210032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3702.0, "discounted_cash": 1295.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD RADIAL 14MM X 22MM MODULAR EXPLOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-210033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3702.0, "discounted_cash": 1295.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD RADIAL 14MM X 24MM MODULAR EXPLOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-210043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3702.0, "discounted_cash": 1295.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD RADIAL 22MM COBALT CHROME ALIGN IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ALN-RHI-220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3644.8, "discounted_cash": 1275.68, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD RADIAL CRUCIFORM 22.0MM LFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TR-H220L-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11095.0, "discounted_cash": 3883.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD RADIAL RIGHT 22.0MM CRUCIFORM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TR-H220R-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6716.0, "discounted_cash": 2350.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD RADIAL STEM 7.0 X 2.0MM CRUCIFORM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TR-S0702-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4090.0, "discounted_cash": 1431.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD RADIAL STEM 8.0 X 4.0MM CRUCIFORM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TR-S0804-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6757.0, "discounted_cash": 2364.95, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD REPLACEMENT INST KIT SILE RADIAL 03.405.000S", "code_information": [{"code": "3.405.000S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1178.0, "discounted_cash": 412.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 3.5MMX26MM SHORT 777352632", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777352632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 3.5MMX30MM FULL 777353002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777353002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 313.0, "discounted_cash": 109.55, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 3.5MMX34MM LONG 777353422", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777353422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 3.5MMX36MM FULL 777353602", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777353602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 3.5MMX44MM FULL 777354402", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777354402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 3.5MMX46MM SHORT 777354632", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777354632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 313.0, "discounted_cash": 109.55, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 4.0MMX24MM SHORT 777402432", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777402432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 133.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 4.0MMX26MM SHORT 777402632", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777402632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 133.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 4.0MMX32MM FULL 777403202", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777403202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 133.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 4.0MMX32MM SHORT 777403232", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777403232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 133.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 4.0MMX34MM SHORT 777403432", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777403432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 133.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 4.0MMX36MM LONG 777403622", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777403622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 133.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 4.0MMX36MM SHORT 777403632", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777403632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 133.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 4.0MMX42MM LONG 777404222", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777404222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 133.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 4.0MMX46MM LONG 777404622", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777404622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 133.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 4.5MMX46MM LONG 777454622", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777454622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 388.0, "discounted_cash": 135.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 4.5MMX48MM LONG 777454822", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777454822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 388.0, "discounted_cash": 135.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 7.5MMX65MM X16 777756562", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777756562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW DARCO ED SCREWS 7.5MMX75MM X32 777757552", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "777757552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW ED 2.5MM X 20MM DART-FIRE COMPRESSION SCREW D1N25020S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N25020S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW ED 3.0MM X 18MM DART-FIRE COMPRESSION SCREW D1N30018S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N30018S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW ED 3.0MM X 40MM DART-FIRE COMPRESSION SCREW D1N30040S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N30040S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW ED 3.5MM X 24MM DART-FIRE COMPRESSION SCREW D1N35024S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N35024S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW ED 3.5MM X 38MM DART-FIRE COMPRESSION SCREW D1N35038S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N35038S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 297.0, "discounted_cash": 103.95, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW ED 4.0MM X 46MM DART-FIRE COMPRESSION SCREW D1N40046S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N40046S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 123.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW LESS 2.5MM X 16MM DART-FIRE COMPRESSION SCREW D2N25016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N25016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 159.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW LESS 2.5MM X 26MM DART-FIRE COMPRESSION SCREW D2N25026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N25026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW LESS 2.5MM X 28MM DART-FIRE COMPRESSION SCREW D2N25028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N25028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW LESS 2.5MM X 30MM DART-FIRE COMPRESSION SCREW D2N25030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N25030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW LESS 2.5MM X 36MM DART-FIRE COMPRESSION SCREW D2N25036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N25036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW LESS 3.0MM X 32MM DART-FIRE COMPRESSION SCREW D2N30032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N30032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW LESS 3.0MM X 34MM DART-FIRE COMPRESSION SCREW D2N30034", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N30034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 381.0, "discounted_cash": 133.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW LESS 3.0MM X 36MM DART-FIRE COMPRESSION SCREW D2N30036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N30036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 381.0, "discounted_cash": 133.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW LESS 3.0MM X 38MM DART-FIRE COMPRESSION SCREW D2N30038", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N30038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 159.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW REPLACEMENT RETAINING FOR GLENOID 508-00-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "508-00-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 51.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SCREW RSP GLENOID W/RETAINING / -4MM OFFSET 36MM 508-36-103", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "508-36-103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1391.0, "discounted_cash": 486.85, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD SURG 24MM RIGHT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TR-H24OR-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6952.0, "discounted_cash": 2433.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEADACHES WITH MCC", "code_information": [{"code": "102", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7014.31, "maximum": 12041.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7014.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10031.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11035.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12041.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEADACHES WITHOUT MCC", "code_information": [{"code": "103", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5045.85, "maximum": 8662.47, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5045.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7216.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7938.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8662.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEADED SCREW 2.5 X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IC2518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEADED SCREW 4.0MM X 38MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IC4038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEADLESS COMPRESSION SCREW 4.0MM/L46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 722.0, "discounted_cash": 252.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALICOIL RG DILATOR 4.75MM DISPOSABLE", "code_information": [{"code": "72203951", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 566.51, "discounted_cash": 198.28, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALIX 6.5 # 3 SUTURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 915.0, "discounted_cash": 320.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALON 10 MG/ML 0.85 ML (SODIUM HYALURONATE INTRAOCULAR LIQ INJ)", "code_information": [{"code": "MED0825", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 425.0, "discounted_cash": 148.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALON 10MG/ML 0.55ML", "code_information": [{"code": "MED0527", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 277.0, "discounted_cash": 96.95, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALON 5/0.6 ML", "code_information": [{"code": "MED0235", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 403.0, "discounted_cash": 141.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALON GV 10 MG/ML 2.5ML", "code_information": [{"code": "MED0237", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 490.0, "discounted_cash": 171.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEARING AID CHECK BOTH EARS", "code_information": [{"code": "92593", "type": "CPT"}], "standard_charges": [{"minimum": 111.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING AID CHECK ONE EAR", "code_information": [{"code": "92592", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 119.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 119.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 119.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING AID EXAM BOTH EARS", "code_information": [{"code": "92591", "type": "CPT"}], "standard_charges": [{"minimum": 309.93, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 309.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 487.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 487.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 487.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING AID EXAM ONE EAR", "code_information": [{"code": "92590", "type": "CPT"}], "standard_charges": [{"minimum": 206.61, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 206.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 324.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 324.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 324.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING LOSS DUP/DEL ANALYS", "code_information": [{"code": "81431", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 849.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1732.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2725.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2725.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2725.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 978.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 978.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING LOSS SEQUENCE ANALYS", "code_information": [{"code": "81430", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2031.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4143.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6516.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6516.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6516.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [{"code": "292", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5252.67, "maximum": 9017.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5252.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7512.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8263.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9017.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [{"code": "291", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7715.07, "maximum": 13244.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7715.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11034.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12137.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13244.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITHOUT CC/MCC", "code_information": [{"code": "293", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3588.36, "maximum": 6160.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3588.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5132.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5645.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6160.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS ADD-ON", "code_information": [{"code": "78496", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 88.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 45.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 48.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS MULTIPLE", "code_information": [{"code": "78483", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 759.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1193.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1193.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1193.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 362.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 386.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS SINGLE", "code_information": [{"code": "78481", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 581.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 913.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 913.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 913.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 280.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 298.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93571", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93572", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART IMAGE SPECT", "code_information": [{"code": "78494", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 765.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1203.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1203.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1203.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 372.17, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 396.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE", "code_information": [{"code": "78466", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 737.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1158.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1158.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1158.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 309.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 329.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (3D)", "code_information": [{"code": "78469", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 820.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1289.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1289.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1289.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 389.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 414.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (EF)", "code_information": [{"code": "78468", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 749.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1178.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1178.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1178.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 348.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 370.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART PACING MAPPING", "code_information": [{"code": "93631", "type": "CPT"}], "standard_charges": [{"minimum": 1826.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1826.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2869.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2869.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2869.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART REVASCULARIZE (TMR)", "code_information": [{"code": "33140", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART RHYTHM PACING", "code_information": [{"code": "93618", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4355.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART SYMP IMAGE PLNR", "code_information": [{"code": "331T", "type": "CPT"}], "standard_charges": [{"minimum": 5559.47, "maximum": 8739.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5559.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8739.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8739.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8739.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART SYMP IMAGE PLNR SPECT", "code_information": [{"code": "332T", "type": "CPT"}], "standard_charges": [{"minimum": 5559.47, "maximum": 8739.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5559.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8739.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8739.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8739.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART TMR W/OTHER PROCEDURE", "code_information": [{"code": "33141", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART/LUNG RESUSCITATION CPR", "code_information": [{"code": "92950", "type": "CPT"}], "standard_charges": [{"minimum": 850.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 850.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1336.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1336.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1336.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAT QUANT SENSORY TEST", "code_information": [{"code": "109T", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 231.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAVY METAL QUAL ANY ANAL", "code_information": [{"code": "83015", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAVY METAL QUANT EACH NES", "code_information": [{"code": "83018", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 88.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 88.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 88.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEINZ BODIES DIRECT", "code_information": [{"code": "85441", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEINZ BODIES INDUCED", "code_information": [{"code": "85445", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HELMINTH ANTIBODY", "code_information": [{"code": "86682", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM AHUS GEN SEQ ALYS 15 GEN", "code_information": [{"code": "268U", "type": "CPT"}], "standard_charges": [{"minimum": 721.34, "maximum": 1134.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 721.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM AUT DM CGEN TRMBCTPNA 22", "code_information": [{"code": "269U", "type": "CPT"}], "standard_charges": [{"minimum": 700.82, "maximum": 1102.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM CGEN COAGJ DO 20 GENES", "code_information": [{"code": "270U", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 2406.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM CGEN NEUTROPENIA 24 GEN", "code_information": [{"code": "271U", "type": "CPT"}], "standard_charges": [{"minimum": 721.34, "maximum": 1134.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 721.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM GEN HYPRFIBRNLYSIS 8 GEN", "code_information": [{"code": "273U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 875.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM GEN PLTLT DO 62 GENES", "code_information": [{"code": "274U", "type": "CPT"}], "standard_charges": [{"minimum": 700.82, "maximum": 1102.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM GEN PLTLT FUNCJ DO 40", "code_information": [{"code": "277U", "type": "CPT"}], "standard_charges": [{"minimum": 700.82, "maximum": 1102.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM GEN THROMBOSIS 14 GENES", "code_information": [{"code": "278U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 875.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM GENETIC BLD DO 60 GENES", "code_information": [{"code": "272U", "type": "CPT"}], "standard_charges": [{"minimum": 875.76, "maximum": 3393.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2157.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3393.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3393.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3393.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 875.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM HEPRN NDUC TRMBCTPNA SRM", "code_information": [{"code": "275U", "type": "CPT"}], "standard_charges": [{"minimum": 26.45, "maximum": 73.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM INH THROMBOCYTOPENIA 42", "code_information": [{"code": "276U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 3525.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3525.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3525.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM RBC ADS WHL BLD HYPOXIC", "code_information": [{"code": "303U", "type": "CPT"}], "standard_charges": [{"minimum": 19.81, "maximum": 3170.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3170.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3170.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM RBC ADS WHL BLD NORMOXIC", "code_information": [{"code": "304U", "type": "CPT"}], "standard_charges": [{"minimum": 19.81, "maximum": 2989.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2989.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM RBC FNCLTY&DFRM SHR STRS", "code_information": [{"code": "305U", "type": "CPT"}], "standard_charges": [{"minimum": 34.07, "maximum": 954.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 954.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 954.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM VW FACTOR&CLGN III BNDG", "code_information": [{"code": "279U", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM VW FACTOR&CLGN IV BNDG", "code_information": [{"code": "280U", "type": "CPT"}], "standard_charges": [{"minimum": 24.86, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM VWD PROPEPTIDE AG LVL", "code_information": [{"code": "281U", "type": "CPT"}], "standard_charges": [{"minimum": 24.86, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMAGGLUTINATION INHIBITION", "code_information": [{"code": "86280", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMATOPOIETIC NUCLEAR TX", "code_information": [{"code": "79403", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 417.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 366.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 576.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 576.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 576.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 196.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 210.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMI GREAT TOE IMPLANT SMALL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "355-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3883.0, "discounted_cash": 1359.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMI IMPLANT SIZER SMALL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "375-0005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 649.0, "discounted_cash": 227.15, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMI TRIAL MEDIUM GREAT TOE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "375-0011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 816.0, "discounted_cash": 285.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMICRT INTRCLRY ALGRFT PRTL", "code_information": [{"code": "20933", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMILAMINECTOMY WITH DECOMPRESSION CERVICAL 63040", "code_information": [{"code": "63040", "type": "CPT"}, {"code": "1481005", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMILAMINECTOMY WITH DECOMPRESSION LUMBAR 63042", "code_information": [{"code": "63042", "type": "CPT"}, {"code": "1481006", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION TOE 28160", "code_information": [{"code": "28160", "type": "CPT"}, {"code": "1481007", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOCLIP INSTINCT 16MM X 230CM ENDOSCOPIC", "code_information": [{"code": "INSC-7-230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMODIALYSIS ACCESS STUDY", "code_information": [{"code": "90940", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS ONE EVALUATION", "code_information": [{"code": "90935", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS REPEATED EVAL", "code_information": [{"code": "90937", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN A1C LEVEL >9.0%", "code_information": [{"code": "M1211", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN CHROMOTOGRAPHY", "code_information": [{"code": "83021", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN COPPER SULFATE", "code_information": [{"code": "83026", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN ELECTROPHORESIS", "code_information": [{"code": "83020", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN F FETAL CHEMICAL", "code_information": [{"code": "83030", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FETAL", "code_information": [{"code": "85460", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FETAL", "code_information": [{"code": "85461", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FTL F ASSAY QUAL", "code_information": [{"code": "83033", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN PLASMA", "code_information": [{"code": "83051", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN THERMOLABILE", "code_information": [{"code": "83065", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 36.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 36.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN UNSTABLE SCREEN", "code_information": [{"code": "83068", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN URINE", "code_information": [{"code": "83069", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN-OXYGEN AFFINITY", "code_information": [{"code": "82820", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOLYSIN ACID", "code_information": [{"code": "85475", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 35.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOLYSINS/AGGLUTININS", "code_information": [{"code": "86941", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOLYSINS/AGGLUTININS AUTO", "code_information": [{"code": "86940", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 35.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOPERFUSION", "code_information": [{"code": "90997", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOPHILUS INFLUENZA ANTIBDY", "code_information": [{"code": "86684", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 63.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 63.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY EXTERNAL-2 OR MORE COLUMNS/GROUPS 46250", "code_information": [{"code": "46250", "type": "CPT"}, {"code": "1481008", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY INTERNAL AND EXTERNAL-MULTIPLE COLUMNS 46260", "code_information": [{"code": "46260", "type": "CPT"}, {"code": "1481009", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY INTERNAL AND EXTERNAL-MULTIPLE COLUMNS W/FISSURECTOMY 46261", "code_information": [{"code": "46261", "type": "CPT"}, {"code": "1481010", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY INTERNAL AND EXTERNAL-MULTIPLE COLUMNS W/FISTULECTOMY 46262", "code_information": [{"code": "46262", "type": "CPT"}, {"code": "1481011", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY INTERNAL AND EXTERNAL-SINGLE COLUMN 46255", "code_information": [{"code": "46255", "type": "CPT"}, {"code": "1481012", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY INTERNAL AND EXTERNAL-SINGLE COLUMN W/FISSURECTOMY 46257", "code_information": [{"code": "46257", "type": "CPT"}, {"code": "1481013", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY INTERNAL AND EXTERNAL-SINGLE COLUMN W/FISTULECTOMY 46258", "code_information": [{"code": "46258", "type": "CPT"}, {"code": "1481014", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY INTERNAL BY BANDING 46221", "code_information": [{"code": "46221", "type": "CPT"}, {"code": "1481015", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY INTERNAL BY LIGATION OTHER THAN RUBBER BAND 2 OR MORE HEMORRHOID GROUP 46946", "code_information": [{"code": "46946", "type": "CPT"}, {"code": "5561473", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY INTERNAL BY LIGATION OTHER THAN RUBBER BAND SINGLE HEMORRHOID COLUMN GROUP 46945", "code_information": [{"code": "46945", "type": "CPT"}, {"code": "13397452", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "gross_charge": 3203.0, "discounted_cash": 1121.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1550.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDOPEXY BY STAPLING", "code_information": [{"code": "46947", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORB SURGICEL FIBRILLAR 1X2 1961", "code_information": [{"code": "1961", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.91, "discounted_cash": 52.47, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORB SURGICEL FIBRILLAR 2X4 1962", "code_information": [{"code": "1962", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 158.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORB SURGICEL FIBRILLAR 4X4 1963", "code_information": [{"code": "1963", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORBABLE SURGICEL NUKNIT 3X4 1943", "code_information": [{"code": "1943", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORBABLE SURGICEL NUKNIT 6X9 1946", "code_information": [{"code": "1946", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORBABLE SURGICEL STRL 2X14 1951", "code_information": [{"code": "1951", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.0, "discounted_cash": 65.1, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORBABLE SURGICEL STRL 2X3 1953", "code_information": [{"code": "1953", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.89, "discounted_cash": 40.21, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORBABLE SURGICEL STRL 4X8 1952", "code_information": [{"code": "1952", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC AGENT ARISTA THROMBIN FREE 3GRAM", "code_information": [{"code": "SM0002-USA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 466.98, "discounted_cash": 163.44, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC CLGN 1GM MICROFIBRILLARINDICATIONS ENCOMPASS NEUROLOGICAL PROCEDUREIN", "code_information": [{"code": "1985", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC CLIPS SURECLIP 11mm 3-Ring Handle 127-1709 11 Max 2.6 235 2.8", "code_information": [{"code": "RC30145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC CLIPS SURECLIP 11mm 3-Ring Handle 129-0197 11 Max 2.6 235 2.8", "code_information": [{"code": "RC30141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC CLIPS SURECLIP 11mm Rotation Handle 132-5723 11 Max 2.6 235 2.8", "code_information": [{"code": "RC30441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC CLIPS SURECLIP 11mm Rotation Handle 132-5724 11 Max 2.6 235 2.8", "code_information": [{"code": "RC30445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC CLIPS SURECLIP Mini 8mm Rotation Handle 132-5180 8 Max 2.6 235 2.8", "code_information": [{"code": "RC30415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 372.0, "discounted_cash": 130.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC CLIPS SURECLIP Mini 8mm Rotation Handle 132-5187 8 Max 2.6 235 2.8", "code_information": [{"code": "RC30411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 372.0, "discounted_cash": 130.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC CLIPS SURECLIP PLUS 16mm Rotation Handle 128-5655 16 Max 2.6 235 2.8", "code_information": [{"code": "RC30381", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.19, "discounted_cash": 113.82, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC CLIPS SURECLIP PLUS 16mm Rotation Handle 128-5657 16 Max 2.6 235 2.8", "code_information": [{"code": "RC30385", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 158.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTATIC SURGICEL SNOW 1X2CM 2081", "code_information": [{"code": "2081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HEP A/HEP B VACC ADULT IM", "code_information": [{"code": "90636", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEP B CORE ANTIBODY TOTAL", "code_information": [{"code": "86704", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEP B IG IM", "code_information": [{"code": "90371", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEP B SURFACE AG NEUTRLZJ IA", "code_information": [{"code": "87341", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 41.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 41.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEP B VAC 3AG 10MCG 3 DOS IM", "code_information": [{"code": "90759", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEP C AB TEST CONFIRM", "code_information": [{"code": "86804", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEP C SCREEN HIGH RISK/OTHER", "code_information": [{"code": "G0472", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 185.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 57.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 118.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 185.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 185.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 185.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 66.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 66.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEP NAFLD SEMIQ EVL 28 LIPID", "code_information": [{"code": "344U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1140.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1140.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1140.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPA VACC PED/ADOL 2 DOSE IM", "code_information": [{"code": "90633", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPA VACC PED/ADOL 3 DOSE", "code_information": [{"code": "90634", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPA VACCINE ADULT IM", "code_information": [{"code": "90632", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPARIN 5000 UNITS/1ML VIAL", "code_information": [{"code": "MED0093", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HEPARIN ASSAY", "code_information": [{"code": "85520", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPARIN FLUSH 100 UNITS/ML 5ML", "code_information": [{"code": "MED0395", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEPARIN FLUSH 20ML KIT 100 units/1ML VIAL", "code_information": [{"code": "MED0094", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HEPARIN INJ 50,000 UNITS/5 ML", "code_information": [{"code": "MED0095", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HEPARIN NEUTRALIZATION", "code_information": [{"code": "85525", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 47.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPARIN SODIUM 1000 UNITS/1ML VIAL", "code_information": [{"code": "MED0096", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HEPARIN-PROTAMINE TOLERANCE", "code_information": [{"code": "85530", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS A IGM ANTIBODY", "code_information": [{"code": "86709", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 45.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 45.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 45.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B DNA AMP PROBE", "code_information": [{"code": "87516", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B DNA QUANT", "code_information": [{"code": "87517", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B SURFACE AG QUAN", "code_information": [{"code": "87467", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS BE AG IA", "code_information": [{"code": "87350", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS BE ANTIBODY", "code_information": [{"code": "86707", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS C PROBE&RVRS TRNSC", "code_information": [{"code": "87521", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS C REVRS TRNSCRPJ", "code_information": [{"code": "87522", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS C RNA DIR PROBE", "code_information": [{"code": "87520", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 79.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 125.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 125.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 125.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 44.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 44.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS D QUANTIFICATION", "code_information": [{"code": "87523", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS DELTA AGENT AG IA", "code_information": [{"code": "87380", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS DELTA AGENT ANTBDY", "code_information": [{"code": "86692", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS G DNA AMP PROBE", "code_information": [{"code": "87526", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 157.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 157.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 56.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS G DNA DIR PROBE", "code_information": [{"code": "87525", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 75.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 119.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 119.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 119.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS G DNA QUANT", "code_information": [{"code": "87527", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 60.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 60.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATOBIL SYST IMAGE W/DRUG", "code_information": [{"code": "78227", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1826.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 838.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 892.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC", "code_information": [{"code": "421", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11603.32, "maximum": 19920.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11603.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16595.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18254.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19920.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC", "code_information": [{"code": "420", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21390.87, "maximum": 36722.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21390.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 30593.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 33652.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 36722.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "422", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8842.25, "maximum": 15179.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8842.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12646.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13910.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15179.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY SYSTEM IMAGING", "code_information": [{"code": "78226", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1335.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2099.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2099.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2099.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 616.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 655.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPB SCREEN HIGH RISK INDIV", "code_information": [{"code": "G0499", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 113.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 43.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 72.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 113.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 113.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 113.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 2 DOSE ADOLESC IM", "code_information": [{"code": "90743", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 2/4 DOSE ADULT IM", "code_information": [{"code": "90739", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 3 DOSE IMMUNSUP IM", "code_information": [{"code": "90740", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 3 DOSE PED/ADOL IM", "code_information": [{"code": "90744", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 4 DOSE IMMUNSUP IM", "code_information": [{"code": "90747", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPB VACCINE 3 DOSE ADULT IM", "code_information": [{"code": "90746", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPCIDIN-25 ELISA SERUM/PLSM", "code_information": [{"code": "251U", "type": "CPT"}], "standard_charges": [{"minimum": 24.86, "maximum": 48.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HER-2 POS", "code_information": [{"code": "G9830", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERCULES FT ANCHOR INSTRUMENT KIT SIZE 4.5 A02 S0004", "code_information": [{"code": "A02 S0004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1102.9, "discounted_cash": 386.02, "setting": "both", "billing_class": "facility"}]}, {"description": "HERCULES KNOTLESS XE 3.5MM X 15MM A40 SP135", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A40 SP135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 820.0, "discounted_cash": 287.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HERCULES KNOTLESS XE INSTRUMENT KIT SIZ 3.5MM LONG A04 S0135", "code_information": [{"code": "A04 S0135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1102.9, "discounted_cash": 386.02, "setting": "both", "billing_class": "facility"}]}, {"description": "HERED BRST CA RLTD DO 17 GEN", "code_information": [{"code": "102U", "type": "CPT"}], "standard_charges": [{"minimum": 1877.69, "maximum": 4483.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2850.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1877.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1877.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERED BRST CA RLTD DO PANEL", "code_information": [{"code": "129U", "type": "CPT"}], "standard_charges": [{"minimum": 1877.69, "maximum": 4483.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2850.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1877.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1877.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERED BRST CA RLTD DO PNL 13", "code_information": [{"code": "131U", "type": "CPT"}], "standard_charges": [{"minimum": 1022.4, "maximum": 2722.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1731.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2722.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2722.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2722.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1022.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1022.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERED COLON CA DO 15 GENES", "code_information": [{"code": "101U", "type": "CPT"}], "standard_charges": [{"minimum": 2511.29, "maximum": 4690.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2982.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4690.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4690.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4690.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2511.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2511.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERED COLON CA DO MRNA PNL", "code_information": [{"code": "130U", "type": "CPT"}], "standard_charges": [{"minimum": 842.26, "maximum": 2345.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1491.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERED COLON CA TRGT MRNA PNL", "code_information": [{"code": "162U", "type": "CPT"}], "standard_charges": [{"minimum": 700.62, "maximum": 2708.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1722.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 700.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 700.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERED GYN CA MRNA PNL 12 GEN", "code_information": [{"code": "135U", "type": "CPT"}], "standard_charges": [{"minimum": 1008.8, "maximum": 4483.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2850.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1008.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1008.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERED OVA CA PNL 24 GENES", "code_information": [{"code": "103U", "type": "CPT"}], "standard_charges": [{"minimum": 2511.29, "maximum": 4483.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2850.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2511.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2511.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERED OVA CA RLTD DO PNL 17", "code_information": [{"code": "132U", "type": "CPT"}], "standard_charges": [{"minimum": 1067.96, "maximum": 2722.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1731.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2722.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2722.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2722.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1067.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1067.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERED PAN CA MRNA PNL 18 GEN", "code_information": [{"code": "134U", "type": "CPT"}], "standard_charges": [{"minimum": 1077.68, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1077.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1077.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERED PRST8 CA RLTD DO 11", "code_information": [{"code": "133U", "type": "CPT"}], "standard_charges": [{"minimum": 994.02, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 994.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 994.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEREDITARY COLON CA DSORDRS", "code_information": [{"code": "81435", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 902.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1491.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEREDITARY COLON CA DSORDRS", "code_information": [{"code": "81436", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 902.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEREDITARY RETINAL DISORDERS", "code_information": [{"code": "81434", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 747.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 860.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 860.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEREDTRY NURONDCRN TUM DSRDR", "code_information": [{"code": "81437", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 677.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1119.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1760.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1760.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1760.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 632.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 632.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEREDTRY NURONDCRN TUM DSRDR", "code_information": [{"code": "81438", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 677.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 632.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 632.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC", "code_information": [{"code": "354", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10856.94, "maximum": 18638.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10856.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15527.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17080.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18638.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC", "code_information": [{"code": "353", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18400.47, "maximum": 31589.03, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18400.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26316.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28948.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31589.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC", "code_information": [{"code": "355", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8274.1, "maximum": 14204.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8274.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11833.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13017.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14204.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEROIN METABOLITE", "code_information": [{"code": "80356", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX 1 AG IF", "code_information": [{"code": "87274", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX 2 AG IF", "code_information": [{"code": "87273", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX NES ANTBDY", "code_information": [{"code": "86694", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX TYPE 1 TEST", "code_information": [{"code": "86695", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX TYPE 2 TEST", "code_information": [{"code": "86696", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HETEROPHILE ANTIBODY ABSRBJ", "code_information": [{"code": "86310", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HETEROPHILE ANTIBODY SCREEN", "code_information": [{"code": "86308", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HETEROPHILE ANTIBODY TITER", "code_information": [{"code": "86309", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEXA GENE", "code_information": [{"code": "81255", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 64.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 131.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 206.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 206.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 206.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEXAGNAL PHOSPH PLTLT NEUTRL", "code_information": [{"code": "85598", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEXAGONAL SCREW DRIVER DEPUY SYNTHES", "code_information": [{"code": "314.40.97", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 790.0, "discounted_cash": 276.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HFE GENE", "code_information": [{"code": "81256", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 100.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 166.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 262.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 262.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 262.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 94.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 94.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HGB METHEMOGLOBIN QUAL", "code_information": [{"code": "83045", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HGB METHEMOGLOBIN QUAN", "code_information": [{"code": "83050", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HGB QUANT TRANSCUTANEOUS", "code_information": [{"code": "88738", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HGB SULFHEMOGLOBIN QUAN", "code_information": [{"code": "83060", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 35.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA AMP PROBE", "code_information": [{"code": "87532", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA DIR PROBE", "code_information": [{"code": "87531", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 72.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 232.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 232.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 232.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 83.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 83.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA QUANT", "code_information": [{"code": "87533", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 60.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 60.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HI ENRGY ESWT PLANTAR FASCIA", "code_information": [{"code": "28890", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HI INTEN SERV FOR SIP MODEL", "code_information": [{"code": "G2020", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIB PRP-OMP VACC 3 DOSE IM", "code_information": [{"code": "90647", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIB PRP-T VACCINE 4 DOSE IM", "code_information": [{"code": "90648", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIB-HEPB VACCINE IM", "code_information": [{"code": "90748", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIB-MENCY VACC 6WK-18M0 IM", "code_information": [{"code": "90644", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIGH RISK RECURRENCE PRO CA", "code_information": [{"code": "G8465", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIMAX C 18MM X 18MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7118-1818KT-C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4441.0, "discounted_cash": 1554.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [{"code": "481", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12750.58, "maximum": 21889.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12750.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18236.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20059.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21889.57, "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": 18405.94, "maximum": 31598.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18405.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26324.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28956.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31598.43, "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": 10011.4, "maximum": 17187.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10011.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14318.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15750.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17187.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHR0 W/DEBRIDEMENT", "code_information": [{"code": "29862", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHR0 W/SYNOVECTOMY", "code_information": [{"code": "29863", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO ACETABULOPLASTY", "code_information": [{"code": "29915", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/FB REMOVAL", "code_information": [{"code": "29861", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/FEMOROPLASTY", "code_information": [{"code": "29914", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP FEMORAL STAND OFF SET SZ 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "425-96-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9888.0, "discounted_cash": 3460.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC", "code_information": [{"code": "521", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18651.69, "maximum": 32020.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18651.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26675.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29343.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32020.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC", "code_information": [{"code": "522", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13318.12, "maximum": 22863.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13318.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19047.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20952.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22863.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIST TYPE DOC ON REPORT", "code_information": [{"code": "G9283", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOCHEMICAL STAINS ADD-ON", "code_information": [{"code": "88314", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 179.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 281.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 281.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 281.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 103.39, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 110.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 97.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 97.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMA ANTIBODY", "code_information": [{"code": "86698", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMA CAPSUL AG IA", "code_information": [{"code": "87385", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMOSIS SKIN TEST", "code_information": [{"code": "86510", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 140.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 220.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 220.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 220.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOTRIPSY MAL HEPATCEL TIS", "code_information": [{"code": "686T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 5161.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV", "code_information": [{"code": "86701", "type": "CPT"}, {"code": "633757", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 167.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 35.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV AG W/HIV1&2 ANTB W/OPTIC", "code_information": [{"code": "87806", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 40.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 83.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 131.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 131.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 131.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 47.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 47.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV COMBINATION ASSAY", "code_information": [{"code": "G0475", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 96.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 34.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV Confirmatory", "code_information": [{"code": "86689", "type": "CPT"}, {"code": "1969169", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 347.0, "discounted_cash": 121.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 128.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV PREP COUNSEL, CLIN STAFF", "code_information": [{"code": "G0013", "type": "HCPCS"}], "standard_charges": [{"minimum": 374.54, "maximum": 588.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 374.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV PREP COUNSEL, MD 15-30M", "code_information": [{"code": "G0011", "type": "HCPCS"}], "standard_charges": [{"minimum": 100.11, "maximum": 157.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 157.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC", "code_information": [{"code": "969", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35597.11, "maximum": 61111.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35597.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50911.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56002.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 61111.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [{"code": "970", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18180.26, "maximum": 31210.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18180.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26001.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28601.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31210.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITH CC", "code_information": [{"code": "975", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7799.01, "maximum": 13388.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7799.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11154.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12269.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13388.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [{"code": "974", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16366.31, "maximum": 28096.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16366.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23407.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25748.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28096.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC", "code_information": [{"code": "976", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5776.42, "maximum": 9916.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5776.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8261.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9087.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9916.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV WITH OR WITHOUT OTHER RELATED CONDITION", "code_information": [{"code": "977", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8055.72, "maximum": 13829.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8055.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11521.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12673.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13829.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV-1 AG IA", "code_information": [{"code": "87390", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 34.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-1 AG W/HIV-1&-2 AB AG IA", "code_information": [{"code": "87389", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 34.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-1 ANTIBODY TESTING OF OR", "code_information": [{"code": "S3645", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-1 DNA DIR PROBE", "code_information": [{"code": "87534", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 87.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 87.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 87.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-1 PROBE&REVERSE TRNSCRPJ", "code_information": [{"code": "87535", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-1 QUANT&REVRSE TRNSCRPJ", "code_information": [{"code": "87536", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 131.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 217.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 341.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 341.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 341.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 122.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 122.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-1/HIV-2 1 RESULT ANTBDY", "code_information": [{"code": "86703", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-2 AG IA", "code_information": [{"code": "87391", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 87.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 87.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 87.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-2 ANTIBODY", "code_information": [{"code": "86702", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-2 DNA DIR PROBE", "code_information": [{"code": "87537", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 87.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 87.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 87.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-2 PROBE&REVRSE TRNSCRIPJ", "code_information": [{"code": "87538", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-2 QUANT&REVRSE TRNSCRIPJ", "code_information": [{"code": "87539", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 73.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 235.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 235.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 235.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 84.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 84.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HL NEO GSAP 5-50 RNA ALYS", "code_information": [{"code": "81451", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1936.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1093.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1093.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HL NEO GSAP 5-50DNA/DNA&RNA", "code_information": [{"code": "81450", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 949.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1936.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1093.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1093.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I HIGH DEFIN QUAL", "code_information": [{"code": "86832", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 404.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 825.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1298.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1298.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1298.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 466.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 466.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I PHENOTYPE QUAL", "code_information": [{"code": "86830", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 124.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 243.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 383.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 383.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 383.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 137.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 137.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I SEMIQUANT PANEL", "code_information": [{"code": "86834", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 551.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 911.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1433.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1433.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1433.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 514.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 514.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I&II ANTIBODY QUAL", "code_information": [{"code": "86828", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 80.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 163.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 257.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 257.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 257.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I/II ANTIBODY QUAL", "code_information": [{"code": "86829", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 80.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 163.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 257.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 257.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 257.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA CLASS II HIGH DEFIN QUAL", "code_information": [{"code": "86833", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 407.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 830.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1306.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1306.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1306.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 469.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 469.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA CLASS II PHENOTYPE QUAL", "code_information": [{"code": "86831", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 106.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 208.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 328.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 328.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 328.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 117.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 117.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA CLASS II SEMIQUANT PANEL", "code_information": [{"code": "86835", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 498.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 823.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1295.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1295.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1295.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 465.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 465.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA I & II TYPE VERIFY LR", "code_information": [{"code": "81371", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 505.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1031.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1622.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1622.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1622.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 582.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 582.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA I & II TYPING HR", "code_information": [{"code": "81378", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 533.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 881.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1385.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1385.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1385.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 497.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 497.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA I & II TYPING LR", "code_information": [{"code": "81370", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 620.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1025.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1612.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1612.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1612.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 579.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 579.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING 1 ALLELE HR", "code_information": [{"code": "81381", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 212.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 433.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 681.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 681.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 681.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 244.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 244.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING 1 ANTIGEN LR", "code_information": [{"code": "81374", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 112.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 189.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 298.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 298.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 298.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 107.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 107.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING 1 LOCUS HR", "code_information": [{"code": "81380", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 273.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 451.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 710.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 710.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 710.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 255.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 255.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING 1 LOCUS LR", "code_information": [{"code": "81373", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 171.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 324.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 510.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 510.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 510.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 183.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 183.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING COMPLETE HR", "code_information": [{"code": "81379", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 517.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 855.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1344.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1344.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1344.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 482.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 482.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING COMPLETE LR", "code_information": [{"code": "81372", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 504.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1029.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1618.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1618.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1618.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 581.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 581.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA II TYPE 1 AG EQUIV LR", "code_information": [{"code": "81377", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 141.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 241.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 379.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 379.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 379.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 136.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 136.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA II TYPING 1 ALLELE HR", "code_information": [{"code": "81383", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 168.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 157.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 157.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA II TYPING 1 LOC HR", "code_information": [{"code": "81382", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 190.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 315.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 495.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 495.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 495.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 178.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 178.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA II TYPING 1 LOCUS LR", "code_information": [{"code": "81376", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 188.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 311.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA II TYPING AG EQUIV LR", "code_information": [{"code": "81375", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 340.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 562.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 885.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 885.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 885.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 317.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 317.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA TYPING A B OR C", "code_information": [{"code": "86812", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 37.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 37.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA TYPING A B OR C", "code_information": [{"code": "86813", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 89.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 232.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 232.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 232.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 83.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 83.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA TYPING DR/DQ", "code_information": [{"code": "86816", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 42.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 120.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 120.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 120.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 43.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 43.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA TYPING DR/DQ", "code_information": [{"code": "86817", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 132.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 270.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 425.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 425.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 425.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 152.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 152.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA X-MATCH NONCYTOTOXC ADDL", "code_information": [{"code": "86826", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 146.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 146.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 146.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 52.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 52.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA X-MATH NON-CYTOTOXIC", "code_information": [{"code": "86825", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 136.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 279.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 439.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 439.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 439.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 157.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 157.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH BHV ASSMT/REASSESSMENT", "code_information": [{"code": "96156", "type": "CPT"}], "standard_charges": [{"minimum": 346.36, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 346.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ FAM 1ST 30", "code_information": [{"code": "96167", "type": "CPT"}], "standard_charges": [{"minimum": 120.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ FAM EA ADDL", "code_information": [{"code": "96168", "type": "CPT"}], "standard_charges": [{"minimum": 103.33, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 103.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ FAM W/O PT EA", "code_information": [{"code": "96171", "type": "CPT"}], "standard_charges": [{"minimum": 127.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 127.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 199.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 199.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 199.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ FAM WO PT 1ST", "code_information": [{"code": "96170", "type": "CPT"}], "standard_charges": [{"minimum": 348.08, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 546.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 546.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 546.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ GRP 1ST 30", "code_information": [{"code": "96164", "type": "CPT"}], "standard_charges": [{"minimum": 120.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ GRP EA ADDL", "code_information": [{"code": "96165", "type": "CPT"}], "standard_charges": [{"minimum": 17.46, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ INDIV 1ST 30", "code_information": [{"code": "96158", "type": "CPT"}], "standard_charges": [{"minimum": 346.36, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 346.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ INDIV EA ADDL", "code_information": [{"code": "96159", "type": "CPT"}], "standard_charges": [{"minimum": 93.76, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH&WB COACHING GROUP", "code_information": [{"code": "593T", "type": "CPT"}], "standard_charges": [{"minimum": 34.97, "maximum": 54.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH&WB COACHING INDIV 1ST", "code_information": [{"code": "591T", "type": "CPT"}], "standard_charges": [{"minimum": 111.26, "maximum": 174.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLTH&WB COACHING INDIV F-UP", "code_information": [{"code": "592T", "type": "CPT"}], "standard_charges": [{"minimum": 225.7, "maximum": 354.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 225.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 354.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 354.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 354.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOLDER KNEE ARTHROSCOPIC POSITIONER FOAM LF DISP", "code_information": [{"code": "GCT31143046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "HOLDER LIMB ARTHROSCOPIC KNEE HOLDER POSITIONER FOAM DEVON LF", "code_information": [{"code": "31143046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HOLDER SCREWDRIVER 1.7/2.3MM", "code_information": [{"code": "62-23170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2170.0, "discounted_cash": 759.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HOLDERS VACUTAINER SINGLE-USE 364815", "code_information": [{"code": "364815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HOMATROPINE HYDROBROMIDE 5% OPHTH SOLUTION 5ML", "code_information": [{"code": "MED0291", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HOME H PHYSIO DATA COLLEC TR", "code_information": [{"code": "G0322", "type": "HCPCS"}], "standard_charges": [{"minimum": 257.46, "maximum": 404.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 257.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 404.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 404.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 404.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "99374", "type": "CPT"}], "standard_charges": [{"minimum": 254.28, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 254.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "99375", "type": "CPT"}], "standard_charges": [{"minimum": 397.34, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 397.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "G0181", "type": "HCPCS"}], "standard_charges": [{"minimum": 483.16, "maximum": 759.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 483.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 759.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 759.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 759.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME NFS VISIT <2 HRS", "code_information": [{"code": "99601", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME NFS VISIT EACH ADDL HR", "code_information": [{"code": "99602", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME SLEEP TEST/TYPE 2 PORTA", "code_information": [{"code": "G0398", "type": "HCPCS"}], "standard_charges": [{"minimum": 352.79, "maximum": 554.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 352.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME SLEEP TEST/TYPE 3 PORTA", "code_information": [{"code": "G0399", "type": "HCPCS"}], "standard_charges": [{"minimum": 352.79, "maximum": 554.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 352.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME SLEEP TEST/TYPE 4 PORTA", "code_information": [{"code": "G0400", "type": "HCPCS"}], "standard_charges": [{"minimum": 352.79, "maximum": 554.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 352.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VENT MGMT SUPERVISION", "code_information": [{"code": "94005", "type": "CPT"}], "standard_charges": [{"minimum": 414.8, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 651.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 651.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 651.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT CATH MAINTAIN", "code_information": [{"code": "99507", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT DAY LIFE ACTIVITY", "code_information": [{"code": "99509", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT FECAL/ENEMA MGMT", "code_information": [{"code": "99511", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT FOR HEMODIALYSIS", "code_information": [{"code": "99512", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT IM INJECTION", "code_information": [{"code": "99506", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT MECH VENTILATOR", "code_information": [{"code": "99504", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT NB CARE", "code_information": [{"code": "99502", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT POSTNATAL", "code_information": [{"code": "99501", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT PRENATAL", "code_information": [{"code": "99500", "type": "CPT"}], "standard_charges": [{"minimum": 370.31, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 370.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 581.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 581.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 581.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT RESP THERAPY", "code_information": [{"code": "99503", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT RN, LPN BY RHC/FQ", "code_information": [{"code": "G0490", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT SING/M/FAM COUNS", "code_information": [{"code": "99510", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT STOMA CARE", "code_information": [{"code": "99505", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST EST HIGH MDM 60", "code_information": [{"code": "99350", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST EST LOW MDM 30", "code_information": [{"code": "99348", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST EST MOD MDM 40", "code_information": [{"code": "99349", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST EST SF MDM 20", "code_information": [{"code": "99347", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST NEW HIGH MDM 75", "code_information": [{"code": "99345", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST NEW LOW MDM 30", "code_information": [{"code": "99342", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST NEW MOD MDM 60", "code_information": [{"code": "99344", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST NEW SF MDM 15", "code_information": [{"code": "99341", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HONOUR CERVICAL LARGE 16MM W X 14MM D X 8MM H 35-1416-080", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "35-1416-080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HONOUR CERVICAL LARGE 16MM W X14MM D X 6MM H 35-1416-060", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "35-1416-060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOD FLYTE SURGICOOL TOGA PEELAWAY XL", "code_information": [{"code": "408-831-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOD PROTECTION PERSONAL PROTECTIVE APPAREL T4 HELMET FOR T4 PERSONAL PROTECTION", "code_information": [{"code": "400800000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOD SURGICAL FLYTE W PEELAWAY 0408-801-500", "code_information": [{"code": "408-801-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.53, "discounted_cash": 36.24, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK 5541342 5.5/6.0 TAH TRNSVRS PROC SM 5541342", "code_information": [{"code": "5541342", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1539.57, "discounted_cash": 538.85, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK ELECTRODE 8.5ININSULATED ARTHROSCOPIC SS", "code_information": [{"code": "E1510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 241.0, "discounted_cash": 84.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK LAP 5MM X 32CM OPEN DISSECTING BLADE TIP SCAPEL CVD HARMONIC ULTRA CISION S", "code_information": [{"code": "HDH05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 576.0, "discounted_cash": 201.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK RETRACTOR 5MM SEMI BLUNT SNGL USE LONE STAR STRL DISP", "code_information": [{"code": "3311-8G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 185.02, "discounted_cash": 64.76, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK STAY ELASTIC 20MM 3335-4G", "code_information": [{"code": "3335-4G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 167.0, "discounted_cash": 58.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK SURG 14MM X 16MM 2 FINGER ELASTIC STAYS BLUNT ENDINSTR", "code_information": [{"code": "3332-4G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 58.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK SURG 5MM BLUNT ELASTIC STAYS", "code_information": [{"code": "3316-8G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.4, "discounted_cash": 66.99, "setting": "both", "billing_class": "facility"}]}, {"description": "HOPD MNTL HLT, GRP", "code_information": [{"code": "C7903", "type": "HCPCS"}], "standard_charges": [{"minimum": 120.57, "maximum": 189.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSE BERKLEY 18 IN CONNECTING BOTTLE TO BOTTLE", "code_information": [{"code": "20714", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.27, "discounted_cash": 3.59, "setting": "both", "billing_class": "facility"}]}, {"description": "HOSE VENT MANUAL W/BAG ARM REUSABLE", "code_information": [{"code": "CFU8004515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HOSP IP/OBS DSCHRG MGMT 30/<", "code_information": [{"code": "99238", "type": "CPT"}], "standard_charges": [{"minimum": 327.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 327.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS DSCHRG MGMT >30", "code_information": [{"code": "99239", "type": "CPT"}], "standard_charges": [{"minimum": 479.98, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 479.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 754.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 754.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 754.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS SAME DATE HI 85", "code_information": [{"code": "99236", "type": "CPT"}], "standard_charges": [{"minimum": 974.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 974.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1530.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1530.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1530.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS SAME DATE MOD 70", "code_information": [{"code": "99235", "type": "CPT"}], "standard_charges": [{"minimum": 758.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 758.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1191.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1191.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1191.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS SM DT SF/LOW 45", "code_information": [{"code": "99234", "type": "CPT"}], "standard_charges": [{"minimum": 596.01, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 596.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 936.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 936.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 936.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP MANAGE CONT DRUG ADMIN", "code_information": [{"code": "1996", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP NEW DX CVA CONSID EVST", "code_information": [{"code": "G9767", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP RECD BY PT DUR MSMT PER", "code_information": [{"code": "G9692", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP RECD BY PT DUR MSMT PER", "code_information": [{"code": "G9723", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP SRV TO PT DUR MSMT PER", "code_information": [{"code": "G9740", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP SRV USED PT IN MSMT PER", "code_information": [{"code": "G9694", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP SRV USED PT IN MSMT PER", "code_information": [{"code": "G9709", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP+PALL CARE SPEC CODE 17", "code_information": [{"code": "M1365", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPC SERV DUR MEAS PD", "code_information": [{"code": "M1159", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPC SERV DUR MEAS PD", "code_information": [{"code": "M1303", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPICE ANYTIME MSMT PER", "code_information": [{"code": "G9687", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPICE ANYTIME MSMT PER", "code_information": [{"code": "G9720", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "99377", "type": "CPT"}], "standard_charges": [{"minimum": 254.28, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 254.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "99378", "type": "CPT"}], "standard_charges": [{"minimum": 397.34, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 397.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "G0182", "type": "HCPCS"}], "standard_charges": [{"minimum": 483.16, "maximum": 759.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 483.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 759.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 759.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 759.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPICE EVALUATION PREELECTI", "code_information": [{"code": "G0337", "type": "HCPCS"}], "standard_charges": [{"minimum": 325.81, "maximum": 511.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 325.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 511.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 511.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 511.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPITAL OUTPT CLINIC VISIT", "code_information": [{"code": "G0463", "type": "HCPCS"}], "standard_charges": [{"minimum": 511.25, "maximum": 803.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPITALISTS SS", "code_information": [{"code": "G4009", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOT OR COLD PACKS THERAPY", "code_information": [{"code": "97010", "type": "CPT"}], "standard_charges": [{"minimum": 28.62, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOT SNARES BRAIDED Extra Large Braided Oval 129-0187 30 7 230 2.8", "code_information": [{"code": "PS51051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES BRAIDED Large Braided Oval 129-0675 24 7 230 2.8", "code_information": [{"code": "PS51041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES BRAIDED Medium Braided Oval 129-0674 20 7 230 2.8", "code_information": [{"code": "PS51031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES BRAIDED Mini Braided Oval 129-0186 10 7 230 2.8", "code_information": [{"code": "PS51011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES BRAIDED Small Braided Oval 129-0673 15 7 230 2.8", "code_information": [{"code": "PS51021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.19, "discounted_cash": 12.32, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES FIRM Extra Large Oval Firm 129-0192 30 7 230 2.8", "code_information": [{"code": "PS51111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES FIRM Jumbo Oval Firm 129-0193 36 7 230 2.8", "code_information": [{"code": "PS51121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES FIRM Large Oval Firm 129-0191 24 7 230 2.8", "code_information": [{"code": "PS51101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES FIRM Medium Oval Firm 129-0190 20 7 230 2.8", "code_information": [{"code": "PS51091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.19, "discounted_cash": 12.32, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES FIRM Mini Oval Firm 129-0188 10 7 230 2.8", "code_information": [{"code": "PS51071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES FIRM Small Oval Firm 129-0189 15 7 230 2.8", "code_information": [{"code": "PS51081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES HEX FIRM Large Hex Firm 129-0195 25 7 230 2.8", "code_information": [{"code": "PS52041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HOT SNARES HEX FIRM Small Hex Firm 129-0194 15 7 230 2.8", "code_information": [{"code": "PS52031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HPA-1 GENOTYPING", "code_information": [{"code": "81105", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 188.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 311.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-15 GENOTYPING", "code_information": [{"code": "81112", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 188.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 311.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-2 GENOTYPING", "code_information": [{"code": "81106", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 188.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 311.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-3 GENOTYPING", "code_information": [{"code": "81107", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 188.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 311.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-4 GENOTYPING", "code_information": [{"code": "81108", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 188.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 311.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-5 GENOTYPING", "code_information": [{"code": "81109", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 188.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 311.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-6 GENOTYPING", "code_information": [{"code": "81110", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 188.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 311.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-9 GENOTYPING", "code_information": [{"code": "81111", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 188.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 311.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 175.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV 5+ HI RISK HPV TYPES", "code_information": [{"code": "500T", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPV COMBO ASSAY CA SCREEN", "code_information": [{"code": "G0476", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 140.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV HI RISK TYPES MALE URINE", "code_information": [{"code": "96U", "type": "CPT"}], "standard_charges": [{"minimum": 50.53, "maximum": 140.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV HI RSK QUAL MRNA E6/E7", "code_information": [{"code": "354U", "type": "CPT"}], "standard_charges": [{"minimum": 50.53, "maximum": 50.53, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV LOW-RISK TYPES", "code_information": [{"code": "87623", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV OROP SWAB 14 HI-RISK TYP", "code_information": [{"code": "429U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 140.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV TYPES 16 & 18 ONLY", "code_information": [{"code": "87625", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 103.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 162.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 162.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 162.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 58.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 58.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPYLORI DETCJ ABX RSTNC DNA", "code_information": [{"code": "8U", "type": "CPT"}], "standard_charges": [{"minimum": 860.99, "maximum": 2397.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 860.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 860.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPYLORI STOOL AG IA", "code_information": [{"code": "87338", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HRDTRY BRST CA-RLATD DSORDRS", "code_information": [{"code": "81432", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1047.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1731.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2722.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2722.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2722.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 977.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 977.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HRDTRY BRST CA-RLATD DSORDRS", "code_information": [{"code": "81433", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 677.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 632.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 632.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HRDTRY CARDMYPY GENE PANEL", "code_information": [{"code": "81439", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 902.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1491.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HRDTRY PERPH NEURPHY PANEL", "code_information": [{"code": "81448", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 902.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1491.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2345.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HRIS FLEXIBLE OSTEO .12X120MM 6210-0-710", "code_information": [{"code": "6210-0-710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 579.0, "discounted_cash": 202.65, "setting": "both", "billing_class": "facility"}]}, {"description": "HRIS FLEXIBLE OSTEO 6X67MM 6210-0-720", "code_information": [{"code": "6210-0-720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 579.0, "discounted_cash": 202.65, "setting": "both", "billing_class": "facility"}]}, {"description": "HSPC DUR MEAS PD", "code_information": [{"code": "M1167", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HSPC PT PRV TIME MEAM PER", "code_information": [{"code": "M1067", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HSPC SVC ANY TIME IN MEAS PD", "code_information": [{"code": "M1191", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HSV DNA AMP PROBE", "code_information": [{"code": "87529", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HSV DNA DIR PROBE", "code_information": [{"code": "87528", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HSV DNA QUANT", "code_information": [{"code": "87530", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HT MUSC IMAGE PLANAR MULT", "code_information": [{"code": "78454", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1680.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2641.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2641.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2641.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 790.21, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 840.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HT MUSCLE IMAGE PLANAR SING", "code_information": [{"code": "78453", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1160.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1824.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1824.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1824.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 525.74, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 559.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HT MUSCLE IMAGE SPECT MULT", "code_information": [{"code": "78452", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1789.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2812.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2812.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2812.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 836.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 890.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HT MUSCLE IMAGE SPECT SING", "code_information": [{"code": "78451", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1237.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1946.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1946.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1946.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 586.02, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 623.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTLV-I ANTIBODY", "code_information": [{"code": "86687", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 36.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 36.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTLV-II ANTIBODY", "code_information": [{"code": "86688", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTR2A HTR2C GENES", "code_information": [{"code": "33U", "type": "CPT"}], "standard_charges": [{"minimum": 503.45, "maximum": 1401.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 891.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1401.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1401.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1401.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 503.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 503.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTT GENE CHARAC ALLELES", "code_information": [{"code": "81274", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTT GENE DETC ABNOR ALLELES", "code_information": [{"code": "81271", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMAN EPIDIDYMIS PROTEIN 4", "code_information": [{"code": "86305", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMAN IG IM", "code_information": [{"code": "90281", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMAN IG IV", "code_information": [{"code": "90283", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMAN IG SC", "code_information": [{"code": "90284", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL 4 X 100MM LEFT PLASMA COATED DISC 540-34-100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "540-34-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7143.0, "discounted_cash": 2500.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 50MM 19MM THICK SIMPLICITI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7122874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 54MMX20MM NEUTRAL 520-54-220", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-54-220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL HEAD ALTIVATE 42 X 16 ANATOMIC OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-42-316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL HEAD ALTIVATE 46 X 16 ANATOMIC NEUTRAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-46-216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL HEAD ASCEND FLEX 39MM X 14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF139", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10084.0, "discounted_cash": 3529.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL HEAD COCR 52MM 19MM SIMPLICITI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7122875", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL HEAD NEUTRAL 42MM X 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-42-216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2491.0, "discounted_cash": 871.85, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL HEAD NEUTRAL 50MM X 20MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-50-220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL HEAD OFFSET 50MM X 20MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-50-320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL HEAD SZ 43 X 13MM SIMPLICITI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7122870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL HEAD SZ 46 SIMPLICITI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7122871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL INSERT RSP MONOBLOCK SEMICONSTRAINED SOCKET HXE+ 32MM 509-01-032", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "509-01-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1580.0, "discounted_cash": 553.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL INSERT RSP MONOBLOCK STANDARD SOCKET +4MM HXE+ 32MM 509-00-432", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "509-00-432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1580.0, "discounted_cash": 553.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL INSERT RSP MONOBLOCK STANDARD SOCKET HXE+ 36MM 509-00-036", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "509-00-036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1578.0, "discounted_cash": 552.3, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL NAIL 9 X 200MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.001.420S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4653.0, "discounted_cash": 1628.55, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL NECK NEUTRAL ALTIVATE ANATOMIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-07-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL STEM 1C ASCEND FLEX STANDARD PTC DWF601C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF601C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7228.0, "discounted_cash": 2529.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL STEM 4A ASCEND FLEX STANDARD PTC DWF604A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF604A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8034.0, "discounted_cash": 2811.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL STEM FRACTURE 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "12-113560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8034.0, "discounted_cash": 2811.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL STEM PERFORM SZ 3 EXTRA LONG DWX3SX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX3SX", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16383.0, "discounted_cash": 5734.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL STEM PERFORM SZ 3 PLUS - LONG DWX3PL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX3PL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10800.0, "discounted_cash": 3780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL STEM REVERSE SIZE 12MMX108MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "530-12-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11973.0, "discounted_cash": 4190.55, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL STEM RSP MONOBLOCK PRIMARY 8 X 101MM 510-00-008", "code_information": [{"code": "510-00-008", "type": "CDM"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL STEM SMALL SHELL 12 X 108MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "533-12-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL STEM STD. SHELL 14MM X 48MM SHORT 530-14-048", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "530-14-048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13168.0, "discounted_cash": 4608.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL STEM TURON PRIMARY 8 X 115MM 520-01-008", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-01-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4839.0, "discounted_cash": 1693.65, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL SYSTEM PERFORM HUMERAL STEM TI6A14V + TI SIZE 4 STD SHORT DWX4SS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX4SS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMIDIFIER HEAT MOISTURE 10 ML DEAD SPACE 30.5 VT0.2L WITHOUT PORT HUMID-VENT", "code_information": [{"code": "11112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HURRICANE SPRAY 20% UD 0.5 ML", "code_information": [{"code": "MED0563", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HX DX FAM/PURE HYPERCHOLES", "code_information": [{"code": "G9782", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYBRID IMPLANT 14X36X14 DEGREES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX143614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 3850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROCORTISONE 100MG/2ML VIAL", "code_information": [{"code": "MED0532", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROCORTISONE PF 250MG PWD-INJ", "code_information": [{"code": "MED0097", "type": "CDM"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDRODISSECTOR .5 X 22MM", "code_information": [{"code": "585037", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROGEN PEROXIDE 4OZ BOTTLE", "code_information": [{"code": "MDS098014", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROGEN PEROXIDE TOPICAL SOLUTION 3% 120ML", "code_information": [{"code": "MED0098", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDRUS MICROSTENT DELIVERY SYSTEM", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "F00022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3074.0, "discounted_cash": 1075.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HYLENEX 150U/ML 1ML", "code_information": [{"code": "MED0569", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 167.0, "discounted_cash": 58.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HYMENOTOMY", "code_information": [{"code": "56442", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOID MYOTOMY AND SUSPENSION 21685", "code_information": [{"code": "21685", "type": "CPT"}, {"code": "42893973", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 12671.0, "discounted_cash": 4434.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 6132.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERBARIC OXYGEN THERAPY", "code_information": [{"code": "99183", "type": "CPT"}], "standard_charges": [{"minimum": 507.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 507.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 797.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 797.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 797.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERINFLATION SYSTEM MAPLESON C NON-REBREATHING CIRCUIT Mapleson C Non-Rebreathing Circuits", "code_information": [{"code": "DYNJAAHY005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HYPERTENSION WITH MCC", "code_information": [{"code": "304", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6673.05, "maximum": 11455.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6673.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9543.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10498.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11455.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITHOUT MCC", "code_information": [{"code": "305", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4500.81, "maximum": 7726.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4500.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6437.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7080.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7726.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITH CC", "code_information": [{"code": "78", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5778.24, "maximum": 9919.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5778.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8264.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9090.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9919.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [{"code": "77", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9324.63, "maximum": 16008.07, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9324.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13336.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14669.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16008.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC", "code_information": [{"code": "79", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4433.29, "maximum": 7610.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4433.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6340.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6974.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7610.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77600", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 384.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1691.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2659.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2659.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2659.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1139.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1212.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77605", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1249.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3012.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4736.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4736.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4736.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 2027.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 2154.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77610", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 914.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2781.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4372.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4372.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4372.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1457.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1549.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77615", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 914.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4308.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6774.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6774.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6774.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 2328.02, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 2476.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77620", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 914.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1922.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3023.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3023.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3023.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1320.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1404.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPNOTHERAPY", "code_information": [{"code": "90880", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPOTHERMIA ILL NEONATE", "code_information": [{"code": "99184", "type": "CPT"}], "standard_charges": [{"minimum": 1006.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1006.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1580.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1580.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1580.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPOXIA RESPONSE CURVE", "code_information": [{"code": "94450", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPRPHENYLALNINMIA MNTR QUAN", "code_information": [{"code": "382U", "type": "CPT"}], "standard_charges": [{"minimum": 278.03, "maximum": 437.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/BLADDER REPAIR", "code_information": [{"code": "51925", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/REVISE VAGINA", "code_information": [{"code": "58280", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSALPINGOGRAPHY", "code_information": [{"code": "58340", "type": "CPT"}, {"code": "1481024", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPE 5.7MM AVETA PEARL DISPOSABLE 214-059", "code_information": [{"code": "214-059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "HYSTEROSCOPE 5.7MM AVETA PEARL DISPOSABLE 214-228", "code_information": [{"code": "214-228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 564.9, "discounted_cash": 197.72, "setting": "both", "billing_class": "facility"}]}, {"description": "HYSTEROSCOPE AVETA CORAL 214-251", "code_information": [{"code": "214-251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 564.9, "discounted_cash": 197.72, "setting": "both", "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY 58555", "code_information": [{"code": "58555", "type": "CPT"}, {"code": "1481025", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY W/BIL.FALLOPIAN TUBE CANNULATION 58565", "code_information": [{"code": "58565", "type": "CPT"}, {"code": "1587127", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY W/REMOVAL OF IMPACTED FOREIGN BODY 58562", "code_information": [{"code": "58562", "type": "CPT"}, {"code": "1587162", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY WITH BIOPSY 58558", "code_information": [{"code": "58558", "type": "CPT"}, {"code": "1481026", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY WITH ENDOMETRIAL ABLATION 58563", "code_information": [{"code": "58563", "type": "CPT"}, {"code": "1481027", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY WITH LYSIS OF ADHESIONS 58559", "code_information": [{"code": "58559", "type": "CPT"}, {"code": "1481028", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY WITH REMOVAL OF LEIOMYOMATA 58561", "code_information": [{"code": "58561", "type": "CPT"}, {"code": "1481029", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY WITH RESECTION OF INTRAUTERINE SEPTUM 58560", "code_information": [{"code": "58560", "type": "CPT"}, {"code": "1481030", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HZV VACC RECOMBINANT IM", "code_information": [{"code": "90750", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HZV VACCINE LIVE SUBQ", "code_information": [{"code": "90736", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hair, Skin, Nail Fungal Culture", "code_information": [{"code": "87101", "type": "CPT"}, {"code": "1888188", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 124.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Harvest of skin for skin cell suspension autograft; each additional 25 sq cm or part thereof (List separately in addition to code for primary procedure)", "code_information": [{"code": "15012", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Harvest of skin for skin cell suspension autograft; first 25 sq cm or less", "code_information": [{"code": "15011", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hearing Test Using Earphones, (Sisi) Sensitivity Index", "code_information": [{"code": "92564", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Helicobacter Pylori Antibody", "code_information": [{"code": "86677", "type": "CPT"}, {"code": "633740", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hematocrit", "code_information": [{"code": "85014", "type": "CPT"}, {"code": "633742", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 205.0, "discounted_cash": 71.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hematology (venous thromboembolism [VTE]), genome-wide single-nucleotide polymorphism variants, including F2 and F5 gene analysis, and Leiden variant, by microarray analysis, saliva, report as risk score for VTE", "code_information": [{"code": "529U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hemoglobin", "code_information": [{"code": "85018", "type": "CPT"}, {"code": "633741", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 218.0, "discounted_cash": 76.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 80.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hemoglobin A1c", "code_information": [{"code": "83036", "type": "CPT"}, {"code": "633743", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 30.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hepatic Function Panel", "code_information": [{"code": "80076", "type": "CPT"}, {"code": "633744", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 50.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hepatitis A Antibody IgG + IgM", "code_information": [{"code": "86708", "type": "CPT"}, {"code": "633745", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 32.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hepatitis B Core Antibody IgG + IgM", "code_information": [{"code": "86705", "type": "CPT"}, {"code": "633748", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 32.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hepatitis B Surface Antibody", "code_information": [{"code": "86706", "type": "CPT"}, {"code": "633751", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 32.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hepatitis B Surface Antigen", "code_information": [{"code": "87340", "type": "CPT"}, {"code": "633752", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 32.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 41.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 41.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hepatitis C Antibody IgM + IgG", "code_information": [{"code": "86803", "type": "CPT"}, {"code": "633755", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 349.0, "discounted_cash": 122.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 129.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.54, "methodology": "fee schedule"}], "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": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hereditary pan-cancer (eg, hereditary sarcomas, hereditary endocrine tumors, hereditary neuroendocrine tumors, hereditary cutaneous melanoma), genomic sequence analysis panel of 88 genes with 20 duplications/deletions using next-generation sequencing (NGS", "code_information": [{"code": "474U", "type": "CPT"}], "standard_charges": [{"minimum": 9876.15, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hereditary prostate cancer-related disorders, genomic sequence analysis panel using next-generation sequencing (NGS), Sanger sequencing, multiplex ligation-dependent probe amplification (MLPA), and array comparative genomic hybridization (CGH), evaluation", "code_information": [{"code": "475U", "type": "CPT"}], "standard_charges": [{"minimum": 2850.85, "maximum": 4483.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2850.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4483.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Herpes simplex virus (HSV) types 1 and 2 and Varicella zoster virus (VZV), amplified probe technique, each pathogen reported as detected or not detected", "code_information": [{"code": "527U", "type": "CPT"}], "standard_charges": [{"minimum": 30.55, "maximum": 48.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "High-resolution gastric electrophysiology mapping with simultaneous patient-symptom profiling, with interpretation and report", "code_information": [{"code": "868T", "type": "CPT"}], "standard_charges": [{"minimum": 2231.67, "maximum": 3508.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3508.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3508.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3508.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Historical trauma (HT) mental health and clinical care for indigenous persons", "code_information": [{"code": "H0053", "type": "HCPCS"}], "standard_charges": [{"minimum": 481.22, "maximum": 756.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 481.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 756.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 756.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 756.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including imaging guidance", "code_information": [{"code": "888T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 5161.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Homocystine Total", "code_information": [{"code": "83090", "type": "CPT"}, {"code": "633758", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 312.0, "discounted_cash": 109.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 115.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 71.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 71.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hospital Observation Care On Day Of Discharge", "code_information": [{"code": "99217", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hospital observation service, per hour G0378", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "16017297", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 561.04, "maximum": 881.63, "gross_charge": 156.0, "discounted_cash": 54.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 561.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 881.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 881.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 881.63, "methodology": "fee 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": 89.48, "maximum": 140.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I & D VAG HEMATOMA NON-OB", "code_information": [{"code": "57023", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I & D VAGINAL HEMATOMA PP", "code_information": [{"code": "57022", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I &D ISCHIORECTAL/INTRAMURAL ABSCESS W/FISTULECTOMY OR FISTULOTOMY SM W/ OR W/O PLACE. SETON 46060", "code_information": [{"code": "46060", "type": "CPT"}, {"code": "5109147", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS P-SPINE L/S/LS", "code_information": [{"code": "22015", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IA INFECTIOUS AGENT ANTIBODY", "code_information": [{"code": "86318", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IA NFCT AB SARSCOV2 COVID19", "code_information": [{"code": "86328", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 115.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 181.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 181.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 65.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 65.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IAAD BLK AC WV BSNSR SARSCV2", "code_information": [{"code": "408U", "type": "CPT"}], "standard_charges": [{"minimum": 115.34, "maximum": 181.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 115.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 181.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 181.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADI 16S&18S RRNA GENES", "code_information": [{"code": "112U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 512.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 512.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 512.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA BARTONELLA DDPCR", "code_information": [{"code": "301U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 378.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 378.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 378.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA BRTNLA DDPCR FLWG LIQ", "code_information": [{"code": "302U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 520.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 520.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 520.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA CHLMYD&GONORR AMP PRB", "code_information": [{"code": "353U", "type": "CPT"}], "standard_charges": [{"minimum": 101.06, "maximum": 101.06, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 101.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 101.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA CNS PTHGN NEXT GEN SEQ", "code_information": [{"code": "323U", "type": "CPT"}], "standard_charges": [{"minimum": 1062.79, "maximum": 3061.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1062.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3061.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3061.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GI PTHGN 31 ORG&21 ARG", "code_information": [{"code": "369U", "type": "CPT"}], "standard_charges": [{"minimum": 600.17, "maximum": 600.17, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN 20BCT&FNG ORG", "code_information": [{"code": "321U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 914.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 914.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 914.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN 21 ORG&21ARG", "code_information": [{"code": "374U", "type": "CPT"}], "standard_charges": [{"minimum": 600.17, "maximum": 600.17, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN SEMIQ DNA16&1", "code_information": [{"code": "371U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 600.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA RSP TR NFCT 17 8 13&16", "code_information": [{"code": "373U", "type": "CPT"}], "standard_charges": [{"minimum": 600.17, "maximum": 600.17, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA SURG WND PTHGN 34&21", "code_information": [{"code": "370U", "type": "CPT"}], "standard_charges": [{"minimum": 600.17, "maximum": 600.17, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA VAG PTHGN PANEL 27 ORG", "code_information": [{"code": "330U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 600.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA-DNA/RNA PROBE TQ 12-25", "code_information": [{"code": "87507", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 643.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1062.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA-DNA/RNA PROBE TQ 6-11", "code_information": [{"code": "87506", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 329.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 670.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 378.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 378.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBMFS SEQ ALYS PNL 30 GENES", "code_information": [{"code": "81441", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 9818.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6243.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3525.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3525.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IC INF PBW 2501-5000 G SUBSQ", "code_information": [{"code": "99480", "type": "CPT"}], "standard_charges": [{"minimum": 535.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 535.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 841.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 841.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 841.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 559.45, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 559.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 879.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 879.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 879.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 615.06, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 615.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 966.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 966.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 966.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ICAR CATH ABLTJ DSCRT ARRHYT", "code_information": [{"code": "93655", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1970.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3096.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3096.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3096.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICE BAG SMALL W/ TIES 5X12", "code_information": [{"code": "11400-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ICG ANGIOGRAPHY I&R UNI/BI", "code_information": [{"code": "92240", "type": "CPT"}], "standard_charges": [{"minimum": 712.04, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 712.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1118.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1118.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1118.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST DRUG/BUG", "code_information": [{"code": "95024", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST-DELAYED", "code_information": [{"code": "95028", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TITRATE-AIRBORN", "code_information": [{"code": "95027", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ID ASPERGILLUS DNA 4 SPECIES", "code_information": [{"code": "109U", "type": "CPT"}], "standard_charges": [{"minimum": 205.39, "maximum": 571.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 363.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ID CA IMMNTX EACH ADDL NJX", "code_information": [{"code": "709T", "type": "CPT"}], "standard_charges": [{"minimum": 266.67, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ID CA IMMNTX PREP & 1ST NJX", "code_information": [{"code": "708T", "type": "CPT"}], "standard_charges": [{"minimum": 266.67, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDENTIFY SPERM TISSUE", "code_information": [{"code": "89264", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDET 1 OR MORE LEVELS", "code_information": [{"code": "22527", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDET SINGLE LEVEL", "code_information": [{"code": "22526", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDH1 (isocitrate dehydrogenase 1 [NADP+]), IDH2 (isocitrate dehydrogenase 2 [NADP+]), and TERT (telomerase reverse transcriptase) promoter (eg, central nervous system [CNS] tumors), next-generation sequencing (single-nucleotide variants [SNV], deletions, ", "code_information": [{"code": "481U", "type": "CPT"}], "standard_charges": [{"minimum": 492.79, "maximum": 774.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 492.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDH1 COMMON VARIANTS", "code_information": [{"code": "81120", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 241.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 492.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDH2 COMMON VARIANTS", "code_information": [{"code": "81121", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 369.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 754.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1186.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1186.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1186.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 425.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 425.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDX EVT DTE PHQ>9 DOC 12 MO", "code_information": [{"code": "G9511", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFNL3 GENE", "code_information": [{"code": "81283", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 94.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 187.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 294.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 294.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 294.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 105.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 105.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFUSE - TORQ 11.5MM X 55 MM 11555T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11555T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6400.0, "discounted_cash": 2240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IFUSE 3D IMPLANT 7.0 MM X 40 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7040M-90", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6440.0, "discounted_cash": 2254.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IFUSE 3D IMPLANT 7.0 MM X 55 MM", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "7055M-90", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6440.0, "discounted_cash": 2254.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IFUSE 3D IMPLANT 7.0 MM X 60 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7060M-90", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6440.0, "discounted_cash": 2254.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IFUSE TORQ 11.5MM X 50MM 11550T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11550T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6644.0, "discounted_cash": 2325.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IFUSE TORQ IMPLANT 11.5MM X 45MM 11545T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11545T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6604.0, "discounted_cash": 2311.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IG LIGHT CHAINS FREE EACH", "code_information": [{"code": "83521", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IG PARAPROTEIN QUAL BLD/UR", "code_information": [{"code": "77U", "type": "CPT"}], "standard_charges": [{"minimum": 62.54, "maximum": 117.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 62.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 62.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGG 1 2 3 OR 4 EACH", "code_information": [{"code": "82787", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH GENE REARRANG DIR PROBE", "code_information": [{"code": "81262", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 85.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 174.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 274.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 274.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 274.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 98.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 98.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH GENE REARRANGE AMP METH", "code_information": [{"code": "81261", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 305.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 504.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 793.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 793.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 793.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 285.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 285.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH VARI REGIONAL MUTATION", "code_information": [{"code": "81263", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 751.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1181.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1181.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1181.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 424.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 424.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH@/BCL2 TRANSLOCATION ALYS", "code_information": [{"code": "81278", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 528.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGK REARRANGEABN CLONAL POP", "code_information": [{"code": "81264", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 230.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 440.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 692.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 692.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 692.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 248.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 248.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV ADJUVANT VACCINE IM", "code_information": [{"code": "90653", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV NO PRSV INCREASED AG IM", "code_information": [{"code": "90662", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV VACC PANDEMIC ADJUVT IM", "code_information": [{"code": "90667", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV VACCINE PANDEMIC IM", "code_information": [{"code": "90668", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90655", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACC NO PRSV 0.5 ML IM", "code_information": [{"code": "90656", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90657", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACCINE SPLT 0.5 ML IM", "code_information": [{"code": "90658", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90685", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACC NO PRSV 0.5 ML IM", "code_information": [{"code": "90686", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90687", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.5 ML IM", "code_information": [{"code": "90688", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IJS-E BASE PLATE ASSEMBLY IJS-ELB-BPA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IJS-ELB-BPA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12335.0, "discounted_cash": 4317.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IKBKAP GENE", "code_information": [{"code": "81260", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 49.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 157.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 157.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 56.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILEOSCOPY THROUGH STOMA; INCL. COLLECTION OF SPECIMENS 44380", "code_information": [{"code": "44380", "type": "CPT"}, {"code": "1481031", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILEOSTOMY/JEJUNOSTOMY", "code_information": [{"code": "44310", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC ART ANGIO,CARDIAC CATH", "code_information": [{"code": "G0278", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC BONE GRAFT MICROVASC", "code_information": [{"code": "20956", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC", "code_information": [{"code": "37220", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC ADD-ON", "code_information": [{"code": "37222", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT", "code_information": [{"code": "37221", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT ADD-ON", "code_information": [{"code": "37223", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILLUMINATOR BIFURCATED ACCESS", "code_information": [{"code": "AC01-90046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 882.32, "discounted_cash": 308.81, "setting": "both", "billing_class": "facility"}]}, {"description": "ILLUMINATOR OPTHALMIC 25GA CHANDELIER 8065751577", "code_information": [{"code": "8065751577", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IM ADMIN 1ST/ONLY COMPONENT", "code_information": [{"code": "90460", "type": "CPT"}], "standard_charges": [{"minimum": 63.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM ADMIN EACH ADDL COMPONENT", "code_information": [{"code": "90461", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER CMPL", "code_information": [{"code": "263T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER HRVST ONL", "code_information": [{"code": "265T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER XCL HRVST", "code_information": [{"code": "264T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAG NO LES", "code_information": [{"code": "G9551", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAG REC", "code_information": [{"code": "G9550", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID COLXN VISC", "code_information": [{"code": "49405", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID PERI/RETRO", "code_information": [{"code": "49406", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID TRNS/VGNL", "code_information": [{"code": "49407", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE NOT STD NOMENCLATURE", "code_information": [{"code": "G9319", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE STD NOMENCLATURE", "code_information": [{"code": "G9318", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAPLNT CLAMP PIN TO ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4940-1-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 713.0, "discounted_cash": 249.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMBIBE 2090-9028", "code_information": [{"code": "2090-9028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1081.0, "discounted_cash": 378.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG GID FLU COLL DRG SFT TIS", "code_information": [{"code": "10030", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG HD ABNML NEURO EXAM", "code_information": [{"code": "G2189", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG HD CLIN TRIAL", "code_information": [{"code": "G9537", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG HEAD (CT OR MRI) OBTND", "code_information": [{"code": "M1027", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS PHY/QHP", "code_information": [{"code": "92228", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS POC ALY", "code_information": [{"code": "92229", "type": "CPT"}], "standard_charges": [{"minimum": 243.23, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 243.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 382.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 382.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 382.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETCJ/MNTR DS STAFF", "code_information": [{"code": "92227", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMM CKPT INHIB NOT HLD NO RX", "code_information": [{"code": "M1185", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMEDIATE INSERTION BREAST PROSTHESIS FOLLOWING MASTOPEXY-MASTECTOMY-OR IN RECON. 19340", "code_information": [{"code": "19340", "type": "CPT"}, {"code": "1482006", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX 1 STING INSECT", "code_information": [{"code": "95130", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX 2 STING INSECTS", "code_information": [{"code": "95131", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX 3 STING INSECTS", "code_information": [{"code": "95132", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX 4 STING INSECTS", "code_information": [{"code": "95133", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX 5 STING INSECTS", "code_information": [{"code": "95134", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX ADMN ELECTROPORATN IM", "code_information": [{"code": "732T", "type": "CPT"}], "standard_charges": [{"minimum": 266.67, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMOBILIZER UNIVERSAL HEAD UHI 100", "code_information": [{"code": "UHI 100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMMUNE ADMIN ORAL/NASAL", "code_information": [{"code": "90473", "type": "CPT"}], "standard_charges": [{"minimum": 266.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNE ADMIN ORAL/NASAL ADDL", "code_information": [{"code": "90474", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNE COMPLEX ASSAY", "code_information": [{"code": "86332", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 97.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 97.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 97.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNFIX E-PHORSIS/URINE/CSF", "code_information": [{"code": "86335", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZATION ADMIN EACH ADD", "code_information": [{"code": "90472", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZATION COUNSELING", "code_information": [{"code": "D1301", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZE COUNS < 21YR 5-15 M", "code_information": [{"code": "G0312", "type": "HCPCS"}], "standard_charges": [{"minimum": 111.26, "maximum": 174.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZE COUNS < 21YR 6-30 M", "code_information": [{"code": "G0313", "type": "HCPCS"}], "standard_charges": [{"minimum": 111.26, "maximum": 174.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZE COUNSEL 16-30 MINS", "code_information": [{"code": "G0311", "type": "HCPCS"}], "standard_charges": [{"minimum": 111.26, "maximum": 174.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZE COUNSEL 5-15 MIN", "code_information": [{"code": "G0310", "type": "HCPCS"}], "standard_charges": [{"minimum": 111.26, "maximum": 174.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY DIPSTICK", "code_information": [{"code": "83518", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY INFECTIOUS AGENT", "code_information": [{"code": "86317", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY NONANTIBODY", "code_information": [{"code": "83516", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY QUANT NOS NONAB", "code_information": [{"code": "83520", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY TUMOR CA 15-3", "code_information": [{"code": "86300", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY TUMOR CA 19-9", "code_information": [{"code": "86301", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY TUMOR OTHER", "code_information": [{"code": "86316", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY TUMOR QUAL", "code_information": [{"code": "86294", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNODIFFUSION NES", "code_information": [{"code": "86329", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNODIFFUSION OUCHTERLONY", "code_information": [{"code": "86331", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOELECTROPHORESIS ASSAY", "code_information": [{"code": "86327", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 43.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 43.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOFIX E-PHORESIS SERUM", "code_information": [{"code": "86334", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 32.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOGLOBULIN ASSAY", "code_information": [{"code": "86023", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOHISTOCHEMICAL STAINS", "code_information": [{"code": "D0478", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOLOGY PROCEDURE", "code_information": [{"code": "86849", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY 2/> INJECTIONS", "code_information": [{"code": "95125", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY INJECTIONS", "code_information": [{"code": "95117", "type": "CPT"}], "standard_charges": [{"minimum": 168.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY ONE INJECTION", "code_information": [{"code": "95115", "type": "CPT"}], "standard_charges": [{"minimum": 168.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY ONE INJECTION", "code_information": [{"code": "95120", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMP BONE TWO STEP 3.4 X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204-30-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3698.0, "discounted_cash": 1294.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMP BONE TWO STEP 3.4 X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204-30-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3080.0, "discounted_cash": 1078.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMP BONE TWO STEP 3.4 X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204-30-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.0, "discounted_cash": 1438.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMP BONE TWO STEP 3.4 X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204-30-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMP FUZE HAMMER TOE 2.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TH25-20T-1100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3286.0, "discounted_cash": 1150.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPALNT SIZE 5 TIBIAL BERING INSERT TRIATHLON CR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-509-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL ABSRB MSH/PRSTH DLY CLS", "code_information": [{"code": "15778", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL BONE 3.2 X 3.5MM HAMMERTOE MIDDLE FINGER PROXIMAL SML JOINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NX-3532MP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1352.0, "discounted_cash": 473.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL FEMUR RIGHT SZ4 PRESSFIT PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5516-F-402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3936.0, "discounted_cash": 1377.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL HAMMER FUZE 2.2MM X 18MM 0 DEG ANGL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TH22-18T-0900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4316.0, "discounted_cash": 1510.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP<100", "code_information": [{"code": "69716", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69729", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SKULL PERQ ESP", "code_information": [{"code": "69714", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL/REDO ELECTRD ANTRUM", "code_information": [{"code": "43881", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT 04MM LENGTH 38MM NEXIS PS050038", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS050038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3483.0, "discounted_cash": 1219.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 04MM LENGTH 42MM NEXIS PS050040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS050040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3382.0, "discounted_cash": 1183.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 04MM LENGTH 42MM NEXIS PS050042", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS050042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1811.0, "discounted_cash": 633.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 04MM LENGTH 48MM NEXIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS050048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3483.0, "discounted_cash": 1219.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 04MM LENGTH 54MM NEXIS PS050054 PS050054", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS050054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3382.0, "discounted_cash": 1183.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 08MM IDS SUPERION DECOMPRESSION 101", "code_information": [{"code": "C1821", "type": "HCPCS"}, {"code": "101-9808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4893.0, "discounted_cash": 1712.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 10MM IDS SUPERION DECOMPRESSION", "code_information": [{"code": "C1821", "type": "HCPCS"}, {"code": "100-9810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19570.0, "discounted_cash": 6849.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 10MM IDS SUPERION DECOMPRESSION 101", "code_information": [{"code": "C1821", "type": "HCPCS"}, {"code": "101-9810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9785.0, "discounted_cash": 3424.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 11MM TI GREEN TOV TOV4-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TOV4-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2396.0, "discounted_cash": 838.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 11X10X10MM SPEED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "SE-1110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2346.0, "discounted_cash": 821.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 12MM BONE DOWEL REVISION KIT ABS-2850-12", "code_information": [{"code": "ABS-2850-12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1358.0, "discounted_cash": 475.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 12MM EASY CLIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EZM12-10-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2131.0, "discounted_cash": 745.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 12MM IDS SUPERION DECOMPRESSION", "code_information": [{"code": "C1821", "type": "HCPCS"}, {"code": "100-9812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19570.0, "discounted_cash": 6849.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 12MM IDS SUPERION DECOMPRESSION 101", "code_information": [{"code": "C1821", "type": "HCPCS"}, {"code": "101-9812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9785.0, "discounted_cash": 3424.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 14MM IDS SUPERION DECOMPRESSION", "code_information": [{"code": "C1821", "type": "HCPCS"}, {"code": "100-9814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4893.0, "discounted_cash": 1712.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 14MM IDS SUPERION DECOMPRESSION 101", "code_information": [{"code": "C1821", "type": "HCPCS"}, {"code": "101-9814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9785.0, "discounted_cash": 3424.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 15 X 15 X 15MM DYNABRIDGE SUPERELASTIC NITINOL DB-15-1515-B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DB-15-1515-B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 16.0MM ACUTRAK FUSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ATF-160-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 767.0, "discounted_cash": 268.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 2.0MM X 42MM INFRAME EXINF922042", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINF922042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 2.9 X 19MM 10\u00c2\u00b0 ANGLED OSSIOFIBER HAMMERTOE FIXATION OF10029191", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "OF10029191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 3.5MM PITON KNOTLESS FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SMK000201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 341.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 3.6 X 40MM INNATE EXINN923640", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EXINN923640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT 3.6MM X 45MM INNATE EXINN923645", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINN923645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3968.0, "discounted_cash": 1388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ABS OPEN TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TN-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ABS W/ UHMWPE TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TN", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ACL TIGHTROPE WITH FIBERTAG ABS AR-1588TNT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TNT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ACL TIGHTROPE WITH FIBERTAG AR-1588RTT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588RTT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1172.0, "discounted_cash": 410.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ADAPTER PRECISION M8 15CM", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "SC-9218-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT AEQUALIS PERFORM+ SP CORTILOC LARGE RIGHT GLENOID AUGMENT 25", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWK405RA25S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ALLOGRAFT 5 CM TO 10 CM .08MM TO 1.4MM ACELLULAR DERMAL MATRIX DERMASPAN", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "48-1100510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ALLOGRAFT DERMASPAN ACD 4 X 7CM 2.20MM", "code_information": [{"code": "Q4126", "type": "HCPCS"}, {"code": "48-2000407", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ALLOGRAFT SNGL STRAND SEMITENDINOSUS TENDON FROZEN STRL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "44317003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2146.0, "discounted_cash": 751.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ANCHOR FIXATION BIOWICK SURELOCK 2.7MM PRELOAD 2 SUTURE 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CM-6127", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2874.0, "discounted_cash": 1005.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ANNULAR CLOSURE DEVICE BARRCAID 10MM BAR-A8-10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BAR-A8-10MM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 3850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ARROW-LOK DIGITAL FUSION 2.5-3.5MM X 28MM ANG 27-253528", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "27-253528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1390.0, "discounted_cash": 486.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BASE/ HEMI TOE TI HA #3 19 X 17 MAGENTA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CHI-3TH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9466.0, "discounted_cash": 3313.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BI-CRUCIATE FEMORAL COMPONENT SIZE 8 LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74024928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BI-CRUCIATE FEMORAL COMPONENT SZ 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74024214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5415.0, "discounted_cash": 1895.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BIO ARCH 8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ST1108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2419.0, "discounted_cash": 846.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BIOASORBABLE BONE IB KIT BC W/ CC FT AND JUMPSTART AR-1788J-CP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1788J-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3338.0, "discounted_cash": 1168.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BIOASORBABLE SPEEDBRIDGE AR-2600SBS-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2600SBS-8", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3935.0, "discounted_cash": 1377.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BIOLOGIC VITOSS 5CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2102-1905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3507.8, "discounted_cash": 1227.73, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BODY STANDARD OPEN PHOENIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-2090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1051.0, "discounted_cash": 367.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE 13.0MM REDUCED DIST TYPE ONE STANDARD OFFSET 133 DEGREE NECK ANGLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "51-103130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19034.0, "discounted_cash": 6661.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE 5CC CARTRIDGE CORTOSS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2101-0005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2142.0, "discounted_cash": 749.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE 9.0MM REDUCED DIST TYPE ONE STANDARD OFFSET 133 DEGREE NECK ANGLE T", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "51-103090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5356.0, "discounted_cash": 1874.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE FIXATION SYSTEM 12MM X 12MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3000-00-121212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4316.0, "discounted_cash": 1510.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE FIXATION SYSTEM 18MM X 18MM 3000-00-181818", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3000-00-181818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5717.0, "discounted_cash": 2000.95, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE LEVEL 4.1MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "21.4108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE LEVEL 4.1MM 14MM SLACTIVE", "code_information": [{"code": "21.4114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BONE SZ 8 LG FRACTURE BODY", "code_information": [{"code": "BOD-0950-020-08LRG", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4371.0, "discounted_cash": 1529.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61531", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61760", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BUNION 4MM X 36 MM PECA PS050036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS050036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3483.0, "discounted_cash": 1219.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT BUNION PECA 04MM X 50MM HALLUX VALGUS PS050050 PS050050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS050050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3483.0, "discounted_cash": 1219.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CANNULA 0DEG PHALINX STRAIGHT SML", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45301002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1671.0, "discounted_cash": 584.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CANNULA 0DEG PHALINX STRAIGHT X-SML", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45301001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1618.0, "discounted_cash": 566.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CARTIVA 10MM CAR-10-US", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CAR-10-US", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6592.0, "discounted_cash": 2307.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CERVICAL DISC 5MMX16MM PRESTIGE LP 6972650", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6972650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7000.0, "discounted_cash": 2450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CERVICAL JOINT DISTRACTOR 4MM DX-50-403", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DX-50-403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7200.0, "discounted_cash": 2520.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CITREFIX 2.9MM X 12.5MM XPRESS SYSTEM 70-810-2912", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-810-2912", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3963.0, "discounted_cash": 1387.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CONCELLTRATE 100 10.0CC JAR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "453100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5662.0, "discounted_cash": 1981.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CONICAL 9MM GRN TI 6AI 4V ELI ARTHROERESIS SUB TALAR LOK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ST5009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2494.0, "discounted_cash": 872.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CONNECTOR 34-40MM HH OS-2830", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS-2830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CORNEA WHOLE LEFT", "code_information": [{"code": "16-1031-200", "type": "CDM"}], "standard_charges": [{"gross_charge": 6077.0, "discounted_cash": 2126.95, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CORNEA WHOLE RIGHT", "code_information": [{"code": "16-1031-100", "type": "CDM"}], "standard_charges": [{"gross_charge": 6077.0, "discounted_cash": 2126.95, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CORTILOC GLENOID AUGMENT SMALL RIGHT ANGLE 25\u00c2\u00b0 DWK403RA25S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWK403RA25S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CORUS PCSS LEVELONE 4MM DX-50-405", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DX-50-405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17200.0, "discounted_cash": 6020.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT CYPASS SYSTEM 241 US", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "8065754003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3502.0, "discounted_cash": 1225.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT DBM PUTTY", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "MDBM0100", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2719.0, "discounted_cash": 951.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT DBM PUTTY 1.0", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "MDBM0010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT DBM PUTTY 2.5", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "MDBM0025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT DBM PUTTY 5.0CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "MDBM0050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1607.0, "discounted_cash": 562.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT DEL DISTAL BICEPS REP BIOCOMPOSITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2260BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2456.0, "discounted_cash": 859.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT DEVICE BIOASORBABLE BONE PLUSBC W/CC FT AND JUMPSTART AR-1789J-CP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AR-1789J-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3241.16, "discounted_cash": 1134.41, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT DEVICE KNOTLESS AC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-2370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2503.0, "discounted_cash": 876.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT DJD COMPONENT DJD II BODY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5195-0-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8446.0, "discounted_cash": 2956.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT DYNACLIP BONE FIXATION SYSTEM 08 X 08 X 08MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3000-00-080808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3840.0, "discounted_cash": 1344.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT DYNACLIP BONE FIXATION SYSTEM 20MM X 22MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3000-00-202222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ELITE 10 28 11-156 DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "541-0014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ENDOSKELETON TCS 6 DEG LORDOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5366-1409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ENDOSKELTON TCS IMPLANT 6 DEGREE SML 7M 5346-1207-N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5346-1207-N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT EYE DRUG SYSTEM", "code_information": [{"code": "67027", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT EYELID 1.2 GRAM .6MM THIN PROFILE GOLD", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "LL4012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL 9MM X 24MM CRUCIFORM APERFIX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CM-2409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1823.0, "discounted_cash": 638.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL CR TRIATHLON SZ 4 RT 5517-F-402", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 2 CRUCIATE RETAINING LFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5510-F-201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2980.0, "discounted_cash": 1043.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 3 CRUCIATE RETAINING LFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5510-F-301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2980.0, "discounted_cash": 1043.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 3 NON POROUS LFT LEGION PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6229.0, "discounted_cash": 2180.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 4 LFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5510-F-401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3069.0, "discounted_cash": 1074.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 4 RIGHT OXINIUM JOURNEY II BCS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3749.0, "discounted_cash": 1312.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 4 RIGHT OXINUM LEGION CR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7265.0, "discounted_cash": 2542.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 5 CRUCIATE RETAINING RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5510-F-502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2980.0, "discounted_cash": 1043.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 5 LFT NON POROUS LEGION PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6229.0, "discounted_cash": 2180.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 5 LFT OXINIUM JOURNEY II BCS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6091.0, "discounted_cash": 2131.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 5 RIGHT CRUCIATE RETAINING NP LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5935.0, "discounted_cash": 2077.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 5 RIGHT OXINIUM JOURNEY II BCS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5828.0, "discounted_cash": 2039.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 6 LFT OXINIUM JOURNEY II BCS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3749.0, "discounted_cash": 1312.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 6 RIGHT NON POROUS LEGION CR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5707.0, "discounted_cash": 1997.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 6 RIGHT POST STABELISED NP LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5932.0, "discounted_cash": 2076.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 7 LFT CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 7 LFT POST STABELISED NP LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6053.0, "discounted_cash": 2118.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 7 RIGHT CRUCIATE RETAINING NP LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3461.0, "discounted_cash": 1211.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 7 RIGHT NON POROUS LEGION PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6356.0, "discounted_cash": 2224.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 7 RIGHT OXINIUM JOURNEY II BCS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3749.0, "discounted_cash": 1312.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 8 LFT CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 8 LFT OXINIUM JOURNEY II BCS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3749.0, "discounted_cash": 1312.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 8 LFT POST STABELISED NP LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5820.0, "discounted_cash": 2037.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMORAL SZ 8 RIGHT OXINIUM JOURNEY II BCS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74022118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3749.0, "discounted_cash": 1312.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FEMRL SZ 4 RT CEMENTED FEMORAL COMPONENT POST STABILIZED TRIATHLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5515-F-402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4952.0, "discounted_cash": 1733.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FIBER TAG TIGHTROPE II W/INTERNAL BRACE AR-1588RTT2-IB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588RTT2-IB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1571.7, "discounted_cash": 550.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FIBERSTITCH CURVED RC AR-19032C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-19032C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1192.1, "discounted_cash": 417.24, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FIBERWIRE POLY IMPLANT FIBERSTITCH CURVED W/ 2-0 AR-4570", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1105.0, "discounted_cash": 386.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FINGER JOINT GROMMETS SIZE 5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "G4700005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1959.0, "discounted_cash": 685.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FIXATION PHALINX 10DEG ANGLD MEDIUM HAMERTOE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45301013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2348.0, "discounted_cash": 821.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FIXATION PHALINX 10DEG ANGLD SMALL HAMERTOE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45301012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2348.0, "discounted_cash": 821.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT FXTN ACL RIGHT W/ TITANIUM AND UHMWPE TIGHTROPE RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588RT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1071.0, "discounted_cash": 374.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT GAIT MED SGARLATO", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "30-100-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6489.0, "discounted_cash": 2271.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT GENIN 5CC CRUSH MIX", "code_information": [{"code": "EHG-05CC", "type": "CDM"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT GLENOID SZ 44 PEGGED AFFINITI CORTILOC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "20061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6386.0, "discounted_cash": 2235.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT GRAFJACKET 4MM X 8MM 1-2MM THICK 86204X08", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "86204X08", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4750.0, "discounted_cash": 1662.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT GREAT TOE HEMI LRG 3S", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "101-00-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT GREAT TOE HEMI MED 3S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "101-00-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT GUIDE MED PARTIAL KNEE ARTHROPLASTY MIDDLE SET SM SIGNATURE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-411561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HAMMER TOE 3.4 X 3.0 X 6MM TWO-STEP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "204-30-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HAMMER TOE 3.4 X 3.0 X 8MM TWO-STEP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "204-30-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3143.0, "discounted_cash": 1100.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HAMMER TOE TWO STEP 3.4 X 3.0 X 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204-24-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 432.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HAMMER TOE TWO STEP 4.5 X 3.0 X 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "204-30-110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3698.0, "discounted_cash": 1294.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HAMMER TOE TWO STEP 4.5 X 3.0 X 12MM TWO STEP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "204-30-112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3698.0, "discounted_cash": 1294.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HAMMERFUZE 2.5MM X 20MM ANGLED TH25-20T-1110", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TH25-20T-1110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3286.0, "discounted_cash": 1150.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HAMMERLOCK PELITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HLXP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2464.0, "discounted_cash": 862.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HAMMERLOCK SMALL ANGLED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HLXSA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2464.0, "discounted_cash": 862.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HAMMERTOE ARROW-LOK STRAIGHT 33MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "21-253533", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1390.0, "discounted_cash": 486.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HAMMERTOE CANNULATED SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1671.0, "discounted_cash": 584.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HEAD 42MM X 16.3MM X 3.5MM HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "502442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11837.0, "discounted_cash": 4142.95, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HEMI SZ 35 LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "100-00-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP STEM ACCOLADE SZ 6 35MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6721-0635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3811.0, "discounted_cash": 1333.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HND REDUCTION SYS WRIST JACK", "code_information": [{"code": "CFD-147", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3106.0, "discounted_cash": 1087.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HORMONE PELLET(S)", "code_information": [{"code": "11980", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT HTR SYSTEM 8MM NON-STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "220-08-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HTR SYSTEM 8MM STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "220-08-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HUMERAL 4MM X 100MM FLANGED LFT W/ BOND COAT DISCOVERY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "114904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7143.0, "discounted_cash": 2500.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HUMERAL 5MM X 100MM LFT FLANGED W/ BOND COAT DISCOVERY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "114906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7143.0, "discounted_cash": 2500.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HUMERAL 5MM X 100MM RIGHT FLANGED W/ BOND COAT DISCOVERY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "114907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7143.0, "discounted_cash": 2500.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HUMERAL BEARING 36MM STD PRLNG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110031418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HUMERAL TRAY STD 40MM 0+", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110031399", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2500.0, "discounted_cash": 875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT IBS 2.0-C DIAM2.0 LG 16MM T7 S20 ST016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S20 ST016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT IBS 2.5-C DIAM 2.5 LG 16MM T7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25ST016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT IFUSE 7.0MM X 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7035M-90", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6440.0, "discounted_cash": 2254.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT IFUSE 7.0MM X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7045M-90", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6440.0, "discounted_cash": 2254.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT IFUSE 7.0MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7050M-90", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6440.0, "discounted_cash": 2254.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT IFUSE SYSTEM 7MMX65MM IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7065M-90", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6604.0, "discounted_cash": 2311.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT INFRAME 2.0MM X 18MM EXINF922018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINF922018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3966.0, "discounted_cash": 1388.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT INFRAME 2.0MM X 24MM EXINF922024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINF922024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT INFRAME IMPLANT 2.0MM X 16MM EXINF922016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINF922016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3966.0, "discounted_cash": 1388.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT INJECTABLE SYRINGE 1ML COAPTITE BULK AGENT 8005M0", "code_information": [{"code": "L8606", "type": "HCPCS"}, {"code": "8005M0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1061.0, "discounted_cash": 371.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT INSTRUMENT KIT A9 CD-DB-0909-SA", "code_information": [{"code": "CD-DB-0909-SA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1514.0, "discounted_cash": 529.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT INSTRUMENT KIT DYNABRIDGE STYLE A 11MM CD-DB-111-SA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CD-DB-111-SA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT INTERPHALANGEAL DUAFIT PIP 0 CA SZ 1", "code_information": [{"code": "A60-SP001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3904.0, "discounted_cash": 1366.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT INTERPHALANGEAL JOINT ARTHRODESIS HAMMERTOE PLANTARFLEXION 3.0MM X 15MM 10D HTS-XS1510-SP2", "code_information": [{"code": "L3925", "type": "HCPCS"}, {"code": "HTS-XS1510-SP2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7931.0, "discounted_cash": 2775.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT INTERPHALANGEAL LYNC M 0D CM010010", "code_information": [{"code": "L8659", "type": "HCPCS"}, {"code": "CM010010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2990.0, "discounted_cash": 1046.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT INTRAMEDULLARY 16MM 10DEG ANGLED W/ HOLE SMART TOE II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ST0A-16P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2559.0, "discounted_cash": 895.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT INTRAMEDULLARY 20MM 10DEG PURPLE ANGLED COLOR CODED SMART TOE II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ST0A-20P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2635.0, "discounted_cash": 922.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ION MICRO SPINE FACET 6.5 X 10MM-S TI-K-65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TI-K-65", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4500.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ISTENT INFINITE TRABECULAR MICRO-BYPASS SYSTEM IS3", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "IS3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4114.0, "discounted_cash": 1439.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT JII UNIT TIB XLPE INS SZ 3-4 8MM RM/LL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71935221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3172.0, "discounted_cash": 1110.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT JOINT SZ 10 PROXIMALINTERPHALANGEAL FINGER SILICONE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PIP-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1667.0, "discounted_cash": 583.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT JOINT SZ 20 PROXIMALINTERPHALANGEAL FINGER SILICONE", "code_information": [{"code": "L8631", "type": "HCPCS"}, {"code": "PIP-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1667.0, "discounted_cash": 583.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT JOINT SZ 30 PROXIMALINTERPHALANGEAL FINGER SILICONE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PIP-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1667.0, "discounted_cash": 583.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT JOINT SZ 40 METACARPAL PHALANGEAL FINGER SILICONE", "code_information": [{"code": "L8630", "type": "HCPCS"}, {"code": "MCP-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1667.0, "discounted_cash": 583.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT JOINT SZ 40 PROXIMALINTERPHALANEAL FINDER SILCONE PIP-40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PIP-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1667.0, "discounted_cash": 583.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT JOINT SZ 50 METACARPAL PHALANGEAL FINGER SILICONE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "MCP-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1667.0, "discounted_cash": 583.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT JOINT SZ 60 METACARPAL PHALANGEAL FINGER SILICONE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "MCP-60", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3251.0, "discounted_cash": 1137.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT K-WIRE1.1MM - IMPLANTABLE 45750001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45750001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT KIT TOGGLELOC WITH ZIPLOOP INLINE 110007421", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2239.0, "discounted_cash": 783.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT KNEE LFT CAP PRICE ITOTAL CARE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M57250600010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT KNEE RIGHT CAP PRICE ITOTAL CARE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M57250600020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT KNEE SZ 3 TO 4 10MM LFT CRUCIATE RETAINING JOURNEY II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74025642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT KNEE SZ 3 TO 4 15MM RIGHT CRUCIATE RETAINING JOURNEY II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74025636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2122.0, "discounted_cash": 742.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT KNOTLESS AC OPEN REPAIR AR-2372BLO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2372BLO", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3783.16, "discounted_cash": 1324.11, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT LARGE 6.0 X 30 METACARPAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "120-32530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3801.0, "discounted_cash": 1330.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT LATERA ABSORBABLE NASAL LATANI24", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "LATANI24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT LATERAL SI JOINT FUSION 10MM SIZE C 10-0122-000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-0122-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 5600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT LATERAL SI JOINT FUSION 10MM SIZE D 10-0123-000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "10-0123-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 5250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT LENS IOL ANTERIOR ASYMMETRIC BOCNVEXL 13MM 6MM +7.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 7.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT LENS IOL SN60AT 29.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60AT 29.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT LNT SYSTEM 3.9 BC SWIVELOCK AR-1665BCSL-39", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1665BCSL-39", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1734.4, "discounted_cash": 607.04, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT LYNC S10 INTRAMEDULLARY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CM010031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4728.0, "discounted_cash": 1654.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT MEDIUM BIOINDUCTIVE IMPLANT WITH ARTHROSCOPIC DELIVERY 4565", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT MEDPOR TITAN 3D OF RIGHT SMALL 81042 Medport", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "81042 Medport", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4893.0, "discounted_cash": 1712.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT METACARPOPHALANGEAL SZ 20", "code_information": [{"code": "L8630", "type": "HCPCS"}, {"code": "MCP-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2190.0, "discounted_cash": 766.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT METACARPOPHALANGEAL SZ 30", "code_information": [{"code": "L8630", "type": "HCPCS"}, {"code": "MCP-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1667.0, "discounted_cash": 583.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT MINIRAIL SHORT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2225.0, "discounted_cash": 778.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT MODULUS CERVICAL 6X17X14MM 7\u00c2\u00b0 67940036P2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "67940036P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3780.0, "discounted_cash": 1323.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT MRI NEUROSTIMULATOR RESTORE ULTRA", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "97712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42120.0, "discounted_cash": 14742.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT NASAL ABSORBABLE 24MM X 1MM LATERA", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "LATANI02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 432.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT NASAL LATERA ABSORBABLE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "LATSYS-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7416.0, "discounted_cash": 2595.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT NASAL LATERA DELIVERY DEVICE POSITIONING GUIDE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "LATDD01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 432.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT NDL 12DEG CVD KNEE POLYDIOXANONE OR POLY L LACTIDE ACID RAPIDLOC MENISCA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 204.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT NDL 27DEG CVD KNEE POLYDIOXANONE OR POLY L LACTIDE ACID RAPIDLOC MENISCA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 204.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT NERVE END", "code_information": [{"code": "64787", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61864", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61868", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61863", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61867", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "61860", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64553", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEXA FGT SZ 40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "FGT-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3762.0, "discounted_cash": 1316.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT NEXA FGT SZ 50", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "FGT-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3790.0, "discounted_cash": 1326.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT NEXA LMP SZ20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "LMP-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3720.0, "discounted_cash": 1302.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT NEXA LMP SZ30", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "LMP-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2575.0, "discounted_cash": 901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT NEXA LMP SZ40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "LMP-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4101.0, "discounted_cash": 1435.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT NITINOL SUPERELASTIC SYSTEM STYLE A 11 X 10 X 10MM DB-11-1010-SA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DB-11-1010-SA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4573.0, "discounted_cash": 1600.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT OMEGA XP 9MMX34MMX11MM 3D C 72-01-093411-03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72-01-093411-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 2800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT OMNIA PATIENT CHARGER CHGR2500", "code_information": [{"code": "C1822", "type": "HCPCS"}, {"code": "CHGR2500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT OPTHALMIC NATURAL IRIS CONFORMER COLOR #1 MEDIUM 26MM X 22MM 89126", "code_information": [{"code": "C1839", "type": "HCPCS"}, {"code": "89126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT OR REPLACE DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INF. SQ 62360", "code_information": [{"code": "62360", "type": "CPT"}, {"code": "1839669", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT ORBITAL 18MM SPHERICAL HYDROXYAPATITE BIO EYE", "code_information": [{"code": "L8042", "type": "HCPCS"}, {"code": "I00018S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1844.0, "discounted_cash": 645.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ORBITAL 20MM SPHERICAL HYDROXYAPATITE BIO EYE", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "I00020S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1844.0, "discounted_cash": 645.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ORBITAL 22MM SPHERICAL HYDROXYAPATITE BIO EYE", "code_information": [{"code": "L8042", "type": "HCPCS"}, {"code": "I00022S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1844.0, "discounted_cash": 645.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT OSTEOSPAN MORPHEUS 12CC", "code_information": [{"code": "C9353", "type": "HCPCS"}, {"code": "MOR-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6994.0, "discounted_cash": 2447.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PACKAGE HAMMERTOE CORRECTION 3.8mm", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "9H00-T030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3259.0, "discounted_cash": 1140.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PACKAGEX-SMALL TOEMATE 9H00-T050", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9H00-T050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3259.0, "discounted_cash": 1140.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA 29MM X 9MM ASYMMETRIC X3 POLYETHYLENE TRIATHLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5551-G-299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2365.0, "discounted_cash": 827.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA 32MM X 6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M57260600050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA 32MM X 7MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M57241600050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA 35MM RESURFACING GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420578", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1473.0, "discounted_cash": 515.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA 35MM SZ 3INSERT BLACK 3 PEG OVAL DOME POLYETHYLENE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "96-0101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1527.0, "discounted_cash": 534.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA 38MM 3 PEG STANDARD PROSTHESIS SIGMA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "96-0102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1619.0, "discounted_cash": 566.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA 38MM X 8.5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M57260600070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA 38MM X 9MM RESURFACING GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71926225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1491.0, "discounted_cash": 521.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA 7.5MM 29MM RESURFACING GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71932635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1628.0, "discounted_cash": 569.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA 7.5MM X 35MM RESURFACING GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71932637", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4501.0, "discounted_cash": 1575.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA 9MM X 29MM RESURFACING CRUCIATE RETAINING GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1474.0, "discounted_cash": 515.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLA SZ A 32MM X 10MM ASYMMETRIC X3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5551-G-320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLAR 32MM RESURFACING GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1547.0, "discounted_cash": 541.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PATELLAR 41MM MEDIALIZED BONE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1518-20-041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PEEK SWVLK IMPLSYS 2NDRY FIXATN AR-1593-P", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "AR-1593-P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1619.0, "discounted_cash": 566.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PEG INSERT 2.0MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "231218012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PHALAUX EXTRA SAMLL", "code_information": [{"code": "45301011", "type": "CDM"}], "standard_charges": [{"gross_charge": 2348.0, "discounted_cash": 821.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PHALINX CANN MED", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "5-042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2526.0, "discounted_cash": 884.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PHALINX CANN X-SML", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "5-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2526.0, "discounted_cash": 884.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PHALINX CANNULATED 0DEG MEDIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45301003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1671.0, "discounted_cash": 584.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PHALINX LARGE CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45301004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1671.0, "discounted_cash": 584.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PHALINX LG ANGLED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45301014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2348.0, "discounted_cash": 821.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PIP 2MM X 15MM STRAIGHT ALLOGRAFT TENFUSE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "TFF-2015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3240.0, "discounted_cash": 1134.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PLAPLE 15MMFT ANKLE SS", "code_information": [{"code": "AR-8715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PNS DUAL LEAD BUNDLE BPNS2", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "BPNS2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37600.0, "discounted_cash": 13160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PRODENSE INJECTABLE 10CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "87SR0100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7148.0, "discounted_cash": 2501.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PRODISC XL 19 X 16MM 5MM C VIVO PDVXL5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PDVXL5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12400.0, "discounted_cash": 4340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PROLAYER 4X8CM 0.4-1.0MM THICK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3102-2548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6592.0, "discounted_cash": 2307.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PROPEL CONTOUR MOMETASONE FUROATE", "code_information": [{"code": "C2625", "type": "HCPCS"}, {"code": "50011 (IMPLANT)", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1216.0, "discounted_cash": 425.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PROSTHESIS LMP SIZE 30 LMP-30T", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "LMP-30T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2991.34, "discounted_cash": 1046.97, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT PUMP SYNCHROMED III 8667-20", "code_information": [{"code": "C1772", "type": "HCPCS"}, {"code": "8667-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11791.0, "discounted_cash": 4126.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT RAPID COMPRESSION LARGE SPEEDMTP SK59", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK59", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6748.0, "discounted_cash": 2361.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT REINFORCEMENT 3CM X 4CM TISSUE ARTELON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "31050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2462.0, "discounted_cash": 861.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ROD 4MM X 70MM WRIST FRACTURE WRX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WRX-5470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6856.0, "discounted_cash": 2399.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ROD 55MM CRVD NOTCHED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AM-10706-055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ROD 8.0MM X 160.0MM CARBON FIBER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "395.779", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT RTS FLEXIBLE 1ST MPJ IMPLANT W/ GROMMETS, SIZE 4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "M30SE040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SHOULDER 41MM STANDARD COMPREHENSIVE REVERSE GLNSPR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "115320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SHOULDER 41MM STANDARD COMPREHENSIVE REVERSE GLNSPR", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "115320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SI JOINT FUSION 10MM SIZE E 10-0124-000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "10-0124-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 5250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SIBER SI 11.5 X 55 MM COMP 44115-45-ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44115-45-ST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SIBER SI 11.5 X 55 MM COMPRESSION 44115-55-ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44115-55-ST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SIBER SI 11.5MMX35MM 44115-35-ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44115-35-ST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SIBER SI 11.5X40MM COMPRESSION 44115-40-ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44115-40-ST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SILKTOE SIZE 40 BRDNEWP4040L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BRDNEWP4040L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8500.0, "discounted_cash": 2975.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SINUS PROPEL STEROID", "code_information": [{"code": "C2625", "type": "HCPCS"}, {"code": "70011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1230.0, "discounted_cash": 430.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SIZE 30 PRIMUS FLEXIBLE GREAT TOE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "FGT-30T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3762.0, "discounted_cash": 1316.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SIZE 50 PRIMUS FLEXIBLE GREAT TOE FGT-50T", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "FGT-50T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3762.0, "discounted_cash": 1316.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SIZE 7 TIBIAL BEARING INSERT- 9MM THICKNESS-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-709-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SLEEVE SCLERAL BUCKLING PRODUCTS STYLE 70 SILICONE 92-13", "code_information": [{"code": "92-13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SMART TOE 15MM NEUTRAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ST0-15P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2218.0, "discounted_cash": 776.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SMART TOE ANGLED 20MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "STOA-20P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2635.0, "discounted_cash": 922.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SMART TOE ANGLED 22MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "STOA-22P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2635.0, "discounted_cash": 922.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPAZIATORE SILKTOE SIZE 35 BRDNEWP3535R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "BRDNEWP3535R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7200.0, "discounted_cash": 2520.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPINAL 8MM STRAIGHT ARENA C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-72000-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPINAL CHORD STIMULATOR MRI", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "97713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24720.0, "discounted_cash": 8652.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFUSION PUMP", "code_information": [{"code": "62361", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT STAPLE 13 MM X 10 MM X 10 MM SPEED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SE-1310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2464.0, "discounted_cash": 862.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM 10MM X 70MM LNG GEN II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71928199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM 12MM X 160MM STRAIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2954.0, "discounted_cash": 1033.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM 30.0MM X 99.0MM SZ 2 132 DEGREE NECK ANGLE HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6720-0230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8673.0, "discounted_cash": 3035.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM 35.0MM X 105.0MM SZ 4 132 DEGREE NECK ANGLE HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6720-0435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3811.0, "discounted_cash": 1333.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM DIA 14MM MODULAR HUMERAL CEMENTLESS HA COATED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "130714000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM ORTHOPEDIC IFUSE SYL30 MM OD 7 MM 7030-90", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7030-90", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6378.0, "discounted_cash": 2232.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM SIZE 12 HIGH OFFSET SYNERGY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8878.0, "discounted_cash": 3107.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM SZ 15 HIGH OFFSET SYNERGY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9234.0, "discounted_cash": 3231.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM SZ 3 30MM X 102MM 127DEG NECK ANGLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6721-0330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3700.0, "discounted_cash": 1295.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM SZ 3 30MM X 102MM ANGLED HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6720-0330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3811.0, "discounted_cash": 1333.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM SZ 3B 74MM 130DEG HUMERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7503303B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9105.0, "discounted_cash": 3186.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM SZ 4 35MM X 105MM 127DEG NECK ANGLE HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6721-0435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4635.0, "discounted_cash": 1622.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STEM SZ 8 37MM X 117MM 127DEG NECK ANGLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6721-0837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3700.0, "discounted_cash": 1295.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT STS 8.5MM 01-008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2884.0, "discounted_cash": 1009.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUB-TALAR WEDGE 14MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PSBT-1407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4753.0, "discounted_cash": 1663.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUBTALAR 10MM MBA TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-0110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6073.0, "discounted_cash": 2125.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUBTALAR 9MM MBA TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-0109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUBTALAR MBA 8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "50108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUBTALAR MBA TI 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "50109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3839.0, "discounted_cash": 1343.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUBTALAR TALAR FIT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "340-0003-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5181.0, "discounted_cash": 1813.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUBTALAR TALAR FIT 11MM", "code_information": [{"code": "340-0004-SP", "type": "CDM"}], "standard_charges": [{"gross_charge": 4831.0, "discounted_cash": 1690.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUBTALAR TITANIUM 9MM HORIZON 17222", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "17222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4100.0, "discounted_cash": 1435.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SURG 18MM ENCOMPASS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "385-0018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6098.0, "discounted_cash": 2134.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SURG 8MM MAGENTA SUBTALAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TOV3-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2396.0, "discounted_cash": 838.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SURG 9MM TALAR FIT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "340-0002-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5181.0, "discounted_cash": 1813.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUSPEND FASCIA LATA 2X12CM 93-7212", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "93-7212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2124.0, "discounted_cash": 743.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUTUREGROOVE GOLD EYELID 1.2G SLIM", "code_information": [{"code": "GSLM-12", "type": "CDM"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SWANSON SZ 45", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "G4260104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1790.0, "discounted_cash": 626.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SYS BIOC ACHILLES W/JUMP AR-8928BCJ-CP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8928BCJ-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4455.0, "discounted_cash": 1559.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM 13 X 10 X 10 MM DYNABRIDGE NITINOL DB-13-1010-SA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DB-13-1010-SA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM 15 X 15X X15MM DYNABRIDGE NITINOL DB-15-1515-SB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DB-15-1515-SB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM 4.75BC SWIVELOCKLOOP N TACK AR-1665BCSL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1665BCSL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1786.0, "discounted_cash": 625.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM CMC LIGAMENT RECONSTRUCTION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-1677BC-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1432.0, "discounted_cash": 501.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM CUFFMEND AR-19043", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-19043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6067.1, "discounted_cash": 2123.49, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM FHL 6.25MM AR-1562BC-CP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1562BC-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3338.0, "discounted_cash": 1168.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM INFINITY PROPHECY", "code_information": [{"code": "PROPINF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2732.0, "discounted_cash": 956.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM LNT 4.75 BC KL SWIVELOCK AR-1665KBCSL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1665KBCSL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.48, "discounted_cash": 652.57, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SZ 3.0 FLEXIBLE HINGE TOE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "426-0030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2594.0, "discounted_cash": 907.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SZ 30 PRIMUS FLEXIBLE GREAT TOE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "FGT-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SZE 4 X 9MM TIBIAL BEARING INSERT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-409-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TAILORS BUNION SMALL 977TIMPS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "977TIMPS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2896.0, "discounted_cash": 1013.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TCAT PULM VLV PERQ", "code_information": [{"code": "33477", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT TENOTAC SOFT TISSUE FEMALE SHORT 6MMX2.2MMX6.5MM P42-322-0065-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P42-322-0065-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.5, "discounted_cash": 357.18, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TENSION RING 10-12.3 MM TYPE 14 MORCHER CTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MR-1400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TENSION RING 12-14.5 MM TYPE 14 MORCHER CTR", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "MR-1410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TI SYNDESMOSIS TIGHTROPE XP AR-8925T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8925T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3080.0, "discounted_cash": 1078.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TIBIAL BEARING INSERT-CR SZ 3 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-309-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TIBIALIS TENDON ANTERIOR FF 1.00 X 30.1 CM", "code_information": [{"code": "C9356", "type": "HCPCS"}, {"code": "AT801FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TIBL 9MM FULLY CANNULATED CRUCIATE LIGAMENT RECONSTRUCTION BIOCOMPOSITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5100-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1164.0, "discounted_cash": 407.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TIBL 9MM X 30MM CANNULATED ORTHO W/ DRIVER APERFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CM-3009C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TIBL SZ 3 CEMENT LFT GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3779.0, "discounted_cash": 1322.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TIBL SZ 3 NON POROUS RIGHT GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3599.0, "discounted_cash": 1259.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TIBL SZ 5 NON POROUS RIGHT GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3779.0, "discounted_cash": 1322.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TIBL SZ 6 CEMENT RIGHT GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3779.0, "discounted_cash": 1322.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TIBL SZ 7 NON POROUS LFT GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420172", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3599.0, "discounted_cash": 1259.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TOE 1ST MPJ HEMI MED-LRG", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "14960", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4069.0, "discounted_cash": 1424.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TOE 1ST MPJ RTS FLEXIBLE W/GROMMETS SIZE 3", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "M30SE030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TOE ELLIPOSID HA 19 X 17MM CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CHI-3CH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8642.0, "discounted_cash": 3024.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TOE GREAT SIZE 2 LPT REGULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4875002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2841.0, "discounted_cash": 994.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TOE HEMI GREAT SMALL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "375-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3790.0, "discounted_cash": 1326.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TOE LG METAL HEMI STRL PACKED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3-6000-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2958.0, "discounted_cash": 1035.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TOE SIZE 40 FGT PRIMUS FLEXIBLE GREAT FGT-40T", "code_information": [{"code": "L8642", "type": "HCPCS"}, {"code": "FGT-40T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3768.0, "discounted_cash": 1318.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TOE SIZE 5S HINGE FLEXIBLE WITH GROMMETS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "G4260105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1770.0, "discounted_cash": 619.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TRANSPROSTATIC STD UROLIFT SYSTEM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "UL400-4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1646.0, "discounted_cash": 576.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TRIAL HEMI SIZE N LRG GREAT TOE", "code_information": [{"code": "375-0012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1067.0, "discounted_cash": 373.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TRILLIAN SUBTALAR TWIST 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "102-10-009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TRILLIANT SUBTALAR TWIST 6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "102-10-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TWIST 10M SUBTALAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "102-10-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5274.0, "discounted_cash": 1845.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TWIST 7MM SUBTALAR 102-10-007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "102-10-007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5274.0, "discounted_cash": 1845.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TWIST 8M SUBTALAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "102-10-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5274.0, "discounted_cash": 1845.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TWO STEP 4.5 X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204-30-114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.0, "discounted_cash": 1438.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ULNA 3MM X 75MM LFT W/ BEARING BOND COAT DISCOVERY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "114812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7868.0, "discounted_cash": 2753.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ULNA 4MM X 75MM LFT W/ BEARING BOND COAT DISCOVERY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "114822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7868.0, "discounted_cash": 2753.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ULNA 4MM X 75MM RIGHT W/ BEARING BOND COAT DISCOVERY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "114823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7868.0, "discounted_cash": 2753.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT ULNA 5MM X 75MM LFT W/ BEARING BOND COAT DISCOVERY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "114832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7868.0, "discounted_cash": 2753.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT URETER IN BOWEL", "code_information": [{"code": "50800", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33975", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33976", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT WALKING SKI DNE-9000-WS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-9000-WS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4150.0, "discounted_cash": 1452.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT WASHER ID 4.5MM X OD 10 M SCREWFT ANKLE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8945W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT XL HEMI", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "101-00-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT, ROTATOR CUFF AUGMENTATION SYSTEM AR-19041S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-19041S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6609.2, "discounted_cash": 2313.22, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT/REPLACE DEVICE INTRA OR EPI.DRUG INFUSION;SUBCUT.RES.PROGRAM PUMP 62362", "code_information": [{"code": "62362", "type": "CPT"}, {"code": "1481037", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT/REPLACE HEARING AID", "code_information": [{"code": "69710", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT/REV.OR REPOSITION TUNNEL INTRA.OR EPI.CATH FOR LONG-TERM MED.ADMIN. 62350", "code_information": [{"code": "62350", "type": "CPT"}, {"code": "1481038", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANTATION OF BIOLOGIC IMPLANT 15777", "code_information": [{"code": "15777", "type": "CPT"}, {"code": "1700053", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANTATION OF BRAIN INTRACAVITARY CHEMOTHERAPY AGENT 61517", "code_information": [{"code": "61517", "type": "CPT"}, {"code": "1481039", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANTATION; REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL/EPIDURAL CATHETER 62351", "code_information": [{"code": "62351", "type": "CPT"}, {"code": "27443547", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "gross_charge": 7220.0, "discounted_cash": 2527.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3494.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANTS 3.5MM LOCKING SCREW SLF-TPING W/STARDRIVE(TM) RECESS 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANTS END CAP NAIL TI T25 0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.001.000S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 132.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANTS LAPIPLASTY MINI-INCISION SYSTEM SK30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10753.0, "discounted_cash": 3763.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANTS PORT 9.6 PORT SINGLE LUMEN (BARD ACCESS)", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "602680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 654.0, "discounted_cash": 228.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLATE CONNECTOR 2MM X 15.0 DEGREE IMP-WC-0215", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IMP-WC-0215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 896.0, "discounted_cash": 313.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLATE DRILL UNICORTICAL 3MM X 41MM IMP-DUC-0341", "code_information": [{"code": "IMP-DUC-0341", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLATE NAIL DISTAL RADIUS LONG IMP-DRN-LNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IMP-DRN-LNG", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1910.0, "discounted_cash": 668.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLATE NAIL METACARPAL STANDARD 4.6 IMP-MCN-S46", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IMP-MCN-S46", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1910.0, "discounted_cash": 668.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLATE REAMER 1 METACARPAL 2.7MM X 87MM IMP-WAN-MR1", "code_information": [{"code": "IMP-WAN-MR1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLATE REAMER 2 METACARPAL 3.4MM X 87MM IMP-WAN-MR2", "code_information": [{"code": "IMP-WAN-MR2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLATE REAMER 3 METACARPAL 4.0MM X 87MM IMP-WAN-MR3", "code_information": [{"code": "IMP-WAN-MR3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLATE REAMER 4 METACARPAL 4.5MM X 87MM IMP-WAN-MR4", "code_information": [{"code": "IMP-WAN-MR4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLATE REAMER 5 METACARPAL 5.0MM X 87MM IMP-WAN-MR5", "code_information": [{"code": "IMP-WAN-MR5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLT ANT SGM IO NBIO RX SYS", "code_information": [{"code": "660T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT CRAN BONE FLAP TO ABDO", "code_information": [{"code": "61316", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV GEN", "code_information": [{"code": "268T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 6045.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV LEAD", "code_information": [{"code": "267T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV TOTAL", "code_information": [{"code": "266T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 6045.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLTJ NTRSTRML CRNL RNG SEG", "code_information": [{"code": "65785", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLTJ SYNTH RNFCMT ABDL WAL", "code_information": [{"code": "437T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLTJ TOT RPLCMT HRT SYS", "code_information": [{"code": "33927", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPR MED TIME EDARR PAIN MED", "code_information": [{"code": "G9426", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPR VIS ACUIT W/IN 90D", "code_information": [{"code": "G9516", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPRESSION CUSTOM PREPARATION PROSTHESIS 21076", "code_information": [{"code": "21076", "type": "CPT"}, {"code": "1481041", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2235.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPROVE VISUAL FUNCT", "code_information": [{"code": "G0913", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPRV CARE LE JNT REPR MVP", "code_information": [{"code": "G0058", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN GNOTYP CD44 EXONS 2 3 6", "code_information": [{"code": "191U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 395.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN-HOSPITAL ON CALL SERVICE", "code_information": [{"code": "99026", "type": "CPT"}], "standard_charges": [{"minimum": 205.02, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 205.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 322.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 322.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 322.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN-PERSON ATTENDANCE G CODE", "code_information": [{"code": "G9886", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.53, "maximum": 112.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INACTIVATED JE VACC IM", "code_information": [{"code": "90738", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INBONE SCREW REMOVER", "code_information": [{"code": "IB200051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INBONE STEINMANN PIN 2.4MM 200072", "code_information": [{"code": "200072", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "INBONE TALAR DOME SZ 2 SULCUS 220220902", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "220220902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10141.0, "discounted_cash": 3549.35, "setting": "both", "billing_class": "facility"}]}, {"description": "INBONE TIB TRAY RT SZ 5 LNG 220222905", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "220222905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3986.0, "discounted_cash": 1395.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [{"code": "642", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7845.85, "maximum": 13469.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7845.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11221.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12343.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13469.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INC THYR NODE <1.0 IN RPT", "code_information": [{"code": "G9552", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN EA SEP/ADDL", "code_information": [{"code": "11107", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCID PULM NODULE", "code_information": [{"code": "G9754", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG CERV", "code_information": [{"code": "22210", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG LUMBAR", "code_information": [{"code": "22214", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG THORAC", "code_information": [{"code": "22212", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS ADDL SPINE SEGMENT", "code_information": [{"code": "22216", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN ADL SEG", "code_information": [{"code": "22208", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN LUMBAR", "code_information": [{"code": "22207", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN THORAC", "code_information": [{"code": "22206", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE & TREAT BLADDER", "code_information": [{"code": "51030", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE BILE DUCT SPHINCTER", "code_information": [{"code": "47460", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE BLADDER/DRAIN URETER", "code_information": [{"code": "51045", "type": "CPT"}], "standard_charges": [{"minimum": 2394.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE DIAPHRAGM NERVE", "code_information": [{"code": "64746", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE EXTERNAL HEMORRHOID", "code_information": [{"code": "46083", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE FLEXOR CARPI RADIALIS", "code_information": [{"code": "25001", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64763", "type": "CPT"}], "standard_charges": [{"minimum": 2297.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64766", "type": "CPT"}], "standard_charges": [{"minimum": 3365.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR", "code_information": [{"code": "69801", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR NERVE", "code_information": [{"code": "69950", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65860", "type": "CPT"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65880", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE STRANDS", "code_information": [{"code": "67030", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE NERVE BACK OF HEAD", "code_information": [{"code": "64744", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61458", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61450", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61460", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL REPAIR", "code_information": [{"code": "62121", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61720", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61735", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPINAL CORD TRACT(S)", "code_information": [{"code": "63170", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE ACCESSORY NERVE", "code_information": [{"code": "63191", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN EYELID LINING", "code_information": [{"code": "68020", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR GLAND", "code_information": [{"code": "68400", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR SAC", "code_information": [{"code": "68420", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE ABSCESS; PERITONSILLAR 42700", "code_information": [{"code": "42700", "type": "CPT"}, {"code": "41583337", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "gross_charge": 4595.0, "discounted_cash": 1608.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2223.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE BELOW FASCIA FOOT 28002", "code_information": [{"code": "28002", "type": "CPT"}, {"code": "2401694", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE BREAST 19020", "code_information": [{"code": "19020", "type": "CPT"}, {"code": "1481042", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE BURSA FOOT 28001", "code_information": [{"code": "28001", "type": "CPT"}, {"code": "10694412", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 159.72, "maximum": 8450.0, "gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 159.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE COMPLEX 10061", "code_information": [{"code": "10061", "type": "CPT"}, {"code": "1481043", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE DEEP ABSCESS/HEMATOMA SOFT TISSUE NECK/THORAX W/PART. RIB OSTECTOMY 21502", "code_information": [{"code": "21502", "type": "CPT"}, {"code": "3825257", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE FINGER COMPLICATED 26011", "code_information": [{"code": "26011", "type": "CPT"}, {"code": "1481045", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE FINGER SIMPLE 26010", "code_information": [{"code": "26010", "type": "CPT"}, {"code": "1481046", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 620.0, "discounted_cash": 217.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 300.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE HIP OR PELVIS 26990", "code_information": [{"code": "26990", "type": "CPT"}, {"code": "1481048", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE HUMERUS 23935", "code_information": [{"code": "23935", "type": "CPT"}, {"code": "1481049", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE LOWER EXTREMITY INFECTED BURSA 27604", "code_information": [{"code": "27604", "type": "CPT"}, {"code": "1481050", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE LOWER EXTREMITY OR ANKLE ABCESS 27603", "code_information": [{"code": "27603", "type": "CPT"}, {"code": "1481051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE LYMPHOCELE-OPEN 49062", "code_information": [{"code": "49062", "type": "CPT"}, {"code": "1481052", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE NECK 21501", "code_information": [{"code": "21501", "type": "CPT"}, {"code": "1481053", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS 56420", "code_information": [{"code": "56420", "type": "CPT"}, {"code": "1481054", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE OF CYST 10121", "code_information": [{"code": "10121", "type": "CPT"}, {"code": "1481055", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1037.69, "maximum": 8450.0, "gross_charge": 2144.0, "discounted_cash": 750.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1037.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE OF EPIDIDYMIS TESTIS AND/OR SCROTAL SPACE 54700", "code_information": [{"code": "54700", "type": "CPT"}, {"code": "1481056", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE OF HEMATOMA 10140", "code_information": [{"code": "10140", "type": "CPT"}, {"code": "1481057", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE OF INTRAMURAL/INTRAMUSCULAR/SUBMUCOSAL ABSCESS TRANSNASAK W/ANES. 46045", "code_information": [{"code": "46045", "type": "CPT"}, {"code": "42593887", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE OF PERIRECTAL ABCESS 46040", "code_information": [{"code": "46040", "type": "CPT"}, {"code": "1481058", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS 56405", "code_information": [{"code": "56405", "type": "CPT"}, {"code": "1481059", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 620.0, "discounted_cash": 217.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 300.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE OF WOUND 10180", "code_information": [{"code": "10180", "type": "CPT"}, {"code": "1481060", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE PELVIS OR HIP JOINT AREA INFECTED BURSA 26991", "code_information": [{"code": "26991", "type": "CPT"}, {"code": "5774512", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE PENIS-DEEP 54015", "code_information": [{"code": "54015", "type": "CPT"}, {"code": "1481061", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE PERIANAL ABSCESS SUPERFICIAL 46050", "code_information": [{"code": "46050", "type": "CPT"}, {"code": "13397456", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1871.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE PILONIDAL CYST COMPLICATED 10081", "code_information": [{"code": "10081", "type": "CPT"}, {"code": "2025473", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "gross_charge": 2143.0, "discounted_cash": 750.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1037.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE PILONIDAL CYSTY SIMPLE 10080", "code_information": [{"code": "10080", "type": "CPT"}, {"code": "1740090", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1542.0, "discounted_cash": 539.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 746.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE RECTAL ABSCESS 45005", "code_information": [{"code": "45005", "type": "CPT"}, {"code": "1481062", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE SHOULDER 23030", "code_information": [{"code": "23030", "type": "CPT"}, {"code": "1481063", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE SPINE CERVICAL 22010", "code_information": [{"code": "22010", "type": "CPT"}, {"code": "1481066", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1036.53, "maximum": 9735.0, "gross_charge": 3141.0, "discounted_cash": 1099.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1520.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1036.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE SURGERY SIMPLE 10060", "code_information": [{"code": "10060", "type": "CPT"}, {"code": "1481064", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 171.82, "maximum": 8450.0, "gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 171.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE THIGH OR KNEE 27301", "code_information": [{"code": "27301", "type": "CPT"}, {"code": "1481067", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE UPPER ARM OR ELBOW 23930", "code_information": [{"code": "23930", "type": "CPT"}, {"code": "1481068", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE UPPER ARM OR ELBOW BURSA 23931", "code_information": [{"code": "23931", "type": "CPT"}, {"code": "1481069", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE WRIST/FOREARM BURSA 25031", "code_information": [{"code": "25031", "type": "CPT"}, {"code": "1481070", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE WRIST/FOREARM DEEP 25028", "code_information": [{"code": "25028", "type": "CPT"}, {"code": "1481071", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND REMOVAL OF FOREIGN BODY 10120", "code_information": [{"code": "10120", "type": "CPT"}, {"code": "1481072", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 213.92, "maximum": 8450.0, "gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 213.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION BONE CORTEX HAND OR FINGER 26034", "code_information": [{"code": "26034", "type": "CPT"}, {"code": "1941669", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION BONE FOOT 28005", "code_information": [{"code": "28005", "type": "CPT"}, {"code": "2401695", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION DEEP BONE CORTEX FOREARM/WRIST 25035", "code_information": [{"code": "25035", "type": "CPT"}, {"code": "1481073", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION EXTENSOR TENDON SHEATH WRIST 25000", "code_information": [{"code": "25000", "type": "CPT"}, {"code": "1481074", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION LEG OR ANKLE 27607", "code_information": [{"code": "27607", "type": "CPT"}, {"code": "1954771", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL SEPTUM", "code_information": [{"code": "46070", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47420", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47425", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61567", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BROW NERVE", "code_information": [{"code": "64732", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BURN SCAB INITI", "code_information": [{"code": "16035", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHEEK NERVE", "code_information": [{"code": "64734", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHIN NERVE", "code_information": [{"code": "64736", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF COLLARBONE JOINT", "code_information": [{"code": "23106", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43020", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43045", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYE", "code_information": [{"code": "65850", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID", "code_information": [{"code": "67710", "type": "CPT"}], "standard_charges": [{"minimum": 985.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 985.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF FACIAL NERVE", "code_information": [{"code": "64742", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47480", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47490", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33020", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33025", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONE", "code_information": [{"code": "27146", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONES", "code_information": [{"code": "27151", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27003", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66505", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW JOINT", "code_information": [{"code": "21010", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW NERVE", "code_information": [{"code": "64738", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LABIAL FRENUM (FRENOTOMY) 40806", "code_information": [{"code": "40806", "type": "CPT"}, {"code": "1481078", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LARGE BOWEL", "code_information": [{"code": "44025", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LINGUAL FRENUM 41010", "code_information": [{"code": "41010", "type": "CPT"}, {"code": "10956178", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIVER DUCT", "code_information": [{"code": "47400", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LYMPH CHANNELS", "code_information": [{"code": "38308", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF NECK OF FEMUR", "code_information": [{"code": "27161", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF PALM TENDON", "code_information": [{"code": "26450", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF PYLORIC MUSCLE", "code_information": [{"code": "43520", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF SMALL BOWEL", "code_information": [{"code": "44010", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF STOMACH NERVES", "code_information": [{"code": "64755", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27448", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27450", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDON", "code_information": [{"code": "27306", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27391", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27392", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF TONGUE NERVE", "code_information": [{"code": "64740", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF VAGUS NERVE", "code_information": [{"code": "64760", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31600", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31601", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31603", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31605", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31610", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION SECONDARY CATARACT", "code_information": [{"code": "66820", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION/FIXATION OF FEMUR", "code_information": [{"code": "27165", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISIONAL BIOPSY OF SKIN SINGLE LESION 11106", "code_information": [{"code": "11106", "type": "CPT"}, {"code": "45432302", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.92, "maximum": 8450.0, "gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IND IMG HD POS HD ACHE", "code_information": [{"code": "G2191", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IND IMG HD RAD NECK", "code_information": [{"code": "G2190", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDEXING FOR OSTEOTOMY", "code_information": [{"code": "D7939", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDIC FOR HEAD CT NOT VALID", "code_information": [{"code": "G9533", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDICATOR BIOLOGICAL CELERITY 20 HP LCB044", "code_information": [{"code": "LCB044", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INDICATOR TEMP ULTRA FOREHEAD 100EA PK 14677-493", "code_information": [{"code": "14677-493", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INDICATOR TEMPERATURE FOREHEAD ULTRA", "code_information": [{"code": "493", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INDIGO CARMINE 0.8% INJ 5 ML", "code_information": [{"code": "MED0099", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 426.0, "discounted_cash": 149.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INDIRECT IMMUNOFLUORESCENCE", "code_information": [{"code": "D0483", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDIV PDC > 0.8", "code_information": [{"code": "G9512", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDIV PDC NOT > 0.8", "code_information": [{"code": "G9513", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDOCYANINE GREEN (CARDIO GREEN) 25 MG", "code_information": [{"code": "MED0272", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 241.0, "discounted_cash": 84.35, "setting": "both", "billing_class": "facility"}]}, {"description": "INDUCED ABORTION BY DILATION AND CURETTAGE 59840", "code_information": [{"code": "59840", "type": "CPT"}, {"code": "1481079", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION BY DILATION AND EVACUATION 59841", "code_information": [{"code": "59841", "type": "CPT"}, {"code": "1481080", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION BY INTRA-AMNIOTIC INJECTION 59850", "code_information": [{"code": "59850", "type": "CPT"}, {"code": "1481081", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION BY INTRA-AMNIOTIC INJECTION WITH HYSTEROTOMY 59852", "code_information": [{"code": "59852", "type": "CPT"}, {"code": "1481082", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION BY VAGINAL SUPPOSITORIES 59855", "code_information": [{"code": "59855", "type": "CPT"}, {"code": "1481083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION BY VAGINAL SUPPOSITORIES W/D& C AND/OR EVACUATION 59856", "code_information": [{"code": "59856", "type": "CPT"}, {"code": "1481084", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION BYINTRA-AMNIOTIC INJECTION W/D& C AND/OR EVACUATION 59851", "code_information": [{"code": "59851", "type": "CPT"}, {"code": "1481085", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION VAGINAL SUPPOSITORIES WITH HYSTEROTOMY 59857", "code_information": [{"code": "59857", "type": "CPT"}, {"code": "1481086", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDUCTION OF VOMITING", "code_information": [{"code": "99175", "type": "CPT"}], "standard_charges": [{"minimum": 116.03, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 116.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDX SUICD IDEA, NO 0 SCR", "code_information": [{"code": "M1359", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDX WHODAS 2.0 OR SDS", "code_information": [{"code": "M1340", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INELIG FOOTWR EVAL", "code_information": [{"code": "G2180", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFANT CAP DOUBLE PLY BLUE STRIPE", "code_information": [{"code": "CAP-B2PLY", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INFANT CAP DOUBLE PLY PINK STRIPE", "code_information": [{"code": "CAP-P2PLY", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "758", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5898.69, "maximum": 10126.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5898.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8436.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9280.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10126.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "757", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9274.75, "maximum": 15922.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9274.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13264.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14591.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15922.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "759", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4157.12, "maximum": 7136.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4157.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5945.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6540.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7136.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "854", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12909.34, "maximum": 22162.13, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12909.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18463.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20309.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22162.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "853", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30219.13, "maximum": 51878.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30219.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43219.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47541.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51878.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "855", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9244.94, "maximum": 15871.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9244.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13222.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14544.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15871.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS DISEASE SS", "code_information": [{"code": "G4010", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFINION CX PERM KIT CONTAINING ENTRADA NEEDLE", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-2417A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5871.0, "discounted_cash": 2054.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "727", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8643.94, "maximum": 14839.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8643.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12362.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13598.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14839.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC", "code_information": [{"code": "728", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4901.07, "maximum": 8413.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4901.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7009.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7710.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8413.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITH CC", "code_information": [{"code": "386", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6053.19, "maximum": 10391.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6053.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8657.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9523.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10391.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITH MCC", "code_information": [{"code": "385", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9868.45, "maximum": 16941.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9868.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14114.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15525.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16941.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC", "code_information": [{"code": "387", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4347.52, "maximum": 7463.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4347.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6217.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6839.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7463.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLATION DEVICE BALLOON CATHETER ACCLARENT SE", "code_information": [{"code": "SEID", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLATION DEVICE Disposable Balloon Inflation Device 60 ml with lock 131-4493", "code_information": [{"code": "DB25011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLATION DEVICE SEID ACCLARENT SE", "code_information": [{"code": "STR005432", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLUENZA A AG IF", "code_information": [{"code": "87276", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA A/B EACH AG IA", "code_information": [{"code": "87400", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA B AG IF", "code_information": [{"code": "87275", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB 1+", "code_information": [{"code": "87501", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 79.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 73.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 73.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB ADDL", "code_information": [{"code": "87503", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 36.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROBE", "code_information": [{"code": "87502", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 131.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 244.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 384.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 384.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 384.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 137.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 137.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS ANTIBODY", "code_information": [{"code": "86710", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME INSTRUMENT KIT FOR 2.0MM EXINF912000", "code_information": [{"code": "EXINF912000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1259.25, "discounted_cash": 440.74, "setting": "both", "billing_class": "facility"}]}, {"description": "INFRARED THERAPY", "code_information": [{"code": "97026", "type": "CPT"}], "standard_charges": [{"minimum": 28.62, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRATEMPORAL APPROACH/SKULL", "code_information": [{"code": "61590", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRATEMPORAL APPROACH/SKULL", "code_information": [{"code": "61591", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUSE KIT BONE GRAFT SMALL 7510200", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "7510200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8879.0, "discounted_cash": 3107.65, "setting": "both", "billing_class": "facility"}]}, {"description": "INFUSE RADIOACTIVE MATERIALS", "code_information": [{"code": "77750", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 384.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 526.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 826.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 826.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 826.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 323.15, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 344.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUSION SLEEVE KIT", "code_information": [{"code": "8065752901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INFUSUIN LINE 27G UNIVERSAL SILICONE", "code_information": [{"code": "1279.HF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 63.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE ADDL 60 MIN", "code_information": [{"code": "95079", "type": "CPT"}], "standard_charges": [{"minimum": 313.11, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 313.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 492.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 492.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 492.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE INI 120 MIN", "code_information": [{"code": "95076", "type": "CPT"}], "standard_charges": [{"minimum": 341.69, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 341.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 536.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 536.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 536.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC", "code_information": [{"code": "351", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9080.09, "maximum": 15588.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9080.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12986.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14285.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15588.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [{"code": "350", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14932.55, "maximum": 25635.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14932.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21356.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23492.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25635.48, "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": 6718.07, "maximum": 11533.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6718.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9608.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10569.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11533.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGUINOFEMORAL LYMPHADENECTOMY SUPERFICIAL CLOQUETS NODE 38760", "code_information": [{"code": "38760", "type": "CPT"}, {"code": "1900990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INHIBIN A", "code_information": [{"code": "86336", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INHLNT ANESTH ONLY FOR INDUC", "code_information": [{"code": "G9955", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INI PHQ9 >9 NO REMISS >=5", "code_information": [{"code": "G9395", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INI PHQ9 >9 NOT ASSESS", "code_information": [{"code": "G9396", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INI PHQ9 >9 REMISS <5", "code_information": [{"code": "G9393", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT DAY HOSP NEONATE CARE", "code_information": [{"code": "99477", "type": "CPT"}], "standard_charges": [{"minimum": 1565.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1565.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2460.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2460.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2460.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 511.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT NB EM PER DAY NON-FAC", "code_information": [{"code": "99461", "type": "CPT"}], "standard_charges": [{"minimum": 282.9, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 282.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 444.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 444.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 444.56, "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": 368.72, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 368.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 579.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 579.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 579.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT PM E/M NEW PAT 65+ YRS", "code_information": [{"code": "99387", "type": "CPT"}], "standard_charges": [{"minimum": 573.74, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 573.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 901.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 901.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 901.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT PM E/M NEW PAT INFANT", "code_information": [{"code": "99381", "type": "CPT"}], "standard_charges": [{"minimum": 344.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 344.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT/SUB PSYCH CARE M 1ST 30", "code_information": [{"code": "G2214", "type": "HCPCS"}], "standard_charges": [{"minimum": 177.99, "maximum": 279.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 177.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 279.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 279.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 279.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAL FOOT EXAM PT LOPS", "code_information": [{"code": "G0245", "type": "HCPCS"}], "standard_charges": [{"minimum": 511.25, "maximum": 803.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAL PREVENTIVE EXAM", "code_information": [{"code": "G0402", "type": "HCPCS"}], "standard_charges": [{"minimum": 511.25, "maximum": 803.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAL TREATMENT OF BURN(S)", "code_information": [{"code": "16000", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAT MED ASSIST TX IN ER", "code_information": [{"code": "G2213", "type": "HCPCS"}], "standard_charges": [{"minimum": 300.37, "maximum": 472.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 300.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 472.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 472.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 472.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ANESTHETIC AGENT/STEROID; OTHER PERIPHERAL NERVE OR BRANCH 64450", "code_information": [{"code": "64450", "type": "CPT"}, {"code": "1646741", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CATH PLACE OF DISG/THERA SUBSTANCE EPIDURAL OR SUBARACHNOID LUMBAR/SACRAL ADDL LEVEL PP 64484", "code_information": [{"code": "64484", "type": "CPT"}, {"code": "9975546", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CATH PLACE OF DISG/THERA SUBSTANCE EPIDURAL OR SUBARACHNOID LUMBAR/SACRAL PP 64483", "code_information": [{"code": "64483", "type": "CPT"}, {"code": "9975545", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DIAG/THERAPEUTIC AGENT PARAVERTEBRAL FACET JOINT W/ IMAGE GUIDANCE LUMBAR/SACRAL 2ND LEVEL 64494", "code_information": [{"code": "64494", "type": "CPT"}, {"code": "1582410", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DIAGNOSTIC/THERAPEUTIC AGENT PARAVERTEBRAL FACET JOINT W/ IMAGE GUIDANCE LUMBAR/SACRAL 64493", "code_information": [{"code": "64493", "type": "CPT"}, {"code": "1582416", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DUPUYTREN CORD W/ENZYME", "code_information": [{"code": "20527", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ W/FLUOR EVAL CV DEVICE", "code_information": [{"code": "36598", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. BONE SUB MAT. INTO SUBCHONDRAL BONE DEFECT W/IMAGE 0707T", "code_information": [{"code": "707T", "type": "CPT"}, {"code": "46020889", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8312.0, "gross_charge": 6022.0, "discounted_cash": 2107.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2914.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ.ANESTHETIC AGENT AND/OR STEROID; LUMBAR/SACRAL 64483", "code_information": [{"code": "64483", "type": "CPT"}, {"code": "1481088", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ.ANESTHETIC AGENT AND/OR STEROID; LUMBAR/SACRAL EA ADD. 64484", "code_information": [{"code": "64484", "type": "CPT"}, {"code": "1583508", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ.DIAG./THERA.AGENT PARAVERTEBRAL FACET JOINT W/IMAGE CERVICAL/THORACIC SINGLE LEVEL 64490", "code_information": [{"code": "64490", "type": "CPT"}, {"code": "1481089", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT FOR LYMPHATIC X-RAY", "code_information": [{"code": "38790", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT SINUS TRACT FOR X-RAY", "code_information": [{"code": "20501", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS >7", "code_information": [{"code": "11901", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/ASPIRATE LIVER CYST", "code_information": [{"code": "47015", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67505", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67515", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTABLE K30003010 AUGMENT 3CC K30003010", "code_information": [{"code": "C1734", "type": "HCPCS"}, {"code": "K30003010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6839.0, "discounted_cash": 2393.65, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION ABDOMINAL SHUNT", "code_information": [{"code": "49427", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT AND/OR STEROID GENICULAR NERVE BRANCH W/IMAGE 64454", "code_information": [{"code": "64454", "type": "CPT"}, {"code": "45577564", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 379.94, "maximum": 8450.0, "gross_charge": 785.0, "discounted_cash": 274.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 379.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT AND/OR STEROID INNERVATING SACROILIAC JT W/IMAGE 64451", "code_information": [{"code": "64451", "type": "CPT"}, {"code": "45577563", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 487.38, "maximum": 8450.0, "gross_charge": 1007.0, "discounted_cash": 352.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 487.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT PLANTAR COMMON DIGITAL NERVE 64455", "code_information": [{"code": "64455", "type": "CPT"}, {"code": "1635703", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT STEROID TRANSFORAMINAL CERV/THOR; EA ADD. 64480", "code_information": [{"code": "64480", "type": "CPT"}, {"code": "1668562", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT STEROID TRANSFORAMINAL CERV/THOR; SINGLE 64479", "code_information": [{"code": "64479", "type": "CPT"}, {"code": "1481087", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;AXILLARY NERVE 64417", "code_information": [{"code": "64417", "type": "CPT"}, {"code": "1481092", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;BRACHIAL PLEXUS CONTINUOUS INFUSION 64416", "code_information": [{"code": "64416", "type": "CPT"}, {"code": "1481093", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;BRACHIAL PLEXUS SINGLE 64415", "code_information": [{"code": "64415", "type": "CPT"}, {"code": "1481094", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;FEMORAL NERVE CONTINUOUS INFUSION 64448", "code_information": [{"code": "64448", "type": "CPT"}, {"code": "1481098", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;FEMORAL NERVE SINGLE 64447", "code_information": [{"code": "64447", "type": "CPT"}, {"code": "1481099", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 985.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;GREATER OCCIPITAL NERVE 64405", "code_information": [{"code": "64405", "type": "CPT"}, {"code": "1481100", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;ILIOINGUINAL ILIOHYPOGASTRIC NERVES 64425", "code_information": [{"code": "64425", "type": "CPT"}, {"code": "1481101", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;INTERCOSTAL NERVE SINGLE 64420", "code_information": [{"code": "64420", "type": "CPT"}, {"code": "1481102", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;INTERCOSTAL NERVES MULTIPLE REGIONAL BLOCK 64421", "code_information": [{"code": "64421", "type": "CPT"}, {"code": "1481103", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;LUMBAR PLEXUS POST.APPROACH CONTINUOUS INFUSION 64449", "code_information": [{"code": "64449", "type": "CPT"}, {"code": "1481105", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;PUDENDAL NERVE 64430", "code_information": [{"code": "64430", "type": "CPT"}, {"code": "1481108", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;SCIATIC NERVE CONTINUOUS INFUSION 64446", "code_information": [{"code": "64446", "type": "CPT"}, {"code": "1481109", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 539.17, "maximum": 8450.0, "gross_charge": 1114.0, "discounted_cash": 389.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 539.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;SCIATIC NERVE SINGLE 64445", "code_information": [{"code": "64445", "type": "CPT"}, {"code": "1481110", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;SUPRASCAPULAR NERVE 64418", "code_information": [{"code": "64418", "type": "CPT"}, {"code": "1481115", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT/STEROID;TRIGEMINAL NERVE ANY DIVISION OR BRANCH 64400", "code_information": [{"code": "64400", "type": "CPT"}, {"code": "1481116", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT;CELIAC PLEXUS 64530", "code_information": [{"code": "64530", "type": "CPT"}, {"code": "1481096", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT;LUMBAR OR THORACIC 64520", "code_information": [{"code": "64520", "type": "CPT"}, {"code": "1481104", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT;SPHENOPALATINE GANGLION 64505", "code_information": [{"code": "64505", "type": "CPT"}, {"code": "1481111", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT;SPINAL ACCESSORY NERVE 64412", "code_information": [{"code": "1481112", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1071.0, "discounted_cash": 374.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT;STELLATE GANGLION 64510", "code_information": [{"code": "64510", "type": "CPT"}, {"code": "1481113", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT;SUPERIOR HYPOGASTRIC PLEXUS 64517", "code_information": [{"code": "64517", "type": "CPT"}, {"code": "1481114", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. CERVICAL/THORACIC W/IMAGE 62321", "code_information": [{"code": "62321", "type": "CPT"}, {"code": "44660562", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. CERVICAL/THORACIC W/O IMAGE 62320", "code_information": [{"code": "62320", "type": "CPT"}, {"code": "44660561", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/IMAGE 62323", "code_information": [{"code": "62323", "type": "CPT"}, {"code": "44660564", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/O IMAGE 62322", "code_information": [{"code": "62322", "type": "CPT"}, {"code": "44660563", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION DIAGNOSTIC OR THERAPEUTIC AGENT W/ IMAGE GUIDANCE LUMBAR/SACRAL 3RD LEVEL 64495", "code_information": [{"code": "64495", "type": "CPT"}, {"code": "1582412", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION DIAGNOSTIC/THERAPEUTIC AGENT CERVICAL/THORACIC 3RD LEVEL 64492", "code_information": [{"code": "64492", "type": "CPT"}, {"code": "1582409", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION DIAGNOSTIC/THERAPEUTIC AGENT PARAVERTEBRAL FACET JOINT W/ IMAGE CERVICAL/THORACIC 64491", "code_information": [{"code": "64491", "type": "CPT"}, {"code": "1582408", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION EPIDURAL OF BLOOD OR CLOT PATCH 62273", "code_information": [{"code": "62273", "type": "CPT"}, {"code": "1481117", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION EXT VENOGRAPHY", "code_information": [{"code": "36005", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR ANKLE X-RAY", "code_information": [{"code": "27648", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", "code_information": [{"code": "51600", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47531", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47532", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR DISCOGRAPHY; EACH LEVEL CERVICAL OR THORACIC 62291", "code_information": [{"code": "62291", "type": "CPT"}, {"code": "4240127", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP ARTHROGRAPHY W/ANESTHESIA 27095", "code_information": [{"code": "27095", "type": "CPT"}, {"code": "1481118", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP ARTHROGRAPHY W/O ANESTHESIA 27093", "code_information": [{"code": "27093", "type": "CPT"}, {"code": "1481119", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SALIVARY X-RAY", "code_information": [{"code": "42550", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SHOULDER ARTHROGRAPHY 23350", "code_information": [{"code": "23350", "type": "CPT"}, {"code": "1481121", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SPLEEN X-RAY", "code_information": [{"code": "38200", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR TEAR SAC X-RAY", "code_information": [{"code": "68850", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50684", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50690", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR WRIST ARTHROGRAPHY 25246", "code_information": [{"code": "25246", "type": "CPT"}, {"code": "1481122", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INC. CATH. PLACEMENT DIAG./THER. SUB. W/NEEDLE OR CATH. CERVICAL/THORACIC W/IMAGE 62325", "code_information": [{"code": "62325", "type": "CPT"}, {"code": "44660572", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INC. CATH. PLACEMENT DIAG./THER. SUB. W/NEEDLE OR CATH. CERVICAL/THORACIC W/O IMAGE 62324", "code_information": [{"code": "62324", "type": "CPT"}, {"code": "44660571", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INC. CATH. PLACEMENT DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/IMAGE 62327", "code_information": [{"code": "62327", "type": "CPT"}, {"code": "44660574", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.36, "maximum": 8450.0, "gross_charge": 1071.0, "discounted_cash": 374.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 518.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INC. CATH. PLACEMENT DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/O IMAGE 62326", "code_information": [{"code": "62326", "type": "CPT"}, {"code": "44660573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.36, "maximum": 8450.0, "gross_charge": 1071.0, "discounted_cash": 374.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 518.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61026", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61055", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO HEMORRHOID(S)", "code_information": [{"code": "46500", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO SPINAL ARTERY", "code_information": [{"code": "62294", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO VOCAL CORD", "code_information": [{"code": "31513", "type": "CPT"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTRALESIONAL UP TO 7 LESIONS 11900", "code_information": [{"code": "11900", "type": "CPT"}, {"code": "1703013", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTRAOP ADD-ON", "code_information": [{"code": "48400", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION JAW JOINT X-RAY", "code_information": [{"code": "21116", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION NEEDLES Injection Needle Lower 129-0170 22/5 2.3 230 2.8", "code_information": [{"code": "IN33151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION NEEDLES Injection Needle Lower 129-0172 25/5 2.3 230 2.8", "code_information": [{"code": "IN33241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION NEEDLES Injection Needle Upper 129-0169 22/5 2.3 180 2.8", "code_information": [{"code": "IN33131", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION NEEDLES Injection Needle Upper 129-0171 25/5 2.3 180 2.8", "code_information": [{"code": "IN33221", "type": "CDM"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION OF SINUS TRACT", "code_information": [{"code": "20500", "type": "CPT"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 402.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION OF VITREOUS SUBSTITUTE PARS PLANA OR LIMBAL APPROACH 67025", "code_information": [{"code": "67025", "type": "CPT"}, {"code": "1481126", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION PLATELET RICH PLASMA INC IMAGE HARVEST/PREP 0232T", "code_information": [{"code": "232T", "type": "CPT"}, {"code": "1764940", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 2881.0, "gross_charge": 1302.0, "discounted_cash": 455.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 630.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION PROCEDURE FOR CHEMONUCLEOLYSIS; INCL. DISCOGRAPHY; LUMBAR 62292", "code_information": [{"code": "62292", "type": "CPT"}, {"code": "45451630", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION PROCEDURE FOR DISCOGRAPHY;LUMBAR 62290", "code_information": [{"code": "62290", "type": "CPT"}, {"code": "1481127", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY 24220", "code_information": [{"code": "24220", "type": "CPT"}, {"code": "1700136", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3598.0, "discounted_cash": 1259.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1741.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION PROCEDURE FOR MYELOGRAPHY AND/OR COMPUTED TOMOGRAPHY LUMBAR 62284", "code_information": [{"code": "62284", "type": "CPT"}, {"code": "1481128", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION PROCEDURE FOR RETROGRADE URETHROCYSTOGRAPHY 51610", "code_information": [{"code": "51610", "type": "CPT"}, {"code": "1839671", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION RECTUS SHEATH 20550", "code_information": [{"code": "20550", "type": "CPT"}, {"code": "1481130", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION SACROILIAC JOINT STEROID W/ OR W/O ARTHROGRAPHY G0260", "code_information": [{"code": "G0260", "type": "HCPCS"}, {"code": "1618454", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 2881.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION SACROILIAC JOINT STEROID W/ OR W/O ARTHROGRAPHY PP G0260", "code_information": [{"code": "G0260", "type": "HCPCS"}, {"code": "9975550", "type": "CDM"}, {"code": "409", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 2881.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION SINGLE TENDON 20551", "code_information": [{"code": "20551", "type": "CPT"}, {"code": "1481132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION THERAPEUTIC CARPAL TUNNEL 20526", "code_information": [{"code": "20526", "type": "CPT"}, {"code": "1915663", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF EYE", "code_information": [{"code": "66030", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64681", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NOSE", "code_information": [{"code": "30200", "type": "CPT"}], "standard_charges": [{"minimum": 402.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 402.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TRIGGER POINT MULTIPLE 20553", "code_information": [{"code": "20553", "type": "CPT"}, {"code": "1481133", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TRIGGER POINT SINGLE 20552", "code_information": [{"code": "20552", "type": "CPT"}, {"code": "1481134", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION VIA DISC NP 100MG VCAD-00100", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "VCAD-00100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION WATER 1000 ML PLASTIC CONTAINER FOR IRRIGATION STRL", "code_information": [{"code": "2B7114X", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE;EPIDURAL CERVICAL OR THORACIC 62281", "code_information": [{"code": "62281", "type": "CPT"}, {"code": "1481137", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE;EPIDURAL LUMBAR SACRAL 62282", "code_information": [{"code": "62282", "type": "CPT"}, {"code": "1481138", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE;SUBARACHNOID 62280", "code_information": [{"code": "62280", "type": "CPT"}, {"code": "1481139", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION; ANTERIOR CHAMBER OF EYE; AIR OR LIQUID 66020", "code_information": [{"code": "66020", "type": "CPT"}, {"code": "44561866", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTOR 5.0 TRANSFER TUBE", "code_information": [{"code": "909-400-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 73.15, "setting": "both", "billing_class": "facility"}]}, {"description": "INNATE IMPLANT 3.6MM X 55MM EXINN923655", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINN923655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3615.0, "discounted_cash": 1265.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INNER SKULL VESSEL SURGERY", "code_information": [{"code": "61702", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT ELECT CAROTID INTERVENT", "code_information": [{"code": "G9689", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT30", "code_information": [{"code": "G0425", "type": "HCPCS"}], "standard_charges": [{"minimum": 446.6, "maximum": 701.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 446.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 701.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 701.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 701.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT50", "code_information": [{"code": "G0426", "type": "HCPCS"}], "standard_charges": [{"minimum": 607.12, "maximum": 954.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 607.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 954.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 954.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 954.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT70", "code_information": [{"code": "G0427", "type": "HCPCS"}], "standard_charges": [{"minimum": 901.14, "maximum": 1416.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 901.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1416.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1416.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1416.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 15", "code_information": [{"code": "G0406", "type": "HCPCS"}], "standard_charges": [{"minimum": 173.22, "maximum": 272.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 173.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 272.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 272.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 272.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 25", "code_information": [{"code": "G0407", "type": "HCPCS"}], "standard_charges": [{"minimum": 322.64, "maximum": 507.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 322.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 507.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 507.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 507.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 35", "code_information": [{"code": "G0408", "type": "HCPCS"}], "standard_charges": [{"minimum": 464.06, "maximum": 729.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 464.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 729.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 729.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 729.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS BONE DEVICE FOR RSA", "code_information": [{"code": "347T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 1ST", "code_information": [{"code": "36245", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 2ND", "code_information": [{"code": "36246", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 3RD", "code_information": [{"code": "36247", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART ADDL", "code_information": [{"code": "36248", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BILAT", "code_information": [{"code": "36252", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNILAT", "code_information": [{"code": "36251", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ BILAT", "code_information": [{"code": "36254", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ UNILAT", "code_information": [{"code": "36253", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS DEVICE FOR RT GUIDE OPEN", "code_information": [{"code": "49412", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37191", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS MARK ABD/PEL FOR RT PERQ", "code_information": [{"code": "49411", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS MARK THOR FOR RT PERQ", "code_information": [{"code": "32553", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61889", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS VAG BRACHYTX DEVICE", "code_information": [{"code": "57156", "type": "CPT"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS. ANT. SEG. DRAINAGE DEVICE TRAB. MESH W/O EXT. RES. CAT ONE OR MORE 0671T", "code_information": [{"code": "671T", "type": "CPT"}, {"code": "46125796", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 6074.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS/REP SUBQ DEFIBRILLATOR", "code_information": [{"code": "33270", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS/RPLCM PRQ ELTRD RA PN EA", "code_information": [{"code": "64597", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS/RPLCMT PRQ ELTRD RA PN 1", "code_information": [{"code": "64596", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS/RPLMT ELTRD RA SPI NSTIM", "code_information": [{"code": "784T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSEMINATION OF OOCYTES", "code_information": [{"code": "89268", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT - PS SZE 4 THKNS 11MM TRIATHLON X3 TIBIAL BEARING 5532-G-411", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3748.0, "discounted_cash": 1311.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT - PS SZE 6 THKNS 9MM TRIATHLON X3 TIBIAL BEARING 5532-G-609-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-609-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT 1 ELECTRODE PM-DEFIB", "code_information": [{"code": "33216", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 1/2 36 MM +3MM REVERSED DWP1363", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP1363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT 2 ELECTRODE PM-DEFIB", "code_information": [{"code": "33217", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 3/4 HUMERAL REVERSED DAI 42MM THICKNESS +6MM DWP2426", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP2426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT 3/4 HUMERAL REVERSED DIA 42MM THICKNESS +3MM DWP2423", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP2423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT 32MM NEUTRAL SMALL SOCKET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "509-02-432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1580.0, "discounted_cash": 553.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT 36 DIAMETER RENTENTIVE REVERSED INSERT+ 9/12.5 B DWF365B", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF365B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4310.0, "discounted_cash": 1508.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT 45 PERCENT SIZE 3/4 DWS2396", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS2396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ABDOMEN-VENOUS DRAIN", "code_information": [{"code": "49425", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ACET RIMLESS VITALITE 36MM ID 58MM 1724-0-3658", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1724-0-3658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3366.04, "discounted_cash": 1178.11, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ADMMDM X3 48 MM OD 28 MM ID X 9.9 MM 7236-2-854", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7236-2-854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT AQUEOUS DRAIN DEVICE", "code_information": [{"code": "253T", "type": "CPT"}], "standard_charges": [{"minimum": 3951.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ARTICULAR SIZE 7-8 11MM LEGIONX L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3757.0, "discounted_cash": 1314.95, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ATTUNE KNEE SYSTEM TIBIAL FIXED BEARING MEDIAL STABILIZED SZ 6 RIGHT 10MM AOX 1520-20-610", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1520-20-610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1400.0, "discounted_cash": 490.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BALLOON DEVICE", "code_information": [{"code": "33973", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT BEARING SZ 4 13MM TIBL CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING SZ 4 9MM TRIATHLON TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3436.0, "discounted_cash": 1202.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING X3 SZ 3 9MM TIBIAL 5531-G-309-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-309-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING X3 SZ 4 9MM TIBIAL 5531-G-409-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-409-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BLADDER CATH COMPLEX", "code_information": [{"code": "51703", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT BLADDER CATHETER", "code_information": [{"code": "51701", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT BRAIN-FLUID DEVICE", "code_information": [{"code": "61215", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CARD ELECTRODES DUAL", "code_information": [{"code": "33211", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/ IMAGE", "code_information": [{"code": "32557", "type": "CPT"}], "standard_charges": [{"minimum": 1334.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1334.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/O IMAGE", "code_information": [{"code": "32556", "type": "CPT"}], "standard_charges": [{"minimum": 1334.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1334.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CERVICAL DILATOR", "code_information": [{"code": "59200", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CM ONLAY TIBIA 35 X 11 340-35-011", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "340-35-011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CR 11MM THICKNESS SIZE 6 TIBIAL BEARING 5530-G-611-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-611-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CUSHION STANDARD PRONEVIEW", "code_information": [{"code": "D28503CE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CV CATH INF & SUP APP", "code_information": [{"code": "C9780", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT DRUG DEL IMPLANT, >=4", "code_information": [{"code": "G0516", "type": "HCPCS"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRD/PM CATH SNGL", "code_information": [{"code": "33210", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRODES FOR EEG", "code_information": [{"code": "95830", "type": "CPT"}], "standard_charges": [{"minimum": 419.57, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 419.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 659.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 659.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 659.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EMERGENCY AIRWAY", "code_information": [{"code": "31500", "type": "CPT"}], "standard_charges": [{"minimum": 598.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ENDOVASC PROSTH TAA", "code_information": [{"code": "33883", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD ENDO", "code_information": [{"code": "33203", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD OPEN", "code_information": [{"code": "33202", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT FLEX SHOULDER SYSTEM REVERSED DWF391C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF391C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HAT TRICK 2.7 X 4 MM 10 DEG PIP FUSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72204370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1380.0, "discounted_cash": 483.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HEART PM ATRIAL", "code_information": [{"code": "33206", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HEART PM VENTRICULAR", "code_information": [{"code": "33207", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HEPATIC SHUNT (TIPS)", "code_information": [{"code": "37182", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HEYMAN UTERI CAPSULE", "code_information": [{"code": "58346", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HI FLEX SZ 3 - 4 25MM POST STABELIZED GII", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2466.0, "discounted_cash": 863.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HI FLEX SZ 5 - 6 25MM POST STABELIZED GII", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2466.0, "discounted_cash": 863.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HIP 28MM RESTORATION ADM X3 FOR CUP OD 48 MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1236-2-848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2560.0, "discounted_cash": 896.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HIP FOR MDM LINER 22.2 MM 38 D", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1236-2-244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HOOD APEX-LNK POLY ACETABULAR UHMWPE D INSERT/36MM ID 10 DEGREE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "H5-54436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUMERAL 36MM PERFORM SHOULDER DWS3360", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS3360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUMERAL 36MM X 9MM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWB994", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2342.0, "discounted_cash": 819.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUMERAL LFT SZ 42 POSITIVE 6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9503L-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2987.0, "discounted_cash": 1045.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUMERAL SIZE 1/2 39MM DWS3393", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS3393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUMERAL SYSTEM SIZE 3 / 4 42MM THICK 3MM DWS4423", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS4423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUMERAL SYSTEM SZ 3 / 4 42MM THICKNESS 6MM DWS4426", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS4426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUMERAL SYSTEM VE RETENTIVE REVERSED SIZE 3/4 0:39MM DWS4396", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS4396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUMERAL VE SZ 1/2 33MM DWS1333", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS1333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT I-AORT PERCUT DEVICE", "code_information": [{"code": "33967", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT IMPLANT 0DEG 36MM TRIDENT X3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "623-00-36F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT INTERBODY DEVICE W/ANT. INST. ANCHOR INTERVERT. DISC EA CONTIGOUS DEFECT 22854", "code_information": [{"code": "22854", "type": "CPT"}, {"code": "44660497", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTERBODY DEVICE W/ANT. INST. ANCHOR INTERVERT. DISC EA SPACE 22853", "code_information": [{"code": "22853", "type": "CPT"}, {"code": "44660496", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTERLAMINAR DISTRACTION DEV. W/O FUSION SECOND LEVEL LUMBAR 22870", "code_information": [{"code": "22870", "type": "CPT"}, {"code": "44660510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTERLAMINAR DISTRACTION DEV. W/O FUSION SINGLE LEVEL LUMBAR 22869", "code_information": [{"code": "22869", "type": "CPT"}, {"code": "44660507", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 9735.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTRACORPOREAL DEVICE", "code_information": [{"code": "33979", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTRAOCULAR LENS PROSTHESIS NOT ASSOCIATED W/CONCURRENT CATARACT REMOVAL 66985", "code_information": [{"code": "66985", "type": "CPT"}, {"code": "1481140", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT JOURNEY 42MM 60MM RIGHT SIZE 1-2 74029213", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74029213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5200.0, "discounted_cash": 1820.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT JOURNEY II BCS CONSTRAINED ARTICULAR SIZE 5-6 LEFT 13MM 74029265", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74029265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5334.0, "discounted_cash": 1866.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT JOURNEY II BCS CONSTRAINED ARTICULAR SIZE 5-6 RIGHT 13MM 74029255", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74029255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5494.0, "discounted_cash": 1922.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT JOURNEY II UNI TIBIAL XLPE SIZE 5-6 8MM LM/RL 71935213", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71935213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2590.0, "discounted_cash": 906.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT JOURNEY II UNI TIBIAL XLPE SIZE 5-6 9MM RM/LL 71935226", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71935226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1403.0, "discounted_cash": 491.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT JRNY II BCS CNSTRD ART ISRT RT 7-8 13M 74029275", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74029275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5494.0, "discounted_cash": 1922.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT KIT PF KNEE REVISION A 464502", "code_information": [{"code": "464502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7477.65, "discounted_cash": 2617.18, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33330", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33335", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT MODULAR 2.5MM OFFSET 3.6MM THICK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9P15-PB01-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4497.0, "discounted_cash": 1573.95, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT NASAL SEPTAL BUTTON", "code_information": [{"code": "30220", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE CATH BOWEL", "code_information": [{"code": "44015", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT NEUTRAL SZ 32MM SMALL SOCKET 508-02-032", "code_information": [{"code": "508-02-032", "type": "CDM"}], "standard_charges": [{"gross_charge": 1391.0, "discounted_cash": 486.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36555", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36556", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65130", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65135", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT OR3O DUAL MOBILITY XLPE 22/38 71358214", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71358214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7674.0, "discounted_cash": 2685.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT OR3O DUAL MOBILITY XLPE 28/44 71358219", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71358219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6216.0, "discounted_cash": 2175.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PACING LEAD & CONNECT", "code_information": [{"code": "33224", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PALATE IMPLANTS", "code_information": [{"code": "C9727", "type": "HCPCS"}], "standard_charges": [{"minimum": 2554.0, "maximum": 3058.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PATELLA ASYMMETRIC 38 X 11MM STERILE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5552-L-381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PELV FIXATION DEVICE", "code_information": [{"code": "22848", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PERFORM 33MM DWS1336", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS1336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PERFORM HUMERAL SYSTEM REVERSED DWS1363", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS1363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PERFORM HUMERAL SYSTEM SIZE 3/4 DWS2366", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS2366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PERFORM HUMERAL SYSTEM VE REVERSED DWS1360", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS1360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PERFORM HUMERAL SYSTEM VE REVERSED VE SIZE 3/4 39MM +0MM THICK DWS2390", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS2390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PERFORM REV SZ 3 4 39MM DWP2396", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP2396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PERFORM REV SZ 3/4 36MM DIA +3 VE DWS2363", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS2363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PESSARY/OTHER DEVICE", "code_information": [{"code": "57160", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36570", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36571", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PLEURAL CATH", "code_information": [{"code": "32550", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT POLYETHYLENE 36.0MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "623-00-36E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PROST URETHRAL STENT", "code_information": [{"code": "53855", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PS SZE 5 THKNS 13MM TIRATHLON X3 TIBIAL BEARING 5532-G-513-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-513-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PSN ASF CPS 14MM VER 3-5CD 42-5226-004-14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5226-004-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8102.0, "discounted_cash": 2835.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN DUAL LEADS", "code_information": [{"code": "33213", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN MULT LEADS", "code_information": [{"code": "33221", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN SNGL LEAD", "code_information": [{"code": "33212", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT REVERSED 36 X 9 X 12.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF362B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2078.0, "discounted_cash": 727.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT REVERSED PERFORM HUMERAL SYSTEM SIZE 3 DWP2393", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP2393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT REVERSED PERFORM UHMWPE + TI6AI4V SZ1/2 39MM +3MM DWP1393", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP1393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT REVISION REVERSED 36 DIAMETER+ 6/7.5 C DWF361C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF361C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT RING SZ F G7 HARD BEARING I 110026855", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110026855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SHOULDER HUMERAL 33MM DWS1330", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS1330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SHOULDER HUMERAL 3X39MM DWS1393", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS1393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SHOULDER REVERSED FLEX 36MM +6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF361B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2078.0, "discounted_cash": 727.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SIZE 3 36MM REVERSED DWP2363", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP2363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SIZE 3 THK 11MM TYP TS TRIATHLON X3 TOTAL STABILIZER PLUS TIBIAL 5537-G-311-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-311-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2318.0, "discounted_cash": 811.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SIZE 3/4 36MM REVERSED DWP2360", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP2360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SIZE 4 THKNS 13MM TYP TS TRIATHLON X3 TOTAL STABILIZER TIBIAL 5537-G-413-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-413-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2196.0, "discounted_cash": 768.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SIZE 5-6 9MM LM/RL JOURNEY II UNI TIBIAL XLPE 71935214", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71935214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2467.0, "discounted_cash": 863.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SMALL SOCKET 36MM NEUTRAL EPLUS 509-02-036", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "509-02-036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1391.0, "discounted_cash": 486.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22841", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22843", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22844", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22847", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SUBQ EXTEN TO IP CATH", "code_information": [{"code": "49435", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 1 TO 2 RIGHT 10MM BI CRUCIATE STABILIZED JOURNEY II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1203.0, "discounted_cash": 421.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 3 TO 4 18MM DISHED GNS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420774", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2395.0, "discounted_cash": 838.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 3 TO 4 LFT 10MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2424.0, "discounted_cash": 848.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 3 TO 4 LFT 12MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 3 TO 4 LFT 13MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2949.0, "discounted_cash": 1032.15, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 3 TO 4 RIGHT 10MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 3 TO 4 RIGHT 11MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1250.0, "discounted_cash": 437.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 3 TO 4 RIGHT 9MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4848.0, "discounted_cash": 1696.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 5 TO 6 18MM DISHED GNS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2491.0, "discounted_cash": 871.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 5 TO 6 LFT 10MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 5 TO 6 LFT 11MM BI CRUCIATE STABILIZED JOURNEY II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 5 TO 6 LFT 12MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1153.0, "discounted_cash": 403.55, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 5 TO 6 LFT 13MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 5 TO 6 RIGHT 10MM BI CRUCIATE STABILIZED JOURNEY II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 5 TO 6 RIGHT 15MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3102.0, "discounted_cash": 1085.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 7 TO 8 18MM POST STABILIZED FLEXIBLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2466.0, "discounted_cash": 863.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 7 TO 8 21MM POST STABILIZED FLEXIBLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2466.0, "discounted_cash": 863.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 7 TO 8 LFT 10MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 7 TO 8 LFT 11MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 7 TO 8 LFT 9MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 7 TO 8 RIGHT 10MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 7 TO 8 RIGHT 12MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SURG SZ 7 TO 8 RIGHT 9MM BI CRUCIATE STABILIZED JOURNEY II XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SZ 1/2 36MM DIA +0 PERFORM REVERSED DWP1360", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWP1360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SZ 3 - 4 13MM DISHED CROSS LINKED POLYETHYLENE LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3907.0, "discounted_cash": 1367.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SZ 3 - 4 15MM DISHED CROSS LINKED POLYETHYLENE LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3907.0, "discounted_cash": 1367.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SZ 3 6MM POLY INFINITY EVERLAST 33683306", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "33683306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8034.0, "discounted_cash": 2811.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SZ 3/4 42MM DIA +0 PERFORM REV DWP2420", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP2420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SZ 5 - 6 11MM DISHED CROSS LINKED POLYETHYLENE LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3907.0, "discounted_cash": 1367.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SZ 7 - 8 13MM DISHED CROSS LINKED POLYETHYLENE LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3757.0, "discounted_cash": 1314.95, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TANDEM CUFF", "code_information": [{"code": "53444", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBAL BEARING SZ 5 11MM TRIATHOLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-511-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 19MM TRIATHLON TS PLUS X3 POLY 5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 867.0, "discounted_cash": 303.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 8MM SIZE 5-6 JOURNEY DEUCE LFT MED RHT LAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71422265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5908.0, "discounted_cash": 2067.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL ARTICULAR FREEDOM TOTAL SZF3-4 9MM MLUCXF309-K", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "MLUCXF309-K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4738.0, "discounted_cash": 1658.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL ATTUNE SZ 9 5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-20-905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL BEARING - CS SZ 3 10MM 5531-G-310-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-310-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL BEARING CR SIZE 2 9MM 5530-G-209-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-209-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL BEARING CS TRIATHLON X3 SZ 4 13MM 5531-G-413-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-413-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL BEARING INSERT CR SIZE 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-411-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL BEARING INSERT CR SIZE 5 TRIATHLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-511-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL BEARING SIZE 3 - 11 THICKNESS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-311-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL BEARING TRIATHLON X3 SZ 2 CS 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-209-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL BEARING TRIATHLON X3 SZ 5 CS 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-509-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL BEARING TRIATHLON X3 SZ 7 CS 9MM 5531-G-709-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-709-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL BEARING TRIATHLON X3 SZ5 CS 11M 5531-G-511-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-511-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL BEARING-CR SZ 4 10MM 5530-G-510-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-510-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL POST STAB SZ5 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-40-510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL VIT E SZ4 9MM 166-7409", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "166-7409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL 16MM TRIATHLON TS PLUS X3 POLY 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5409.0, "discounted_cash": 1893.15, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL 19MM X3 #5 POST TRIATHLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2243.0, "discounted_cash": 785.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL 6MM X 13MM BEARING CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3748.0, "discounted_cash": 1311.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL 9MM RIGHT MEDIAL LFT LAT JOURNEY UNI STRL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71422256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1288.0, "discounted_cash": 450.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL 9MM X3 #7 POST TRIATHLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL BEARING SZ 3 13MM 5531-G-313-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-313-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 1 2 10MM CRUCIATE RETAINING LFT XLPE JOURNEY II IMP", "code_information": [{"code": "74025622", "type": "CDM"}], "standard_charges": [{"gross_charge": 2719.0, "discounted_cash": 951.65, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 1 TO 2 18MM CONSTRAINED GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3761.0, "discounted_cash": 1316.35, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 2 13MM BEARING CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3228.0, "discounted_cash": 1129.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 2 CEMENTED RIGHT GENESIS II IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71420180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4146.0, "discounted_cash": 1451.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 2.5 10MM CV PFC SIGMA RP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "962021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3166.0, "discounted_cash": 1108.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 4 11MM DISHED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3757.0, "discounted_cash": 1314.95, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 4 11MM HIGH FLEXIBLE POST STABILIZED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3872.0, "discounted_cash": 1355.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 4 13MM HIGH FLEXIBLE POST STABILIZED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3688.0, "discounted_cash": 1290.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 4 15MM ARTICULAR CONFINED POLYETHYLENE GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5299.2, "discounted_cash": 1854.72, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 4 18MM HIGH FLEXIBLE POST STABILIZED GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2757.0, "discounted_cash": 964.95, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 4 21MM HIGH FLEXIBLE POST STABILIZED GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2565.0, "discounted_cash": 897.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 4 9MM DISHED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3907.0, "discounted_cash": 1367.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 4 9MM HIGH FLEXIBLE POST STABILIZED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 9MM BEARING ST", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3436.0, "discounted_cash": 1202.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 TO 4 13MM CONSTRAINED GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 TO 4 18MM CONSTRAINED GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6718.0, "discounted_cash": 2351.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3 TO 4 25MM CONSTRAINED GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 3-4 8MM LM TL UNICOMPARTMENTAL KNEE SYS JOURNEY IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71422251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1288.0, "discounted_cash": 450.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 4 15MM ROTATING PLATFORM PFC SIGMA IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "962143", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3329.0, "discounted_cash": 1165.15, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 4 CEMENTED RIGHT GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3599.0, "discounted_cash": 1259.65, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5 11MM BEARING POST STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2244.0, "discounted_cash": 785.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5 16MM BEARING POST STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3694.0, "discounted_cash": 1292.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5 6 11MM HIGH FLEXIBLE POST STABILIZED LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3872.0, "discounted_cash": 1355.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5 6 13MM DISHED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453286", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3688.0, "discounted_cash": 1290.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5 6 13MM HIGH FLEXIBLE POST STABILIZED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3872.0, "discounted_cash": 1355.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5 6 15MM HIGH FLEXIBLE POST STABILIZED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3688.0, "discounted_cash": 1290.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5 6 18MM HIGH FLEXIBLE POST STABILIZED GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2693.0, "discounted_cash": 942.55, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5 6 21MM HIGH FLEXIBLE POST STABILIZED GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2565.0, "discounted_cash": 897.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5 6 9MM DISHED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3907.0, "discounted_cash": 1367.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5 9MM BEARING POST STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2243.0, "discounted_cash": 785.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5 TO 6 15MM CONSTRAINED GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6718.0, "discounted_cash": 2351.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5-6 12MM RIGHT BI CRUCIATE ARTICULAR XLPE JOURNEY II BCS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74027254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 5MM TO 9MM BEARING CRUCIATE RETAINING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3228.0, "discounted_cash": 1129.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 6 CEMENTED LFT GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8055.0, "discounted_cash": 2819.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 7 8 11MM HIGH FLEXIBLE POST STABILIZED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3688.0, "discounted_cash": 1290.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 7 8 9MM DISHED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3907.0, "discounted_cash": 1367.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 7 8 9MM HIGH FLEXIBLE POST STABILIZED XLPE LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71453231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4493.0, "discounted_cash": 1572.55, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 7 NON POROUS CRUCIATE RETAINING LFT LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5707.0, "discounted_cash": 1997.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 7 NON POROUS RIGHT GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3461.0, "discounted_cash": 1211.35, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ 7 TO 8 18MM CONSTRAINED GENESIS II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420558", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6718.0, "discounted_cash": 2351.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TISSUE EXPANDER(S)", "code_information": [{"code": "11960", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TRIATHLON TIBIAL BEARING PS SZ 5 PS 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-p-516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2744.0, "discounted_cash": 960.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TRIATHLON X3 TIBIAL BEARING INSERT PS SZE 4 THKNS 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-409-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH PERC", "code_information": [{"code": "49418", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH W/PORT", "code_information": [{"code": "49419", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36557", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36558", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36560", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36563", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36565", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36566", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ULTRA-CONGRUENT CM 13MM SIZE 6 380-13-506", "code_information": [{"code": "380-13-506", "type": "CDM"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT URETERAL SUPPORT", "code_information": [{"code": "50605", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT VE RETENTIVE REVERSED SIZE 1/2 36MM DWS3366", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS3366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT VE REVERSED SIZE 3/4 39MM +3MM THICK DWS2393", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS2393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT/PLACE HEART CATHETER", "code_information": [{"code": "93503", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT/REPLACE PERIPHERAL/GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECIEVER 64590", "code_information": [{"code": "64590", "type": "CPT"}, {"code": "1481141", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTER REPLCEMENT 23G DISP", "code_information": [{"code": "1272.EDPP6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERTER REPLCEMENT 25G DISP", "code_information": [{"code": "1272.EDPP5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERTER REPLCEMENT 27G DISP", "code_information": [{"code": "1272.EDPP4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERTER TUNNEL SPHERE SMOOTH SURFACE MEDPOR 18MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "80010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1450.0, "discounted_cash": 507.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36620", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36625", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36640", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36660", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION DIALYSIS CATHETER PERITONEAL-OPEN 49421", "code_information": [{"code": "49421", "type": "CPT"}, {"code": "1481143", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION DRUG DELIVERY IMPLANT 11981", "code_information": [{"code": "11981", "type": "CPT"}, {"code": "4440540", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1114.0, "discounted_cash": 389.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 539.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION INTRAMEDULLARY NAIL FEMUR W/OR W/O SCREWS 27506", "code_information": [{"code": "27506", "type": "CPT"}, {"code": "1481146", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1792.56, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1792.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION INTRAMEDULLARY NAIL TIBIA 27745", "code_information": [{"code": "27745", "type": "CPT"}, {"code": "1481147", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF ANT. SEG. AQUEOUS DRAINAGE DEVICE; WITHOUT EXTRAOCULAR RESERVOIR; EXT. APPROACH 66183", "code_information": [{"code": "66183", "type": "CPT"}, {"code": "18370605", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEV. W/O EXTRAOCULAR RESERVOIR; EA. ADD DEVICE 0376T", "code_information": [{"code": "376T", "type": "CPT"}, {"code": "45355485", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE; W/CREATION OF INTRAOCULAR RESEVOIR 0474T", "code_information": [{"code": "474T", "type": "CPT"}, {"code": "44743051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4719.0, "discounted_cash": 1651.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2283.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36800", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36810", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36815", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA(S)", "code_information": [{"code": "36823", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36481", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36500", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36510", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CHEST TUBE", "code_information": [{"code": "32551", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CHEST WALL RESP. SENSOR ELEC. W/CONN. PULSE GEN. 0466T", "code_information": [{"code": "466T", "type": "CPT"}, {"code": "44660489", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4595.0, "discounted_cash": 1608.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERTION OF INFUSION PUMP", "code_information": [{"code": "36260", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INTERVERTEBRAL BIOMECHANICAL DEVICE; W/O INTERBODY EA/CONTIGUOUS DEFECT 22859", "code_information": [{"code": "22859", "type": "CPT"}, {"code": "44660440", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INTRAUTERINE DEVICE 58300", "code_information": [{"code": "58300", "type": "CPT"}, {"code": "1587160", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF IRIS PROSTHESIS", "code_information": [{"code": "616T", "type": "CPT"}], "standard_charges": [{"minimum": 3951.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF MULTI-COMPONENT INFLATABLE PENILE PROSTHESIS 54405", "code_information": [{"code": "54405", "type": "CPT"}, {"code": "1481149", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF PENILE PROSTHESIS;INFLATABLE 54401", "code_information": [{"code": "54401", "type": "CPT"}, {"code": "1481150", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF PENILE PROSTHESIS;NON-INFLATABLE 54400", "code_information": [{"code": "54400", "type": "CPT"}, {"code": "1481151", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF SINUS TARSI IMPLANT 0335T", "code_information": [{"code": "335T", "type": "CPT"}, {"code": "21566168", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 6074.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF SPINAL NEUROSTIMULATOR 63685", "code_information": [{"code": "63685", "type": "CPT"}, {"code": "1481152", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER SIMPLE 51702", "code_information": [{"code": "51702", "type": "CPT"}, {"code": "14002266", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1114.0, "discounted_cash": 389.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 539.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF TESTICULAR PROSTHESIS 54660", "code_information": [{"code": "54660", "type": "CPT"}, {"code": "1481153", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF UTERINE TANDEM AND/OR VAGINAL OVOIDS 57155", "code_information": [{"code": "57155", "type": "CPT"}, {"code": "1481154", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF WIRE OR PIN W/ APPLICATION SKELETAL TRACTION LOWER EXTREMITY 20650", "code_information": [{"code": "20650", "type": "CPT"}, {"code": "1479969", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OR REPLACE CRANIAL NEUROSTIM. GEN. DIRECT/INDUCTIVE 2 OR MORE ELECTRODE 61886", "code_information": [{"code": "61886", "type": "CPT"}, {"code": "1481155", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 18935.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OR REPLACE CRANIAL NEUROSTIM. GEN. DIRECT/INDUCTIVE SINGLE ELECTRODE 61885", "code_information": [{"code": "61885", "type": "CPT"}, {"code": "1481156", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION PALATE PROSTHESIS", "code_information": [{"code": "42281", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION SS DFB ELECTRODE", "code_information": [{"code": "572T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION TISSUE EXPANDER 19357", "code_information": [{"code": "19357", "type": "CPT"}, {"code": "1481159", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION TOOL IMPLANT DRIVER BIT 112-00-003", "code_information": [{"code": "112-00-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERTION TUNNELED IMPLANTABLE VENOUS ACCESS PORT 36561", "code_information": [{"code": "36561", "type": "CPT"}, {"code": "1481160", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION URINARY SPHINCTER 53445", "code_information": [{"code": "53445", "type": "CPT"}, {"code": "1481161", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION VASCULAR PEDICLE TO CARPAL BONE 25430", "code_information": [{"code": "25430", "type": "CPT"}, {"code": "1481162", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION (FISH)", "code_information": [{"code": "88364", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 250.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 394.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 394.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 394.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 150.18, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 159.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 142.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 142.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION (FISH)", "code_information": [{"code": "88366", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 324.77, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 345.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION AUTO", "code_information": [{"code": "88367", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 120.02, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 127.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION MANUAL", "code_information": [{"code": "88368", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 168.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 179.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV 1ST", "code_information": [{"code": "449T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV EACH", "code_information": [{"code": "450T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ BIOPROSTC VLV FEM VN", "code_information": [{"code": "744T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ GTUBE PERQ MAG GASTRPXY", "code_information": [{"code": "647T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 4382.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "446T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH SEC IO LENS", "code_information": [{"code": "618T", "type": "CPT"}], "standard_charges": [{"minimum": 3951.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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": 3951.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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": 1719.0, "maximum": 6045.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTERIAL", "code_information": [{"code": "33990", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTL&VEN", "code_information": [{"code": "33991", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD R HRT VENOUS", "code_information": [{"code": "33995", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM SYS", "code_information": [{"code": "33276", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33277", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PICC 5 YR+ W/O IMAGING", "code_information": [{"code": "36569", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PICC <5 YR W/O IMAGING", "code_information": [{"code": "36568", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I 5 YR+", "code_information": [{"code": "36573", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I <5 YR", "code_information": [{"code": "36572", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ RX ELUT IMPLT LAC CANAL", "code_information": [{"code": "68841", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22867", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22868", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33285", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ IMPLTBL DFB ELCTRD", "code_information": [{"code": "33271", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV BOTH COMPNT PG", "code_information": [{"code": "517T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV COMPL SYS", "code_information": [{"code": "515T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV ELTRD ONLY", "code_information": [{"code": "516T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ ATR ELT", "code_information": [{"code": "410T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ PLS GN", "code_information": [{"code": "409T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ VNT ELT", "code_information": [{"code": "411T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CARDIAC MODULJ SYS", "code_information": [{"code": "408T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT BRST IMPLT SEP D", "code_information": [{"code": "19342", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT COMPL IIMS", "code_information": [{"code": "525T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT DEFIB W/LEAD(S)", "code_information": [{"code": "33249", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT ICDS SS ELTRD", "code_information": [{"code": "571T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS ELTRD ONLY", "code_information": [{"code": "526T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS IMPLT MNTR", "code_information": [{"code": "527T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PG ONLY ISDSS", "code_information": [{"code": "680T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PRQ RA SAC NSTIM", "code_information": [{"code": "786T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT A & V PM W/L VENT LEAD", "code_information": [{"code": "C7539", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT ATRIL PM W/L VENT LEAD", "code_information": [{"code": "C7537", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT HEART PM ATRIAL & VENT", "code_information": [{"code": "33208", "type": "CPT"}], "standard_charges": [{"minimum": 2347.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/DUAL LEADS", "code_information": [{"code": "33230", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/MULT LEADS", "code_information": [{"code": "33231", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/SINGL LEAD", "code_information": [{"code": "33240", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT VENT PM W/L VENT LEAD", "code_information": [{"code": "C7538", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INST AWL 3S HEMI TOE IMPLANT SYSTEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "111-00-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INST KIT TENFUSE PIP REAMERS-FORCEPS", "code_information": [{"code": "78100000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1230.0, "discounted_cash": 430.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTAFIX IMPLANT KIT 8X8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400-3701-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2575.0, "discounted_cash": 901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63740", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63741", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTENT INJECT TRABECULAR MICRO-BYPASS SYSTEM G2-W-US", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "G2-W-US", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3471.0, "discounted_cash": 1214.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTILL PHARM RENAL PELVIS", "code_information": [{"code": "C9789", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTLJ FECAL MICROBIOTA SSP", "code_information": [{"code": "780T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTLL RX AGNT INTO RNAL TUB", "code_information": [{"code": "50391", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTR BIOPSY MAXCORE PINK SWTCH 18GX25CM", "code_information": [{"code": "MC1825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT 1.8MM FOR 2.5MM SUTURE ANCHOR THN00509", "code_information": [{"code": "THN00509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1210.5, "discounted_cash": 423.68, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT APPLIER W/ MALLEABLE GRAFT RETRACTOR OMNISPAN", "code_information": [{"code": "228143", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1009.0, "discounted_cash": 353.15, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT AWL 3.8MM TAPEREDINSTR DISP", "code_information": [{"code": "72202621", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.0, "discounted_cash": 56.35, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BB TAK SURG", "code_information": [{"code": "AR-13226", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 178.0, "discounted_cash": 62.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BB TAK THREADED ORTHO", "code_information": [{"code": "AR-13226T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 293.93, "discounted_cash": 102.88, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CANNULA 5.5MM X 55MM ORANGE THREADED CLEAR", "code_information": [{"code": "214104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.82, "discounted_cash": 45.09, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CANNULA 8.0MM X 75MM DRI-LOK DISTAL THREAD 3910-075-802", "code_information": [{"code": "3910-075-802", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.48, "discounted_cash": 26.42, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CANNULA 8MM X 75MM FULLY THREADED ARTHROSCOPIC DRI LOK DISP", "code_information": [{"code": "3910-075-800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.48, "discounted_cash": 26.42, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CAUTERY HEAT LOOP STRL DISP", "code_information": [{"code": "905414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.0, "discounted_cash": 78.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CLAMP MED COMBINATION MR SAFE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "390.031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1405.0, "discounted_cash": 491.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CLAMP MED OPEN ADJ MR SAFE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "390.035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1159.0, "discounted_cash": 405.65, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CNULA 5.75MM X 7 CM OPTIONAL 1-WAY STPCCK POLYCARBONATE W/ OBTURATOR", "code_information": [{"code": "AR-6560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CNULA 7MM X 75MM THRD SHLDR FOR GENERAL ARTHROSCOPIC SURG USE CLEAR", "code_information": [{"code": "214116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CNULA 8.5MM X 55MM THRD SHLDR FOR GENERAL ARTHROSCOPIC SURG USE CLEAR", "code_information": [{"code": "214118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CORNER CHISEL TMT RAPID RELEASE SN38", "code_information": [{"code": "SN38", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 941.5, "discounted_cash": 329.53, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT COUNTERSINK 2.4MM", "code_information": [{"code": "DSDS1024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT COUNTERSINK FOR 1.3 MM AND 1.5 MM CORTEX SCREWS SS", "code_information": [{"code": "310.971", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 155.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT COUNTERSINK MINI FRAGMENT FOR 2 MM AND 2.4 MM CORTEX SCREWS", "code_information": [{"code": "310.972", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT CUTTER 10MM FLIP FLIPCUTTER II STRLINSTR", "code_information": [{"code": "AR-1204AF-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1288.0, "discounted_cash": 450.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT DRILL 2.6MM X 122MM WL 70MM AO SHAFT", "code_information": [{"code": "45-35010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 166.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT DRILL MODIFIED RELIEF NON STRL FOR FOREFOOT RECONSTRUCTION SYS", "code_information": [{"code": "PA019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT DRIVER UNIVERSAL T20 QUICK CONNECT", "code_information": [{"code": "DRVR-UQC-T20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.89, "discounted_cash": 83.96, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT GRSPR 5MM X 35 CM 20MM JAW LAP DIRECT DRIVE EPIX DISP", "code_information": [{"code": "C4130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 406.0, "discounted_cash": 142.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT GUIDED RELEASE SPEED RELEASE SN20 SN20", "code_information": [{"code": "SN20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT HANDPIECE W/ HIGH FLOW TIP AND SUCTION TUBEINTERPULSE", "code_information": [{"code": "210-114-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.63, "discounted_cash": 35.57, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT HARMONIC SHEARS 36CM SHAFT HAR1136", "code_information": [{"code": "HAR1136", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1318.1, "discounted_cash": 461.34, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT INTRACEPT ACCESS 2 VB RLV0045", "code_information": [{"code": "RLV0045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4117.2, "discounted_cash": 1441.02, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT JAMSHIDI BONE MARROW BIOPSY/ASPIRTATION NEEDLE 13G X 3\" DJ3513X", "code_information": [{"code": "DJ3513X", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 69.31, "discounted_cash": 24.26, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT JAW SMALL LIGASURE STERIL LF1212A", "code_information": [{"code": "LF1212A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1147.0, "discounted_cash": 401.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT KIT 4.0MM STERILE RIK40-S", "code_information": [{"code": "RIK40-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4128.15, "discounted_cash": 1444.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT KIT ALLOAID PIP CO1 S0001", "code_information": [{"code": "CO1 S0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT LEOS 2.0MM K-WIRE 7624-2020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7624-2020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 81.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT LIGASURE IMPACT OPEN TISS LF4418", "code_information": [{"code": "LF4418", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1480.0, "discounted_cash": 518.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT MILAGRO ADVANCE TAP 9-10MM 219497", "code_information": [{"code": "219497", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1776.09, "discounted_cash": 621.63, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT NANOGRASPER TIPSTRAIGHT SHAFT DISPOSABLE AR-10913D-1", "code_information": [{"code": "AR-10913D-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 772.73, "discounted_cash": 270.46, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT OBTURATOR 11MM W/ 5 MM PLUS SEAL VERSAPORT PLUS", "code_information": [{"code": "179102P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 165.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT OBTURATOR FLEXIBLE", "code_information": [{"code": "AR-2275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT PACK DISPOSABLE", "code_information": [{"code": "ST0101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT PEANUT 5MM ENDO", "code_information": [{"code": "173019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER 10.5MM ACRON KNEE FOR CRUCIATE LIGAMENT RECONSTRUCTION", "code_information": [{"code": "232409", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 806.0, "discounted_cash": 282.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER 10.5MM LOW PROFILE STRLINSTR", "code_information": [{"code": "AR-1410LP-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER 10MM ACRON KNEE FOR CRUCIATE LIGAMENT RECONSTRUCTION", "code_information": [{"code": "232408", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 432.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER 2.7MM X 16MM X 18MM", "code_information": [{"code": "XRM27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 936.0, "discounted_cash": 327.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER 5.5MM DRILL BIT", "code_information": [{"code": "7117-7135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2357.0, "discounted_cash": 824.95, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER 7.5MM LOW PROFILE", "code_information": [{"code": "906571", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 789.0, "discounted_cash": 276.15, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER 7MM PILOTED HEADED", "code_information": [{"code": "AR-1452", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 812.0, "discounted_cash": 284.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER 8.5MM ACRON STRL", "code_information": [{"code": "232405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 707.0, "discounted_cash": 247.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER 8.5MM LOW PROFILE", "code_information": [{"code": "906573", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 789.0, "discounted_cash": 276.15, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER 9MM LOW PROFILE", "code_information": [{"code": "906574", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 789.0, "discounted_cash": 276.15, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT REAMER SZ 3 TO 4 TAPERED", "code_information": [{"code": "MDDRLG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1462.0, "discounted_cash": 511.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT RELEASE CENTERLINE ENDO CARPAL TUNNEL", "code_information": [{"code": "AR-8850", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 583.19, "discounted_cash": 204.12, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT RETROCUTTER 10.5MM STRL DISP", "code_information": [{"code": "AR-1204R-105S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT RETROCUTTER 10MM STRL DISP", "code_information": [{"code": "AR-1204R-10S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT RETROCUTTER 11MM STRL DISP", "code_information": [{"code": "AR-1204R-11S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT RETROCUTTER 7.5MM STRL DISP", "code_information": [{"code": "AR-1204R-075S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT RETROCUTTER 7MM STRL DISP", "code_information": [{"code": "AR-1204R-07S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT RETROCUTTER 8.5MM STERILE DISPOSABLE", "code_information": [{"code": "AR-1204R-085S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT RETROCUTTER 8MM STRL DISP", "code_information": [{"code": "AR-1204R-08S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 598.0, "discounted_cash": 209.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT RETROCUTTER 9.5MM STRL DISP", "code_information": [{"code": "AR-1204R-095S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT RETROCUTTER 9MM STRL DISP", "code_information": [{"code": "AR-1204R-09S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT ROD 11MM X 400MM CARBON FIBER TRAUMATOLOGY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "394.87", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 718.0, "discounted_cash": 251.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SCISSORS 33 CM 5MM", "code_information": [{"code": "970010PC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1215.0, "discounted_cash": 425.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SCREWDRIVER 2MM CANNULATED AO COUPLING", "code_information": [{"code": "45-20001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 981.0, "discounted_cash": 343.35, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SEALING 10MM VESSEL HND CONTROL LIGASURE", "code_information": [{"code": "LS1037", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1021.0, "discounted_cash": 357.35, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SLEEV IRRIGATION FOR PM2 58PM2SLV", "code_information": [{"code": "58PM2SLV", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1268.01, "discounted_cash": 443.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SURG 8.5MM SHRT FLIP CUTTER FLIPCUTTER II", "code_information": [{"code": "AR-1204AS-85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1288.0, "discounted_cash": 450.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SURG 8MM SHRT FLIP CUTTER FLIPCUTTER II", "code_information": [{"code": "AR-1204AS-80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1288.0, "discounted_cash": 450.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SURGICAL BURR DIAMOND 16-0202 16-0202", "code_information": [{"code": "16-0202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1223.95, "discounted_cash": 428.38, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SURGICALSUPPORT TUBE 16-0104 16-0104", "code_information": [{"code": "16-0104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 605.25, "discounted_cash": 211.84, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SYSTEM 3.0MM ALLOMATE KIT-ABS-130 KIT-ABS-130", "code_information": [{"code": "KIT-ABS-130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT TRACKER COPILOT Q 360 5502-100-000", "code_information": [{"code": "5502-100-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2829.48, "discounted_cash": 990.32, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT TRACKER ENT", "code_information": [{"code": "9733533XOM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 426.37, "discounted_cash": 149.23, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT USAGE FEE 992", "code_information": [{"code": "992", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 696.0, "discounted_cash": 243.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT WIPE 7.3 CM X 7.3 CM 581047", "code_information": [{"code": "581047", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 6.2, "discounted_cash": 2.17, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENTS DISPOSABLE 4.0MM SCREW COMPRESSION THN00057", "code_information": [{"code": "THN00057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1259.25, "discounted_cash": 440.74, "setting": "both", "billing_class": "facility"}]}, {"description": "INSUFF10' 0.1MICRON STD LUERS", "code_information": [{"code": "CFASU1510", "type": "CDM"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULATED DILATOR", "code_information": [{"code": "ML-0441S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2378.34, "discounted_cash": 832.42, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULATED HOT PACK LARGE 6X9", "code_information": [{"code": "30104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULIN ANTIBODIES", "code_information": [{"code": "86337", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 85.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 85.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 85.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN SUPPRESSION PANEL", "code_information": [{"code": "80432", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 208.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 422.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 664.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 664.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 664.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 238.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 238.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80434", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 356.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 726.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1142.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1142.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1142.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 410.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 410.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80435", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 158.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 262.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 413.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 413.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 413.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 148.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 148.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INT HRHC TRANAL DARTLZJ 2+", "code_information": [{"code": "46948", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTELLIS PATIENT RECHARGER", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "97755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1147.0, "discounted_cash": 401.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INTEN OUTPT SVS,MIN 9 PR 7 D", "code_information": [{"code": "G0137", "type": "HCPCS"}], "standard_charges": [{"minimum": 441.97, "maximum": 694.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 441.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 694.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 694.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 694.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB NO EXER", "code_information": [{"code": "G0423", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.31, "maximum": 819.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 521.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 819.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 819.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 819.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB W/EXERC", "code_information": [{"code": "G0422", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.31, "maximum": 819.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 521.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 819.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 819.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 819.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENT POT REMV TIME PLACEMT", "code_information": [{"code": "G9539", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODIE COVEX 11 X 14MM X 07MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "403-21407C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1823.0, "discounted_cash": 638.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY CERVICAL 12X14X8MM 7 DEG CASCADIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2121408CL7-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1770.0, "discounted_cash": 619.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY FUSION DEVICE 6 DEGREE LARGE 9MM 5386-1608-N", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "5386-1608-N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY FUSION SYSTEM DUAL T/PLIF 8 DEG X 10-13MM EXPANDING POSTERIOR LUMBAR 1282-1000-006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1282-1000-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11536.0, "discounted_cash": 4037.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY FUSION SYSTEM DUALX T/PLIF 0DEG X 7-9MM LUMBAR 1282-1000-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1282-1000-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11536.0, "discounted_cash": 4037.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY LATERAL CASCADIA 18MM X 45MM X 10MM X 8DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2184510LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 2800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY SYSTEM CASCADIA 10X50X18MM 8DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2185010LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 2800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY SYSTEM CASCADIA 12MM X 50MM X 22MM 8DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2225012LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 2800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY SYSTEM CASCADIA 22MM X 55MM X 12MM 8DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2225512LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 2800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCALARY ALGRFT COMPL", "code_information": [{"code": "20934", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERDENTAL WIRING", "code_information": [{"code": "21497", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERDISCAL PERQ ASPIR DX", "code_information": [{"code": "62267", "type": "CPT"}], "standard_charges": [{"minimum": 1067.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERLAMINAR FUSION DEVICE SIZE 8 10-0100-000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-0100-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 5250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERMEDIATE VISUAL FIELD XM", "code_information": [{"code": "92082", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERNAL BRACE LIGAMENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1688-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3164.0, "discounted_cash": 1107.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERNAL MEDICINE SS", "code_information": [{"code": "G4011", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERNAL NEUROLYSIS REQUIRING USE OF OPERATING MICROSCOPE 64727", "code_information": [{"code": "64727", "type": "CPT"}, {"code": "1792998", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERRO EVAL CARDIAC MODULJ", "code_information": [{"code": "418T", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 251.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICDS SS IP", "code_information": [{"code": "576T", "type": "CPT"}], "standard_charges": [{"minimum": 92.44, "maximum": 145.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICPMS IP", "code_information": [{"code": "93290", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL IIMS IP", "code_information": [{"code": "529T", "type": "CPT"}], "standard_charges": [{"minimum": 92.44, "maximum": 145.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ISDSS IP", "code_information": [{"code": "685T", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 251.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL SCRMS IP", "code_information": [{"code": "93291", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL WCS IP", "code_information": [{"code": "521T", "type": "CPT"}], "standard_charges": [{"minimum": 58.62, "maximum": 92.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEVICE EVAL HEART", "code_information": [{"code": "93289", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG EVL PM/LDLS PM IP", "code_information": [{"code": "93288", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG W/O PRGRMG IPNSS", "code_information": [{"code": "93153", "type": "CPT"}], "standard_charges": [{"minimum": 406.73, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 406.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 639.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 639.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 639.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG&PRGRMG IPNSS", "code_information": [{"code": "93151", "type": "CPT"}], "standard_charges": [{"minimum": 406.73, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 406.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 639.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 639.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 639.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG&PRGRMG IPNSS POLYSM", "code_information": [{"code": "93152", "type": "CPT"}], "standard_charges": [{"minimum": 1255.04, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1255.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1972.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1972.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1972.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATE CRTD SNS DEV", "code_information": [{"code": "272T", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 958.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATE CRTD SNS W/PGRMG", "code_information": [{"code": "273T", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 958.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATE SUBQ DEFIB", "code_information": [{"code": "93261", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATION VAD IN PERSON", "code_information": [{"code": "93750", "type": "CPT"}], "standard_charges": [{"minimum": 209.78, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 209.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 329.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 329.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 329.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [{"code": "197", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6125.58, "maximum": 10516.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6125.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8760.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9636.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10516.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [{"code": "196", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10575.9, "maximum": 18156.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10575.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15125.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16638.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18156.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC", "code_information": [{"code": "198", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4522.1, "maximum": 7763.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4522.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6467.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7114.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7763.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERTHORACOSCPLR AMPUTATION", "code_information": [{"code": "23900", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERV REQ FOR LEAK", "code_information": [{"code": "G9306", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERVENTIONAL RAD SS", "code_information": [{"code": "G4012", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTESTINAL STRICTUROPLASTY", "code_information": [{"code": "44615", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLANT LIVE", "code_information": [{"code": "44136", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLNT CADAVER", "code_information": [{"code": "44135", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 12.6-20 CM", "code_information": [{"code": "12055", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 20.1-30.0", "code_information": [{"code": "12056", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 5.1-7.5 CM", "code_information": [{"code": "12053", "type": "CPT"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 7.6-12.5CM", "code_information": [{"code": "12054", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM >30.0 CM", "code_information": [{"code": "12057", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT20.1-30", "code_information": [{"code": "12046", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT7.6-12.5", "code_information": [{"code": "12044", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 12.6-20", "code_information": [{"code": "12035", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 20.1-30", "code_information": [{"code": "12036", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/TR/EXT >30.0 CM", "code_information": [{"code": "12037", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL PACING", "code_information": [{"code": "93610", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 40787.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25955.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL RECORDING", "code_information": [{"code": "93602", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 40787.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25955.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAABDOMINAL PRESSURE TEST", "code_information": [{"code": "51797", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS 66983", "code_information": [{"code": "66983", "type": "CPT"}, {"code": "1481163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACARDIAC ECG (ICE)", "code_information": [{"code": "93662", "type": "CPT"}], "standard_charges": [{"minimum": 646.86, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 646.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1016.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1016.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1016.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACEPT ACCESS INSTRUMENTS FG 0060", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "FG 0060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3873.0, "discounted_cash": 1355.55, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRACRAN ANGIOPLSTY W/STENT", "code_information": [{"code": "61635", "type": "CPT"}], "standard_charges": [{"minimum": 3365.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL ANGIOPLASTY", "code_information": [{"code": "61630", "type": "CPT"}], "standard_charges": [{"minimum": 3365.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL COMPLETE STUDY", "code_information": [{"code": "93886", "type": "CPT"}], "standard_charges": [{"minimum": 1006.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1006.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1580.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1580.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1580.94, "methodology": "fee schedule"}], "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": 6204.66, "maximum": 10651.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6204.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8874.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9761.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10651.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [{"code": "64", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11672.67, "maximum": 20039.07, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11672.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16694.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18363.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20039.07, "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": 4328.66, "maximum": 7431.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4328.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6190.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6810.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7431.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL LIMITED STUDY", "code_information": [{"code": "93888", "type": "CPT"}], "standard_charges": [{"minimum": 495.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 495.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 779.21, "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": 45887.11, "maximum": 78776.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45887.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 65628.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72191.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 78776.77, "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": 62879.97, "maximum": 107949.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 62879.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89931.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 98925.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 107949.29, "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": 29458.75, "maximum": 50573.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29458.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 42132.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46345.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50573.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61680", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61682", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61684", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61686", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61690", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61692", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRANASAL RECONSTRUCTION", "code_information": [{"code": "30620", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRANASAL SPLINT NON-BIODEGRADABLE SP-79300-05", "code_information": [{"code": "SP-79300-05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITH CC/MCC", "code_information": [{"code": "116", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11452.46, "maximum": 19661.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11452.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16379.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18017.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19661.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "117", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6333.62, "maximum": 10873.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6333.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9058.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9964.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10873.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOP COLON LAVAGE ADD-ON", "code_information": [{"code": "44701", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP CYST EVAL NOT DONE", "code_information": [{"code": "G9608", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP CYST EVAL TRAC INJ", "code_information": [{"code": "G9606", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP HIPEC PX 1ST 60 MIN", "code_information": [{"code": "96547", "type": "CPT"}], "standard_charges": [{"minimum": 125.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 125.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BREAST CAVITY", "code_information": [{"code": "353T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BRST/NODE SPEC", "code_information": [{"code": "351T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOPERATIVE NEUROMONITORING DURING SURGERY", "code_information": [{"code": "INM FEE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1805.0, "discounted_cash": 631.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRAOPERATIVE NEUROPHYSIOLOGY TESTING 95920", "code_information": [{"code": "1618455", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"gross_charge": 1875.0, "discounted_cash": 656.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRAUTERINE TRANSFUSION FTL", "code_information": [{"code": "36460", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAVENOUS INFUSION FOR THERAPY PROPHYLAXIS OR DIAGNOSIS INITIAL UP TO 1 HOUR 96365", "code_information": [{"code": "96365", "type": "CPT"}, {"code": "2401822", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 321.05, "maximum": 8450.0, "gross_charge": 960.0, "discounted_cash": 336.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAVENTRICULAR PACING", "code_information": [{"code": "93612", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 40787.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25955.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40787.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAVERTEBRAL FX AUG IMPL", "code_information": [{"code": "C1062", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT 67028", "code_information": [{"code": "67028", "type": "CPT"}, {"code": "1481165", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "gross_charge": 1655.0, "discounted_cash": 579.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 801.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRINSIC FACTOR ANTIBODY", "code_information": [{"code": "86340", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRM OPH EXAM EST PATIENT", "code_information": [{"code": "92012", "type": "CPT"}], "standard_charges": [{"minimum": 511.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRM OPH EXAM NEW PATIENT", "code_information": [{"code": "92002", "type": "CPT"}], "standard_charges": [{"minimum": 511.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36901", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36902", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36903", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO GASTROINTESTINAL TUBE", "code_information": [{"code": "44500", "type": "CPT"}], "standard_charges": [{"minimum": 789.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO MIX SALINE&AIR F/SSG", "code_information": [{"code": "568T", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 1723.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO NDL ICATH UPR/LXTR ART", "code_information": [{"code": "36140", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO WINDPIPE WIRE/TUBE", "code_information": [{"code": "31730", "type": "CPT"}], "standard_charges": [{"minimum": 1416.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1416.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRODUCER ABDOMINAL 21MM TRANS ANAL DISP", "code_information": [{"code": "EEATAID21D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 80.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER TRACH STRAIGHT 15 FR 70 CM 9-0212-72", "code_information": [{"code": "9-0212-72", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER TRANS ANAL/ABDOMINAL 25MM STAPLER", "code_information": [{"code": "EEATAID25D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 80.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER TUBE 7MM TRACHEAL COUDE TIP", "code_information": [{"code": "9021270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.13, "discounted_cash": 10.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER TUBE 7MM X 15FR ENDO COUDE TIP", "code_information": [{"code": "9-0212-70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.29, "discounted_cash": 9.55, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY 1ST", "code_information": [{"code": "37252", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY ADDL", "code_information": [{"code": "37253", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO ALLOGRAFT FOR SPINE SX ONLY STRUCTURAL 20931", "code_information": [{"code": "20931", "type": "CPT"}, {"code": "1643971", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM INIT", "code_information": [{"code": "95980", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM SUBSQ", "code_information": [{"code": "95981", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO GA N-STIM SUBSQ W/REPROG", "code_information": [{"code": "95982", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO MAP OF SENT LYMPH NODE", "code_information": [{"code": "38900", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVER BY ELCTRNS", "code_information": [{"code": "77425", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 13239.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13239.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1143.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1797.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1797.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1797.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVERY BY X-RAY", "code_information": [{"code": "77424", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 13239.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13239.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1055.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1658.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1658.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1658.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RADIATION TX MANAGEMENT", "code_information": [{"code": "77469", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1417.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2228.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2228.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2228.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IOL ACRYSOF SN60AT 39.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60AT 39.0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL CLAREN ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOADED 7.5D", "code_information": [{"code": "CNA0T0.075", "type": "CDM"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL INTRACULAR LENS 22.0D TECNIS MULTIFOCAL ZLB00 22.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZLB00 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1803.0, "discounted_cash": 631.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS 22.00 ENVISTA PRELOADE SIMPLIFEYE INJECTOR MX60PL 22.00", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60PL 22.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS 22.50 ENVISTA PRELOADED SIMPLIFEYE INJECTOR MX60PL 22.50", "code_information": [{"code": "MX60PL 22.50", "type": "CDM"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS 24.00 ENVISTA PRELOADED SIMPLIFEYE INJECTOR MX60PL 24.00", "code_information": [{"code": "MX60PL 24.00", "type": "CDM"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS ACRYSOF SINGLE-PIECE 13.0MM L 6.0M BICONVEX 34.0 SA60AT.340", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SA60AT.340", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS CNA0T0 10.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 10.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS MONOFOCAL HYDROPHOBIC +20.0D CT LUCIA 602.US/+20.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CT LUCIA 602.US/+20.0D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS SN60AT 36.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60AT 36.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS TORIC 11.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB00 11.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS TORIC 32.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB00 32.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS TORIC 32.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB00 32.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS TORIC 6.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB00 6.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS TORIC 7.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB00 7.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENS TORIC 7.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCB00 7.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL LENSES RAYONE ASPHERIC 19.00 RAO600C 19.00", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "RAO600C 19.00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL MODEL # MA60AC 13.5 LENS", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 13.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL MODEL # MA60AC 15.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 15.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL MODEL # MA60AC 18.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL MODEL # MA60AC 19.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL MODEL # MA60AC 24.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IOL TECNIS SYNERGY with SIMPLICITY DIOPTER 19.5 DFR00VU195", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "DFR00VU195", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2050.0, "discounted_cash": 717.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IONM REMOTE/>1 PT OR PER HR", "code_information": [{"code": "95941", "type": "CPT"}], "standard_charges": [{"minimum": 816.91, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 816.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1283.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1283.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1283.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IOP DEC <20% FROM BASE", "code_information": [{"code": "M1224", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IOP DEC>=20% FROM BASE", "code_information": [{"code": "M1225", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IOP NOT DOC", "code_information": [{"code": "M1226", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IOPAMIDOL 41% /ISOVUE M200 20ML", "code_information": [{"code": "MED0101", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IOPAMIDOL 41%/ISOVUE M200 10ML VIAL", "code_information": [{"code": "MED0100", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "IOPAMIDOL 61%/ ISOVUE 300 50ML", "code_information": [{"code": "MED0103", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IOPAMIDOL 61%/ISOVUE 300 100ML", "code_information": [{"code": "MED0102", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IOPIDINE 0.5% OPHTHALMIC 5ML", "code_information": [{"code": "MED0105", "type": "CDM"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IP/OBS CNSLTJ NEW/EST LOW 45", "code_information": [{"code": "99253", "type": "CPT"}], "standard_charges": [{"minimum": 516.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 516.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 811.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 811.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 811.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CNSLTJ NEW/EST MOD 60", "code_information": [{"code": "99254", "type": "CPT"}], "standard_charges": [{"minimum": 750.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 750.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1178.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1178.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1178.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CONSLTJ NEW/EST HI 80", "code_information": [{"code": "99255", "type": "CPT"}], "standard_charges": [{"minimum": 902.73, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 902.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1418.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1418.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1418.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CONSLTJ NEW/EST SF 35", "code_information": [{"code": "99252", "type": "CPT"}], "standard_charges": [{"minimum": 335.34, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 335.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 526.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 526.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 526.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPG IMPLANTABLE PULSE GENERATOR IV MODEL 3028", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37544.0, "discounted_cash": 13140.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IPG KIT CONTAING GENERATOR, PROGRAMER AND CHARGING KIT", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1060L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35638.0, "discounted_cash": 12473.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IPG KIT CONTAINING GENRATOR AND CHARGING KIT", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1210A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35638.0, "discounted_cash": 12473.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IPG WAVEWRITER ALPHA + CHARGER SC-1240A", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1240A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35638.0, "discounted_cash": 12473.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IPG WAVEWRITER ALPHA SC-1280A", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1280A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37698.0, "discounted_cash": 13194.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IR , Epidurography", "code_information": [{"code": "72275", "type": "CPT"}, {"code": "1171990", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2270.0, "discounted_cash": 794.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 931.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 931.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1149.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 843.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Arthro Inj Sacroiliac Joint G0259", "code_information": [{"code": "G0259", "type": "HCPCS"}, {"code": "2616139", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "gross_charge": 1056.0, "discounted_cash": 369.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 511.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Arthrography Injection Wrist 25246", "code_information": [{"code": "25246", "type": "CPT"}, {"code": "1748390", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Discography C/T Spine 72285", "code_information": [{"code": "72285", "type": "CPT"}, {"code": "1171969", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 11811.93, "gross_charge": 3479.0, "discounted_cash": 1217.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1428.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1428.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1761.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2818.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1292.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7513.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1791.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2160.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 184.1, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 195.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Discography Lumbar 72295", "code_information": [{"code": "72295", "type": "CPT"}, {"code": "1171978", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 11811.93, "gross_charge": 3478.0, "discounted_cash": 1217.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1427.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1427.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1760.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2818.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1291.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7513.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11811.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1791.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2159.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 172.03, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 182.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Shoulder Arthrography Bl 73040", "code_information": [{"code": "73040", "type": "CPT"}, {"code": "1553479", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1347.0, "discounted_cash": 471.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 552.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 552.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 681.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 500.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 693.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 836.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 247.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 263.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Shoulder Arthrography Left 73040", "code_information": [{"code": "73040", "type": "CPT"}, {"code": "1171975", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 276.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 276.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 341.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 250.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 347.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 418.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 247.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 263.16, "methodology": "fee schedule"}], "billing_class": "facility"}, {"minimum": 0.51, "maximum": 8450.0, "gross_charge": 676.0, "discounted_cash": 236.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 277.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 277.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 342.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 251.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 348.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 419.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 247.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 263.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Shoulder Arthrography Right 73040", "code_information": [{"code": "73040", "type": "CPT"}, {"code": "1171974", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 276.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 276.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 341.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 250.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 347.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 418.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 247.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 263.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Urography w/w/o KUB w/w/o tomo 74400", "code_information": [{"code": "74400", "type": "CPT"}, {"code": "1171968", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1537.0, "discounted_cash": 537.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 630.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 630.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 778.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 570.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 418.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 658.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 658.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 658.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 791.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 954.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 264.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 281.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Wrist Arthrography Bilateral 73115", "code_information": [{"code": "73115", "type": "CPT"}, {"code": "1553484", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 869.0, "discounted_cash": 304.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 356.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 356.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 439.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 322.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 447.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 539.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 250.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 266.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Wrist Arthrography Left 73115", "code_information": [{"code": "73115", "type": "CPT"}, {"code": "1171981", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 221.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 162.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 271.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 250.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 266.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Wrist Arthrography Right 73115", "code_information": [{"code": "73115", "type": "CPT"}, {"code": "1171982", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 221.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 162.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 271.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 250.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 266.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRE ABLTJ 1+TUM ORGAN PERQ", "code_information": [{"code": "600T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRE ABLTJ 1+TUMORS OPEN", "code_information": [{"code": "601T", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRIDECTOMY OPTICAL 66635", "code_information": [{"code": "66635", "type": "CPT"}, {"code": "1481166", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRIDECTOMY PERIPHERAL FOR GLAUCOMA 66625", "code_information": [{"code": "66625", "type": "CPT"}, {"code": "1481167", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2235.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRIDECTOMY SECTOR FOR GLAUCOMA 66630", "code_information": [{"code": "66630", "type": "CPT"}, {"code": "1481168", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRIDECTOMY WITH CORNEOSCLERAL OR CORNEAL SECTION;FOR REMOVAL OF LESION 66600", "code_information": [{"code": "66600", "type": "CPT"}, {"code": "1481169", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRIDECTOMY WITH CYCLECTOMY 66605", "code_information": [{"code": "66605", "type": "CPT"}, {"code": "1481170", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRIDOTOMY 66500", "code_information": [{"code": "66500", "type": "CPT"}, {"code": "1481171", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRIDOTOMY/IRIDECTOMY BY LASER SURGERY 66761", "code_information": [{"code": "66761", "type": "CPT"}, {"code": "1481172", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRIS CONFORMER #5 26MM X 22MM X 10MM NATURAL MD MED BROWN", "code_information": [{"code": "89130", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 723.0, "discounted_cash": 253.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IRIS CONFORMER COLOR #2 MEDIUM NATURAL 89127", "code_information": [{"code": "89127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IRIS CONFORMER COLOR #3 MEDIUM NATURAL 89128", "code_information": [{"code": "89128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 723.0, "discounted_cash": 253.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IRON STAIN PERIPHERAL BLOOD", "code_information": [{"code": "85536", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRR SOL SODIUM CHLORIDE 0.9% 500 ML", "code_information": [{"code": "2F7123", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 10.16, "discounted_cash": 3.56, "setting": "both", "billing_class": "facility"}]}, {"description": "IRRIG DRUG DELIVERY DEVICE", "code_information": [{"code": "96523", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATION SODIUM CHLORIDE 0.9 USP 3L BAG", "code_information": [{"code": "BMGR8206", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 69.13, "discounted_cash": 24.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IRRIGATION TUBING SET AR-200 OEM04364100", "code_information": [{"code": "OEM04364100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 56.7, "setting": "both", "billing_class": "facility"}]}, {"description": "IRRIGATOR BULB 10 TUBING PA701", "code_information": [{"code": "PA701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.53, "discounted_cash": 60.04, "setting": "both", "billing_class": "facility"}]}, {"description": "IRRIMAX USA ISEPT-450-USA", "code_information": [{"code": "ISEPT-450-USA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.35, "discounted_cash": 72.57, "setting": "both", "billing_class": "facility"}]}, {"description": "ISA NOT RED 3PTS /NO ASSESS", "code_information": [{"code": "M1198", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISA NOT RED 3PTS/NO ASSESS", "code_information": [{"code": "M1206", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISA REDUCED >=3", "code_information": [{"code": "M1205", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISA REDUCED >=3 FR IXV", "code_information": [{"code": "M1197", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "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": 12094.83, "maximum": 20763.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12094.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17298.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19028.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20763.82, "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": 17587.17, "maximum": 30192.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17587.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25153.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27668.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 30192.8, "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": 10400.11, "maximum": 17854.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10400.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14874.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16361.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17854.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISLAND PEDICLE FLAP 15740", "code_information": [{"code": "15740", "type": "CPT"}, {"code": "1481173", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISLET CELL ANTIBODY", "code_information": [{"code": "86341", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 60.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 94.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 94.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 94.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISOPROPYL ALCOHOL 70% SOLUTION 473ML", "code_information": [{"code": "MED0290", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ISPAN C3F8 CONSTELLATION 125GM 8065797105", "code_information": [{"code": "8065797105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2311.0, "discounted_cash": 808.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ISTENT INJECT TRABECULAR MICRO-BYPASS SYSTEM", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "G2-M-IS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3647.0, "discounted_cash": 1276.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IV CONTAINER 0.9% SODIUM CHLORIDE INJECTION USP 500 ML L8001", "code_information": [{"code": "L8001", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 13.51, "discounted_cash": 4.73, "setting": "both", "billing_class": "facility"}]}, {"description": "IV INFUSION, FOR THERAPY, PROPHYLAXIS, DIAGNOSIS EACH ADDITIONAL HOUR 96366", "code_information": [{"code": "96366", "type": "CPT"}, {"code": "44654369", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 96.93, "maximum": 8450.0, "gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 96.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 152.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 152.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 152.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INJ RA DRUG DX STUDY", "code_information": [{"code": "78808", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IV Infusion Therapy/Prophylaxis DX 1st > 1 hour 96365", "code_information": [{"code": "96365", "type": "CPT"}, {"code": "7063263", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 321.05, "maximum": 8450.0, "gross_charge": 960.0, "discounted_cash": 336.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV SET EXTENSION 30\" DYNDTN2006", "code_information": [{"code": "DYNDTN2006", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 4.89, "discounted_cash": 1.71, "setting": "both", "billing_class": "facility"}]}, {"description": "IV SOL DEXTROSE 5% IN LR 1000 ML", "code_information": [{"code": "2B2074X", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IV SOL DEXTROSE 5% IN WATER 250 ML", "code_information": [{"code": "2B0062Q", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IV START 1624 SEPP", "code_information": [{"code": "1-9001A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IV START KIT WITH CHLORAPREP APPLICATOR DYND74260", "code_information": [{"code": "DYND74260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.93, "discounted_cash": 2.08, "setting": "both", "billing_class": "facility"}]}, {"description": "IV START TD 24 ALC 072 STANDARD 01-0901C", "code_information": [{"code": "1-0901C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.68, "discounted_cash": 1.29, "setting": "both", "billing_class": "facility"}]}, {"description": "IV START TD 24 CHLORASCRUB", "code_information": [{"code": "1-8700A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IV START TD 24 FREPP (00PL )072", "code_information": [{"code": "1-9000PL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IV START TD 24 PVP SEPP ALC", "code_information": [{"code": "1-09001C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "IV START TD 24 SEPP (00CPL)072", "code_information": [{"code": "1-9001C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IV START W 1683 AND FREPP R (01 )070", "code_information": [{"code": "1-9601A", "type": "CDM"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IXV NRS VRS IQA >=4", "code_information": [{"code": "M1196", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IXV NRS VRS IQA >=4", "code_information": [{"code": "M1204", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Immunofluorescence, per specimen; each additional single antibody stain procedure 88350", "code_information": [{"code": "88350", "type": "CPT"}, {"code": "45369029", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 124.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 195.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 195.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 195.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 136.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 121.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 121.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Immunofluorescence, per specimen; initial 88346", "code_information": [{"code": "88346", "type": "CPT"}, {"code": "44690709", "type": "CDM"}, {"code": "312", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 67.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 170.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 181.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Immunohistochemistry or immunocytochemistry, each addl 88341", "code_information": [{"code": "88341", "type": "CPT"}, {"code": "22671170", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 205.0, "discounted_cash": 71.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 164.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 258.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 258.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 258.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 107.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 114.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 90.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 90.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, 88344", "code_information": [{"code": "88344", "type": "CPT"}, {"code": "22802328", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 54.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 210.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 223.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain 88342", "code_information": [{"code": "88342", "type": "CPT"}, {"code": "42593014", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 114.0, "discounted_cash": 39.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 42.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 130.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Immunologic Analysis For Detection Of Organism By Immunoassay Technique, Single Step Method", "code_information": [{"code": "87450", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Impl pressure sensor w/angio", "code_information": [{"code": "C9741", "type": "HCPCS"}], "standard_charges": [{"minimum": 8700.0, "maximum": 8700.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Implant Metacarpal XL 7.0mm x 30mm", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "120-42530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3801.0, "discounted_cash": 1330.35, "setting": "both", "billing_class": "facility"}]}, {"description": "Implantation Of Brain Neurostimulator Electrodes", "code_information": [{"code": "61870", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Implantation of iris prosthesis, including suture fixation and repair or removal of iris, when performed", "code_information": [{"code": "66683", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning and adjustments, with imaging guidance (eg, fluoroscopy)", "code_information": [{"code": "C8003", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Implantation of subcutaneous peritoneal ascites pump system, percutaneous, including pump-pocket creation, insertion of tunneled indwelling bladder and peritoneal catheters with pump connections, including all imaging and initial programming, when perform", "code_information": [{"code": "870T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "In situ hybridization, each probe 88365", "code_information": [{"code": "88365", "type": "CPT"}, {"code": "33764312", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 339.0, "discounted_cash": 118.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 125.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 206.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 219.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Incision Of Valve Between Lower Right Heart Chamber And Main Lung Artery, Closed Heart Procedure, Approached Through Heart", "code_information": [{"code": "33470", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infec agen detec ampli probe", "code_information": [{"code": "U0005", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious agent detection by nucleic acid (DNA or RNA); Helicobacter pylori (H. pylori), clarithromycin resistance, amplified probe technique", "code_information": [{"code": "87513", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious agent detection by nucleic acid (DNA or RNA); Hepatitis C, screening, amplified probe technique", "code_information": [{"code": "G0567", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.61, "maximum": 125.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 79.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 125.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 125.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 125.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), separately reported high-risk types (eg, 16, 18, 31, 45, 51, 52) and high-risk pooled result(s)", "code_information": [{"code": "87626", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 179.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 281.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 281.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 281.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious agent detection by nucleic acid (DNA or RNA); Mycobacterium tuberculosis, rifampin resistance, amplified probe technique", "code_information": [{"code": "87564", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 195.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 307.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 307.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 307.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious agent detection by nucleic acid (DNA or RNA); Pneumocystis jirovecii, amplified probe technique", "code_information": [{"code": "87594", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious agents (sexually transmitted infection), Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, multiplex amplified probe technique, vaginal, endocervical, gynecological specimens, oropharyngeal swabs, rectal swabs, female or ", "code_information": [{"code": "455U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 140.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (Mycoplasma genitalium), macrolide sensitivity (23S rRNA point mutation), oral, rectal, or vaginal swab, algorithm reported as probability of macrolide resistance", "code_information": [{"code": "484U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 140.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (Neisseria gonorrhoeae), sensitivity, ciprofloxacin resistance (gyrA S91F point mutation), oral, rectal, or vaginal swab, algorithm reported as probability of fluoroquinolone resistance", "code_information": [{"code": "483U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 140.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (acid-fast bacteria and invasive fungi), DNA (673 organisms), next-generation sequencing, plasma", "code_information": [{"code": "531U", "type": "CPT"}], "standard_charges": [{"minimum": 52.17, "maximum": 82.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacteria, viruses, fungi, and parasites), cerebrospinal fluid (CSF), metagenomic next-generation sequencing (DNA and RNA), bioinformatic analysis, with positive pathogen identification", "code_information": [{"code": "480U", "type": "CPT"}], "standard_charges": [{"minimum": 1062.79, "maximum": 1671.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1062.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacterial and/or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 10 viral targets and 4 bacterial targets, qualitative RT-PCR, upper respiratory specimen, each pathogen reported as positive or negative", "code_information": [{"code": "564U", "type": "CPT"}], "standard_charges": [{"minimum": 1062.79, "maximum": 1671.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1062.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacterial and/or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 11 viral targets and 4 bacterial targets, qualitative RT-PCR, upper respiratory specimen, each pathogen reported as positive or negative", "code_information": [{"code": "563U", "type": "CPT"}], "standard_charges": [{"minimum": 1062.79, "maximum": 1671.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1062.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific DNA and RNA by real-time PCR, 12 targets, nasopharyngeal or oropharyngeal swab, including multiplex reverse transcription for RNA targets, each analyte reported as dete", "code_information": [{"code": "556U", "type": "CPT"}], "standard_charges": [{"minimum": 1062.79, "maximum": 1671.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1062.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacterial vaginosis and vaginitis), real-time amplification of DNA markers for Atopobium vaginae, Gardnerella vaginalis, Megasphaera types 1 and 2, bacterial vaginosis associated bacteria-2 and -3 (BVAB-2, BVAB-3), Mobiluncus species, ", "code_information": [{"code": "557U", "type": "CPT"}], "standard_charges": [{"minimum": 670.62, "maximum": 1054.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 670.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacterial, fungal, or viral infection), semiquantitative biomechanical assessment (via deformability cytometry), whole blood, with algorithmic analysis and result reported as an index", "code_information": [{"code": "441U", "type": "CPT"}], "standard_charges": [{"minimum": 46.13, "maximum": 72.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (respiratory infection), Myxovirus resistance protein A (MxA) and C-reactive protein (CRP), fingerstick whole blood specimen, each biomarker reported as present or absent", "code_information": [{"code": "442U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 140.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (urinary tract infection), identification of 17 pathologic organisms, urine, real-time PCR, reported as positive or negative for each organism", "code_information": [{"code": "504U", "type": "CPT"}], "standard_charges": [{"minimum": 20.63, "maximum": 32.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease (vaginal infection), identification of 32 pathogenic organisms, swab, real-time PCR, reported as positive or negative for each organism", "code_information": [{"code": "505U", "type": "CPT"}], "standard_charges": [{"minimum": 363.71, "maximum": 571.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 363.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Infectious disease, bacterial vaginosis and vaginitis, real-time PCR amplification of DNA markers for Atopobium vaginae, Atopobium species, Megasphaera type 1, and Bacterial Vaginosis Associated Bacteria-2 (BVAB-2), utilizing vaginal-fluid specimens, algo", "code_information": [{"code": "81515", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 670.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine (IIV), H5, pandemic formulation, split virus, adjuvanted, for intramuscular use", "code_information": [{"code": "90631", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, H5N1, derived from cell cultures, adjuvanted, for intramuscular use", "code_information": [{"code": "90635", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, H5N8, derived from cell cultures, adjuvanted, for intramuscular use", "code_information": [{"code": "90695", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, quadrivalent (qIRV), mRNA; 30 mcg/0.5 mL dosage, for intramuscular use", "code_information": [{"code": "90637", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, quadrivalent (qIRV), mRNA; 60 mcg/0.5 mL dosage, for intramuscular use", "code_information": [{"code": "90638", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, quadrivalent, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 40 mcg/0.4 mL dosage, for intramuscular use", "code_information": [{"code": "90613", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, trivalent, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 31.7 mcg/0.32 mL dosage, for intramuscular use", "code_information": [{"code": "90612", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inhalation Of Allergic Substances With Reaction Analysis", "code_information": [{"code": "95071", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inhalation bronchial challenge testing; w/histamine, etc 95070", "code_information": [{"code": "95070", "type": "CPT"}, {"code": "25371156", "type": "CDM"}, {"code": "924", "type": "RC"}], "standard_charges": [{"minimum": 143.06, "maximum": 8450.0, "gross_charge": 491.0, "discounted_cash": 171.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 143.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Initial Hospital Observation Care Per Day, Typically 30 Minutes", "code_information": [{"code": "99218", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Initial Hospital Observation Care Per Day, Typically 50 Minutes", "code_information": [{"code": "99219", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Initial Hospital Observation Care Per Day, Typically 70 Minutes", "code_information": [{"code": "99220", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection(s), bone-substitute material for bone and/or soft tissue hardware fixation augmentation, including intraoperative imaging guidance, when performed", "code_information": [{"code": "869T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, ustekinumab-aauz (Otulfi), biosimilar, 1 mg", "code_information": [{"code": "Q9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inpatient Hospital Consultation, Typically 20 Minutes", "code_information": [{"code": "99251", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion Of Catheter Into Right And Left Heart Chambers For Evaluation Of Congenital Abnormalities", "code_information": [{"code": "93531", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion Of Catheter Into Right And Left Heart Chambers Through Existing Septal Opening For Evaluation Of Congenital Abnormalities", "code_information": [{"code": "93533", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion Of Catheter Into Right And Left Heart Chambers Through Intact Septum For Evaluation Of Congenital Abnormalities", "code_information": [{"code": "93532", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion Of Catheter Into Right Upper Heart Chamber For Evaluation Of Congenital Abnormalities", "code_information": [{"code": "93530", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; dual transvenous leads (pacing and defibrillation) only", "code_information": [{"code": "918T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; pulse generator and dual transvenous electrodes/leads (pacin", "code_information": [{"code": "915T", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; pulse generator only", "code_information": [{"code": "916T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; single transvenous lead (pacing or defibrillation) only", "code_information": [{"code": "917T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion of transurethral ablation transducer for delivery of thermal ultrasound for prostate tissue ablation, including suprapubic tube placement during the same session and placement of an endorectal cooling device, when performed", "code_information": [{"code": "51721", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion or replacement of epicranial neurostimulator system, including electrode array and pulse generator, with connection to electrode array", "code_information": [{"code": "968T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intensive Care Unit Burn Care", "code_information": [{"code": "207", "type": "RC"}], "standard_charges": [{"minimum": 5143.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Intensive Care Unit General", "code_information": [{"code": "200", "type": "RC"}], "standard_charges": [{"minimum": 2875.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2875.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Intensive Care Unit Intermediateicu", "code_information": [{"code": "206", "type": "RC"}], "standard_charges": [{"minimum": 2875.0, "maximum": 2875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2875.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Intensive Care Unit Medical", "code_information": [{"code": "202", "type": "RC"}], "standard_charges": [{"minimum": 5143.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Intensive Care Unit Other", "code_information": [{"code": "209", "type": "RC"}], "standard_charges": [{"minimum": 2875.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2875.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Intensive Care Unit Pediatric", "code_information": [{"code": "203", "type": "RC"}], "standard_charges": [{"minimum": 2875.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2875.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Intensive Care Unit Psychiatric", "code_information": [{"code": "204", "type": "RC"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Intensive Care Unit Surgical", "code_information": [{"code": "201", "type": "RC"}], "standard_charges": [{"minimum": 5143.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Intensive Care Unit Trauma", "code_information": [{"code": "208", "type": "RC"}], "standard_charges": [{"minimum": 5143.0, "maximum": 6510.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6510.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5143.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty   whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, includ", "code_information": [{"code": "G0546", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.2, "maximum": 124.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 124.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 124.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 124.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, includin", "code_information": [{"code": "G0547", "type": "HCPCS"}], "standard_charges": [{"minimum": 159.91, "maximum": 251.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, includin", "code_information": [{"code": "G0548", "type": "HCPCS"}], "standard_charges": [{"minimum": 242.11, "maximum": 380.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 380.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 380.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 380.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, includin", "code_information": [{"code": "G0549", "type": "HCPCS"}], "standard_charges": [{"minimum": 324.31, "maximum": 509.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 324.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 509.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 509.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 509.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, includin", "code_information": [{"code": "G0550", "type": "HCPCS"}], "standard_charges": [{"minimum": 149.45, "maximum": 234.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 234.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 234.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 234.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, 30", "code_information": [{"code": "G0551", "type": "HCPCS"}], "standard_charges": [{"minimum": 156.91, "maximum": 246.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 156.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 246.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 246.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 246.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Interrogation device evaluation (in person) with analysis, review, and report, including connection, recording, and disconnection, per patient encounter, implantable cardiac contractility modulation-defibrillation system", "code_information": [{"code": "927T", "type": "CPT"}], "standard_charges": [{"minimum": 95.09, "maximum": 149.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 95.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation system with interim analysis, review and report(s) by a physician or other qualified health care professional", "code_information": [{"code": "948T", "type": "CPT"}], "standard_charges": [{"minimum": 79.94, "maximum": 125.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 79.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 125.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 125.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 125.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation system, remote data acquisition(s), receipt of transmissions, technician review, technical support, and distribution of results", "code_information": [{"code": "949T", "type": "CPT"}], "standard_charges": [{"minimum": 95.09, "maximum": 149.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 95.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation-defibrillation system with interim analysis and report(s) by a physician or other qualified health care professional", "code_information": [{"code": "928T", "type": "CPT"}], "standard_charges": [{"minimum": 79.94, "maximum": 125.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 79.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 125.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 125.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 125.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation-defibrillation system, remote data acquisition(s), receipt of transmissions, technician review, technical support, and distribution of results", "code_information": [{"code": "929T", "type": "CPT"}], "standard_charges": [{"minimum": 95.09, "maximum": 149.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 95.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Recombinant Spike Protein Nanoparticle, Saponin-Based Adjuvant, Preservative Free, 5 Mcg/0.5ml Dosage; First Dose", "code_information": [{"code": "41A", "type": "CPT"}], "standard_charges": [{"minimum": 176.4, "maximum": 277.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Recombinant Spike Protein Nanoparticle, Saponin-Based Adjuvant, Preservative Free, 5 Mcg/0.5ml Dosage; Second Dose", "code_information": [{"code": "42A", "type": "CPT"}], "standard_charges": [{"minimum": 176.4, "maximum": 277.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intraoperative assessment for abnormal (tumor) tissue, in-vivo, following partial mastectomy (eg, lumpectomy) using computer-aided fluorescence imaging (List separately in addition to code for primary procedure)", "code_information": [{"code": "945T", "type": "CPT"}], "standard_charges": [{"minimum": 182.67, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 182.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 287.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 287.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 287.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; each additional nerve (List separately in addition to code for primary proce", "code_information": [{"code": "883T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; initial nerve (List separately in addition to code for primary procedure)", "code_information": [{"code": "882T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intravascular imaging of extracranial cerebral vessels using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report; each additional ve", "code_information": [{"code": "985T", "type": "CPT"}], "standard_charges": [{"minimum": 349.64, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intravascular imaging of extracranial cerebral vessels using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report; initial vessel (Li", "code_information": [{"code": "984T", "type": "CPT"}], "standard_charges": [{"minimum": 439.4, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 439.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 690.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 690.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 690.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intravascular imaging of intracranial cerebral vessels using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report; each additional ve", "code_information": [{"code": "987T", "type": "CPT"}], "standard_charges": [{"minimum": 349.64, "maximum": 549.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intravascular imaging of intracranial cerebral vessels using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report; initial vessel (Li", "code_information": [{"code": "986T", "type": "CPT"}], "standard_charges": [{"minimum": 439.4, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 439.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 690.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 690.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 690.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour 96365", "code_information": [{"code": "96365", "type": "CPT"}, {"code": "44654327", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 321.05, "maximum": 8450.0, "gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intravenous infusion, hydration; each additional hour 96361", "code_information": [{"code": "96361", "type": "CPT"}, {"code": "44654304", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 60.37, "maximum": 8450.0, "gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 60.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intravenous infusion, hydration; initial, 31 minutes to 1 hour 96360", "code_information": [{"code": "96360", "type": "CPT"}, {"code": "44647140", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 170.05, "maximum": 8450.0, "gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 170.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 267.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, who either have moderate-to-severe immune compromise due to ", "code_information": [{"code": "M0224", "type": "HCPCS"}], "standard_charges": [{"minimum": 1984.5, "maximum": 3118.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1984.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Iron Binding Capacity Total", "code_information": [{"code": "83550", "type": "CPT"}, {"code": "633764", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 19.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Irradiation of Blood Unit", "code_information": [{"code": "P9021", "type": "HCPCS"}, {"code": "1099826", "type": "CDM"}, {"code": "381", "type": "RC"}], "standard_charges": [{"gross_charge": 1031.0, "discounted_cash": 360.85, "setting": "both", "billing_class": "facility"}]}, {"description": "Iv cipaglucosidase alfa-atga", "code_information": [{"code": "G0138", "type": "HCPCS"}], "standard_charges": [{"minimum": 2868.71, "maximum": 4507.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2868.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4507.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4507.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4507.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JACKET XRAY 14IN X 18IN", "code_information": [{"code": "XJ3030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "JAK2 GENE", "code_information": [{"code": "81270", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 141.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 233.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 367.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 367.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 367.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 131.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 131.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JAK2 GENE TRGT SEQ ALYS", "code_information": [{"code": "27U", "type": "CPT"}], "standard_charges": [{"minimum": 175.55, "maximum": 488.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 310.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 488.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 488.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 488.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 175.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 175.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JAK2 GENE TRGT SEQUENCE ALYS", "code_information": [{"code": "81279", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 472.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JAW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29800", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JAW ENSEAL G2 CURVED 45CM 6EA/BX NSLG2C45", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NSLG2C45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 833.0, "discounted_cash": 291.55, "setting": "both", "billing_class": "facility"}]}, {"description": "JII UNI TIB XLPE INS SZ 3-4 9MM LM/RL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71935210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "JK GNOTYP SLC14A1 EXON 9", "code_information": [{"code": "192U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 395.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOHN CUNNINGHAM ANTIBODY", "code_information": [{"code": "86711", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOINT PROSTHESIS PIP SILICONE SZ 1", "code_information": [{"code": "L8658", "type": "HCPCS"}, {"code": "SPIP-520-1-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2963.16, "discounted_cash": 1037.11, "setting": "both", "billing_class": "facility"}]}, {"description": "JOINT SF UNIVERSAL", "code_information": [{"code": "9000-SFUJ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1466.0, "discounted_cash": 513.1, "setting": "both", "billing_class": "facility"}]}, {"description": "JOURNEY II BCS CNSTRD ART ISRT 5-6 LT 21M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74029268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5494.0, "discounted_cash": 1922.9, "setting": "both", "billing_class": "facility"}]}, {"description": "JOURNEY II BCS CONSTRAINED ARTICULAR INSERT SIZE 7-8 LEFT 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74029282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 0.02, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "JR GNOTYP ABCG2 EXONS 2-26", "code_information": [{"code": "193U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 407.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JRNY BCS PAT RESRF RD 38 MM STD 74024838", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74024838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 886.0, "discounted_cash": 310.1, "setting": "both", "billing_class": "facility"}]}, {"description": "JUGGERLOC SOFT TISSUE UNICORTICAL FIXATION #2 MAXBRAID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110017314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 759.0, "discounted_cash": 265.65, "setting": "both", "billing_class": "facility"}]}, {"description": "JUNI OX FB FEM SZ 6 RM LL 71422356", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71422356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3749.0, "discounted_cash": 1312.15, "setting": "both", "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE MULTIPLE", "code_information": [{"code": "78709", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1363.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2144.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2144.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2144.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 644.69, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 686.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/DRUG", "code_information": [{"code": "78708", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 537.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 844.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 844.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 844.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 290.17, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 309.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/O DRUG", "code_information": [{"code": "78707", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 845.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1329.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1329.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1329.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 406.76, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 433.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K WIRE .054 WS-1406 ST", "code_information": [{"code": "WS-1406 ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE 1.4 X 150", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P40-292-1415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE DRILL TIP 2.0 X 234 MM", "code_information": [{"code": "705002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE MAX VPC 0.90 X 95", "code_information": [{"code": "231209095", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE NITINOL 500MM", "code_information": [{"code": "S100241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 473.0, "discounted_cash": 165.55, "setting": "both", "billing_class": "facility"}]}, {"description": "K- WIRE WIRE-1.6/150", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.6/150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "292.10E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .035 DOUBLE ENDED TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-24-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .035IN X 6.0IN", "code_information": [{"code": "WS-0906ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .045 DOUBLE ENDED TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-24-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .045 DOUBLE ENDED TROCAR POINT KM172-24-28", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-24-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .045 X 6 DOUBLE ENDED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .054 DOUBLE ENDED TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-24-54", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .062 DOUBLE ENDED TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-24-62", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29.04, "discounted_cash": 10.16, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .110 X 12IN PARTIAL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "215-70-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .110 X 12IN SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "215-70-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .62 X 9 INCH STYLE 1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.2MM PROXIMAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "L210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.8 X 120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-0.8/120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.8, TROCAR, 2-END, 100MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5043.00/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9 TITANIUM PHALINX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45302000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9 X 150MM SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-192-0915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9 X 152.4MM VKW01000", "code_information": [{"code": "VKW01000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.58, "discounted_cash": 26.1, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9 X 70MM BIOMET", "code_information": [{"code": "110018526", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9MM", "code_information": [{"code": "1-000002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.53, "discounted_cash": 32.04, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9MM K100-09-S", "code_information": [{"code": "K100-09-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9MM X 150MM", "code_information": [{"code": "DSDS-1009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9MM X 152MM DOUBLE TROCAR KWIR-HCS-09152", "code_information": [{"code": "KWIR-HCS-09152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.22, "discounted_cash": 25.63, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9MM X-SMALL/SMALL PHALINX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45302001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1 K100-110", "code_information": [{"code": "K100-110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1/100 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.1/100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1MMX150MM THREADED TROCAR TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-450375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.2 X 50MM P99-192-1215", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "P99-192-1215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.25 THREADED 200/10MM A-5044.30/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5044.30/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.25 X 200MM A-5040.30/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5040.30/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.4MM", "code_information": [{"code": "705233S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 344.0, "discounted_cash": 120.4, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.4MM X 18IN NITINOL BLUNT TIP 108-320-118", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "108-320-118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.5MM X 127MM KWIR-DES-15127", "code_information": [{"code": "KWIR-DES-15127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.5MM X 127MM KWIR-STD-15127", "code_information": [{"code": "KWIR-STD-15127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.25, "discounted_cash": 29.84, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6/065", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.6/065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6/100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.6/100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6MM L200MM 705136", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "705136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 134.05, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6MM OSTEOMED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "320-5016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6MM X 230MM TRIMED WIRE-1.6/230", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.6/230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6MM X 60MM OLIVE 10MM A-5045.41/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5045.41/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 56.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6MM X 6IN SMOOTH TROCARTIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-1147-094-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 117.0, "discounted_cash": 40.95, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 2.0 57790010", "code_information": [{"code": "57790010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.0, "discounted_cash": 167.3, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 2.0 60M OLIVE 10MM A-5045.61/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5045.61/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 178.0, "discounted_cash": 62.3, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 2.0MM X 15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "494.20E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 2.3 X 150MM SINGLE ENDED TROCAR TIP SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-192-2315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 2.3 X 230MM SINGLE ENDED TROCAR TIP SMOOTH", "code_information": [{"code": "P99-192-2323", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 2.5MM OS900024-NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS900024-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 41.65, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 3.0 SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NK013027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 3.2MM FOR PF NAILS 9206320", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9206320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2202.0, "discounted_cash": 770.7, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 300MM GZA030000", "code_information": [{"code": "GZA030000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 500MM 1.4MM ROUND TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LS-351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 6220-003", "code_information": [{"code": "6220-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.6, "discounted_cash": 47.46, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE ACUMED .054 X 7", "code_information": [{"code": "WS-1407ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE APTUS 1.6 X 150MM WRIST OLIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5045.40/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 233.0, "discounted_cash": 81.55, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE APTUS LANCET 1.2MM X 150MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5042.21/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 143.0, "discounted_cash": 50.05, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE APTUS LANCET 1.6MM X 150MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5042.41/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE ASNIS 2.0MM JFX UNTREADED", "code_information": [{"code": "705355", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 274.34, "discounted_cash": 96.02, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE ASNIS III THREADED 702462", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "702462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE BLUNT TIP 1.4MM X 24IN NITINOL 108-320-124", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "108-320-124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE DOUBLE DIAMON THD .054", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM173-49-54", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE DOUBLE TROCAR 0.9 X 152MM KWIR-DT-09152", "code_information": [{"code": "KWIR-DT-09152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.6, "discounted_cash": 47.46, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE DOUBLE TROCAR 1.6MM X 150MM OS216150", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS216150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE DT .062", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WS1606DT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE EXTREMILOCK 1.1 MM X .045IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "320-5011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.26, "discounted_cash": 14.09, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE FOR 2.0MM SCREW SINGLE TROCAR 0.7X70MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS900023-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 43.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE FOR 3.0MM SCREW SINGLE TROCAR 1.0 X 70MM (COCR)", "code_information": [{"code": "OS900025-NS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 199.0, "discounted_cash": 69.65, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE FOR 5.0MM SCREW DRILL TIP 2.0 X 150MM OS900027-NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS900027-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 41.65, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE FOR USE WITH THE PICCOLO COMPOSITE DISTAL RADIUS PLATE SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PL921210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE FUSION ORTHO 0.9MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CD-FX-0009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE FUSION ORTHO 1.1MM", "code_information": [{"code": "CD-FX-0011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE GUIDE 3X285MM 2351-3028S", "code_information": [{"code": "2351-3028S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 308.0, "discounted_cash": 107.8, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE HCS 1.4MM X 165MM KWIR-HCS-14165", "code_information": [{"code": "KWIR-HCS-14165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.22, "discounted_cash": 25.63, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE JONES-FX 1.7MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JF1009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE LATERAL ACCESS BLUNT 1.5MM X 350MM I62-60-23", "code_information": [{"code": "I62-60-23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.6, "discounted_cash": 47.46, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE LEOS 1.6MM SMOOTH 7624-2016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7624-2016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.2, "discounted_cash": 65.52, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE LISFRANC 1.6 X 150MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4411-2008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE NITINOL BLUNT 550MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48280232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE OLIVE 0.062IN 330-60-005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "330-60-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE OLIVE 1.8MM SMOOTH SHORT TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-202-1810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE OLIVE 300-60-005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-60-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE PACK MIS LAPIDUS 57KWPACK", "code_information": [{"code": "57KWPACK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 981.85, "discounted_cash": 343.65, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE PHALINX 0.9MM X 4IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE PHALINX 1.4MM HAMMERTOE FIXATION SYSTEM LARGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45302003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE PHALINX 1.4MM X 4IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE REAMER CANNULATED 3.5MM W/1.1.5 11220", "code_information": [{"code": "11220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 490.0, "discounted_cash": 171.5, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE SHORT 1.4MM P20-900-0008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-900-0008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 434.0, "discounted_cash": 151.9, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE SINGLE DIAMOND 1.5MM X 127MM KWIR-SD-15127", "code_information": [{"code": "KWIR-SD-15127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.77, "discounted_cash": 37.02, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE SINGLE DIAMOND 2.0 MM X 152MM KWIR-SD-20152", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KWIR-SD-20152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 116.62, "discounted_cash": 40.82, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE SINGLE ENDED TROCAR TIP SMOOTH 2.3 X 300MM P99-192-2330", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-192-2330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE SINGLE TROCAR 0.9MM X 152MM KWIR-ST-09152", "code_information": [{"code": "KWIR-ST-09152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.01, "discounted_cash": 56.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE SINGLE TROCAR 1.4MM X 165MM KWIR-ST-14165", "code_information": [{"code": "KWIR-ST-14165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.89, "discounted_cash": 46.51, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE SINGLE USE-SHARP I62-60-24", "code_information": [{"code": "I62-60-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.6, "discounted_cash": 47.46, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE SMOOTH 1.4MM X 100MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45-80200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE SMOOTH 1.4MM X 150MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-192-1415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE STANDARD DIAMOND TIP W/STOP 2.0MM X 152MM KWIR-SDS-20152", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KWIR-SDS-20152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 118.4, "discounted_cash": 41.44, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE STANDARD TIP .9MM X 152MM KWIR-STD-09152", "code_information": [{"code": "KWIR-STD-09152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.22, "discounted_cash": 25.63, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE STANDARD TIP 2.0 MM X 152 MM KWIR-STD-20152", "code_information": [{"code": "KWIR-STD-20152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.78, "discounted_cash": 30.37, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE THREADED .062 X 9 SGL TROCAR KM173-19-62", "code_information": [{"code": "KM173-19-62", "type": "CDM"}], "standard_charges": [{"gross_charge": 35.36, "discounted_cash": 12.38, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE THREADED .094 X 12IN", "code_information": [{"code": "215-55-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE THREADED 0.062IN X 9IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM173-39-62", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE THREADED 2.2 TROCAR 250/10MM", "code_information": [{"code": "A-5044.74/1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.43, "discounted_cash": 43.9, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE TROCAR 0.045 X 4.72IN", "code_information": [{"code": "IFI491414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 445.0, "discounted_cash": 155.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE TROCAR 1.1MM X 150MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS292110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 398.0, "discounted_cash": 139.3, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE TROCAR POINT 1.6MM X 150MM 1 END", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4901-016-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE TROCAR TIP 1.2MM X 150MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5040.21/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE TROCAR TIP 2.8MM X 300MM", "code_information": [{"code": "110008397", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE TROCAT TIP 1.25MM X 150MM", "code_information": [{"code": "110008393", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 528.0, "discounted_cash": 184.8, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE WITH STOP 1.6 X 150MM 705134", "code_information": [{"code": "705134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 529.93, "discounted_cash": 185.48, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE WITH STOP 1.6 X 150MM 705150", "code_information": [{"code": "705150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 344.52, "discounted_cash": 120.58, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE \u00c3\u02dc1.0 LG150 TR/RD COCR CKW02004", "code_information": [{"code": "CKW02004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE \u00c3\u02dc1.0 LG150 TR/RD COCR CKW02005", "code_information": [{"code": "CKW02005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE1.2 X 150MM 707091202", "code_information": [{"code": "707091202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE1.4MM 24872018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "24872018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE2.5MM X 150MM 58862515", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58862515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRES 1.6MM X 6IN 7000-16KW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7000-16KW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRES TROCAR POINT 1 END 1.25MM X 15MM", "code_information": [{"code": "-4901-012-15", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRESTEM 2.5MM X 230MM THREADED CHARLOTTE F and A SYSTEM 44182523", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44182523", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRESTEM JONES 228MM CHARLOTTEF and A SYSTEM 56010228", "code_information": [{"code": "56010228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIREVALOR NAIL 3.0MM K-WIRE 4150004025", "code_information": [{"code": "4150004025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 616.01, "discounted_cash": 215.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KEL GNOTYP KEL EXON 8", "code_information": [{"code": "194U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 266.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KENALOG 40/ TRIAMCINOLONE ACETONIDE 40 MG/ML", "code_information": [{"code": "MED0106", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KENDALL SCD EXPRESS COMPRESSION SLEEVE KNEE LENGTH MEDIUM", "code_information": [{"code": "9529R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.63, "discounted_cash": 14.22, "setting": "both", "billing_class": "facility"}]}, {"description": "KERATOPLASTY;ANTERIOR LAMELLAR 65710", "code_information": [{"code": "65710", "type": "CPT"}, {"code": "1481177", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KERATOPLASTY;ENDOTHELIAL 65756", "code_information": [{"code": "65756", "type": "CPT"}, {"code": "1481178", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2631.5, "maximum": 9357.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KERATOPLASTY;PENETRATING 65730", "code_information": [{"code": "65730", "type": "CPT"}, {"code": "1481179", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KERATOPLASTY;PENETRATING IN APHAKIA 65750", "code_information": [{"code": "65750", "type": "CPT"}, {"code": "1481180", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KERATOPLASTY;PENETRATING IN PSEUDOPHAKIA 65755", "code_information": [{"code": "65755", "type": "CPT"}, {"code": "1481181", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KERECIS OMEGA3 WOUND; 3X7CM", "code_information": [{"code": "Q4158", "type": "HCPCS"}, {"code": "50200S2B00", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1835.0, "discounted_cash": 642.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KETAMINE AND NORKETAMINE", "code_information": [{"code": "80357", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KETOROLAC TROMETHAMINE/ TORADOL 60 MG", "code_information": [{"code": "MED0107", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KETOROLAC/TORADOL 30 MG/1 ML", "code_information": [{"code": "MED0108", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC", "code_information": [{"code": "657", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11768.78, "maximum": 20204.07, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11768.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16831.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18515.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20204.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC", "code_information": [{"code": "656", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19982.66, "maximum": 34305.26, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19982.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28579.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31437.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34305.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC", "code_information": [{"code": "658", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9598.37, "maximum": 16478.01, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9598.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13727.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15100.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16478.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [{"code": "660", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8778.38, "maximum": 15070.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8778.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12554.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13810.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15070.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [{"code": "659", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16219.71, "maximum": 27845.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16219.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23197.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25517.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27845.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC", "code_information": [{"code": "661", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6470.49, "maximum": 11108.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6470.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9254.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10179.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11108.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "code_information": [{"code": "689", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6777.68, "maximum": 11635.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6777.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9693.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10662.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11635.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [{"code": "690", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4829.9, "maximum": 8291.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4829.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6907.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7598.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8291.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [{"code": "687", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6387.76, "maximum": 10966.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6387.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9135.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10049.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10966.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC", "code_information": [{"code": "686", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11407.45, "maximum": 19583.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11407.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16315.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17946.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19583.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC", "code_information": [{"code": "688", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4171.72, "maximum": 7161.81, "estimated_discounted_cash": 23585.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4171.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5966.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6563.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7161.81, "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": 6920.63, "maximum": 11881.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6920.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9897.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10887.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11881.0, "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": 4208.83, "maximum": 7225.51, "estimated_discounted_cash": 23989.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4208.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6019.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6621.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7225.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50551", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50570", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1475.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50557", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50561", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50576", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50580", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY FUNCTION STUDY", "code_information": [{"code": "78725", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 407.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 194.51, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 207.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY HISTOTRIPSY W/IMAGE", "code_information": [{"code": "C9790", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 5161.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING MORPHOL", "code_information": [{"code": "78700", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 677.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1064.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1064.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1064.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 327.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 349.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING WITH FLOW", "code_information": [{"code": "78701", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 877.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1379.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1379.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1379.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 439.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 468.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KINGWOOD SPECIALTY ARTHRO PACK", "code_information": [{"code": "DYNJ31663B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 53.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KINIFE 10MM ACL GRAFT 231110", "code_information": [{"code": "231110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 651.0, "discounted_cash": 227.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIRSCHNER WIRE 100 X 0.7MM TROCAR/ROUND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P22-27-607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIRSCHNER WIRE 100 X 0.9 MM TROCAR/ROUND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P22-27-609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KIRSCHNER WIRES 1.6MM X 150MM PART THREAD TROC TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1147-94", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 117.0, "discounted_cash": 40.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 11G IVAS BONE BIOPSY", "code_information": [{"code": "306-116-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 243.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 3 PTP LTP ELECTRODE EMG SSEP AIX12215", "code_information": [{"code": "AIX12215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3843.45, "discounted_cash": 1345.21, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 3CC SCP FRACTURE FOOT AND ANKLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "514.315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8075.0, "discounted_cash": 2826.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 5.8MM SPINEJACK EXPANSION 0909-200-058", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909-200-058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1288.0, "discounted_cash": 450.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 6MM X 6.5MM TENOTAC STERILE P42-022-0065-SK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P42-022-0065-SK", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1976.0, "discounted_cash": 691.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACC LEAD INTRODUCER", "code_information": [{"code": "3550-18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESS AFFIRM VCF CANNULATED A5P", "code_information": [{"code": "658.933S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6485.0, "discounted_cash": 2269.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESS URINARY CONTROL SYS", "code_information": [{"code": "C1815", "type": "HCPCS"}, {"code": "720066-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2750.0, "discounted_cash": 962.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESSORY 14GA 6IN CURVED TIP NEEDLE WITH STYLET", "code_information": [{"code": "3550-43", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 44.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESSORY 14GA X 3.5IN CURVED TIP NDL W/ STYLET STRL", "code_information": [{"code": "3550-14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESSORY AMS 700", "code_information": [{"code": "72401850", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1972.0, "discounted_cash": 690.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESSORY INSTAFIX 3.5MM 400-7777", "code_information": [{"code": "400-7777", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.0, "discounted_cash": 159.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADAPTABLE ARM POSITIONER DISPOSABLE 3105-400-010", "code_information": [{"code": "3105-400-010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 245.63, "discounted_cash": 85.97, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ALLOAID PIP INSTRUMENT C01 S0001", "code_information": [{"code": "C01 S0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1102.9, "discounted_cash": 386.02, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT AMENITY PREMIUM W/ 7IN COMB CONDITIONER HND BODY LOTION SHAMPOO AND BODY BAT", "code_information": [{"code": "DYKD100AMM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ANCHOR 3.5 X 13.5MM DX SWIVELOCK", "code_information": [{"code": "AR-8979DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 266.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ANCHOR FLEXBAND TWIST 30 TW030", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "TW030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11390.5, "discounted_cash": 3986.68, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ANGEL BMC ARTHREX", "code_information": [{"code": "AR-10062", "type": "CDM"}], "standard_charges": [{"gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT APPLICATOR 8MM FALOPE RING BAND DUALINCISION TROCAR DISP", "code_information": [{"code": "A4264", "type": "HCPCS"}, {"code": "5280-901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 682.0, "discounted_cash": 238.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT APPLICATOR MANUAL SPRAY WITHOUT TIP BIOMET BIOLOGICS", "code_information": [{"code": "800-0250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT APPLICATOR RING BAND FALOPE DUALINSCISON WITHOUT TROCAR DISP", "code_information": [{"code": "A4264", "type": "HCPCS"}, {"code": "6889-901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 362.0, "discounted_cash": 126.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ART PRP PLUS PROCESSING 0885-2000 0885-2000", "code_information": [{"code": "885-2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARTHRODESIS PIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9F00-1050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 448.0, "discounted_cash": 156.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARTHROSCOPIC GRAFT DELIVERY C01-S1111", "code_information": [{"code": "C01-S1111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.55, "discounted_cash": 466.04, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARWY 37FR TRACHEAL ESOPHAGEAL EMERGENCY ROLL UP W/ SYRNG AND DOUBLE LUMEN SU", "code_information": [{"code": "5-18437", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARWY 41FR TRACHEAL ESOPHAGEAL EMERGENCY ROLL UP W/ SYRNG AND DOUBLE LUMEN SU", "code_information": [{"code": "KDL518441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ASEPTIC 48IN TUBING X 10IN ASEPTIC TRANSFER SYS KIT CHEST BREAST TRAY LF", "code_information": [{"code": "350-8400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ASSEMBLY", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "91-9480SC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1211.0, "discounted_cash": 423.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BALLOON 11G 15MM IVASELITE SINGLE KIT", "code_information": [{"code": "808-115-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5645.0, "discounted_cash": 1975.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BALLOON DILATION UROMAX 15 X 4 225-121", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "225-121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 656.0, "discounted_cash": 229.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BALLOON OMNICURVE FRACTURE 11G X 20MM 1032-120-000", "code_information": [{"code": "1032-120-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5639.0, "discounted_cash": 1973.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BANDAGE SUPER 7", "code_information": [{"code": "4225-2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 582.0, "discounted_cash": 203.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BEARING ULNA ELBOW REV DISCOVERY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "114800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3588.0, "discounted_cash": 1255.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BIOCARTILAGE LG JOINT", "code_information": [{"code": "ABS-1000-L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 679.0, "discounted_cash": 237.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BIOCARTILAGE SMALL JOINT", "code_information": [{"code": "ABS-1000-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 714.41, "discounted_cash": 250.04, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BIOCOMPOSITE MENISCAL ROOT REPAIR AR-4550BC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4550BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 1328.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BIOPSY 11GA BONE VERT BODY STRLINSTR", "code_information": [{"code": "306115000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BIOPSY CARTILAGE CARTICEL", "code_information": [{"code": "80001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1372.0, "discounted_cash": 480.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BLOOD ANALYZER SLF CONTAINED ONE CRITICAL DISTRIBUTION WAIVED I-STAT", "code_information": [{"code": "4J60-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31219.0, "discounted_cash": 10926.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BOARD GRAFT PREP", "code_information": [{"code": "100-GPB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 179.0, "discounted_cash": 62.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE BIOPSY IVAS 5IN 10G", "code_information": [{"code": "306-104-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE BX VERTEBRAL 11GA 5IN BLUNT", "code_information": [{"code": "306-115-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.53, "discounted_cash": 58.99, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE DOWEL 16MM REVISION ABS-2850-16", "code_information": [{"code": "ABS-2850-16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1241.0, "discounted_cash": 434.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE DOWEL 18MM REVISION ABS-2850-18", "code_information": [{"code": "ABS-2850-18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1773.0, "discounted_cash": 620.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE DOWEL REVISION KIT 13MM", "code_information": [{"code": "ABS-2850-13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE GRAFT LARGE INFUSE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7510600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12175.0, "discounted_cash": 4261.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE GRAFT MED 5.6CC 1IN X 2ININFUSE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7510400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11800.0, "discounted_cash": 4130.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE IVAS BALLOON KYPHOPLASTY INFLATABLE VERTEBRAL AUGMENTATION SYSTEM BEVEL TIP CUSTOM 11G X 15", "code_information": [{"code": "705-315-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2193.0, "discounted_cash": 767.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE MARROW ASPIRATE CONCENTRATE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "SMI-BMAS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5628.0, "discounted_cash": 1969.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE MARROW PROCESSING ANGEL", "code_information": [{"code": "ABS-10062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2211.0, "discounted_cash": 773.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE MARROW PROCESSING ANGEL ANTICOAGULANT", "code_information": [{"code": "ABS-10062T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2211.0, "discounted_cash": 773.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE STAPLE 10 X 10MM MOTOCLIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1442-1010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3286.0, "discounted_cash": 1150.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BUTTON LARGE PECTORIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3685.0, "discounted_cash": 1289.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CARAFE MAUVE PITCHER FOAM JACKET GRAPHITE", "code_information": [{"code": "DYKD100CM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CARE PATIENT FIRM SPINAL TABLE POSITIONING PAD WILSON", "code_information": [{"code": "5322", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CATHETER RADIAL ARTERY 20GX1 3 4 RA-04020", "code_information": [{"code": "RA-04020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.79, "discounted_cash": 19.18, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CHARGING SYS CHARGER BASE STATION AC DC PWR SUPPLY CHARGER 2.0 CHARGING BELT", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-6412-3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6602.0, "discounted_cash": 2310.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CONDYLE HUMERAL W/ HEXALOBULAR BLADE DISCOVERY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "114700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2876.0, "discounted_cash": 1006.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CONENTRATION PLATELET BIOCUE", "code_information": [{"code": "800-0611A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2820.0, "discounted_cash": 987.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CONSTA VAC BLOOD CONSERVATION CBC II", "code_information": [{"code": "225-414-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1401.0, "discounted_cash": 490.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CONTACT LEAD 50CM 16", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-2316-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7218.0, "discounted_cash": 2526.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CONTACT LEAD 50CM 17", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-2317-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5871.0, "discounted_cash": 2054.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CROSS PIN 2.7MM BONE TO BONE ACL RECONSTRUCTION KNEE POLY L LACTIDE ACID ABS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210127", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 925.0, "discounted_cash": 323.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CROSS PIN 3.3MM FEMORAL SOFT TISSUE KNEE POLY L LACTIDE ACID ABSORBL POLYMER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1192.0, "discounted_cash": 417.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CROSS PIN SOFT TISSUE RIGIDFIX", "code_information": [{"code": "100-RST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CVC 4FR DOUBLE LUMEN 13CM", "code_information": [{"code": "AK-14402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.0, "discounted_cash": 49.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DEFOGGER OVAL W/ X RAY DETECT FOAM PAD SOL LF STRL BT", "code_information": [{"code": "28-0101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.39, "discounted_cash": 6.44, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISC 13 X 15 X 5MM REPLACEMENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MB3355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISC 13 X 17 X 5MM REPLACEMENT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "MB3375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISP NON-CERVICAL TI-K-1000", "code_information": [{"code": "TI-K-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1971.0, "discounted_cash": 689.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE 1.5MM CURVED SOFT ANCHOR JUGGERKNOT", "code_information": [{"code": "912041C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 681.0, "discounted_cash": 238.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE 1.5MM STRAIGHT SOFT ANCHOR JUGGERKNOT DISP", "code_information": [{"code": "912041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 681.0, "discounted_cash": 238.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE 2.4MM TRANSTIBIAL ACL GRAFT HARVESTING W/ HALL STYLE SAW BLADE", "code_information": [{"code": "AR-1897S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 236.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE ACL ORTHO DISP", "code_information": [{"code": "CM-1501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 317.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE CURVED FIBERTAK", "code_information": [{"code": "AR-3638DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 874.25, "discounted_cash": 305.99, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE FOR BIO TENODESIS SCREW", "code_information": [{"code": "AR-1676DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.61, "discounted_cash": 199.01, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE KNEEINCLUDE BREAKAWAY PIN TUBEROSITY PIN", "code_information": [{"code": "AR-13217", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1608.0, "discounted_cash": 562.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE SITE CLOSURE 2 PIECE", "code_information": [{"code": "PMI12", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE SITE CLOSURE 3 PIECE", "code_information": [{"code": "PMI512", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE TRANSTIBIAL ACL WITHOUT SAW BLADES", "code_information": [{"code": "AR-1898S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISTRACTION COMPRESSION EFFI PLUS PRO", "code_information": [{"code": "100113-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2142.0, "discounted_cash": 749.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRESSING EAR ADULT STERILE S-1000", "code_information": [{"code": "S-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL 7MM", "code_information": [{"code": "CM-9570", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL ACORN 4MM CANNUMLATED 1.4MM GUIDE WIRE", "code_information": [{"code": "CM-9540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL ACORN 5MM CANNULATED 1.4MM GUIDE WIRE", "code_information": [{"code": "CM-9550", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL BIT 1.5MM FOR 2.0MM SCREWS", "code_information": [{"code": "DBK 020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 870.0, "discounted_cash": 304.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL BIT 1.8MM FOR 2.4MM SCREWS", "code_information": [{"code": "DBK 024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL BIT 2.0MM FOR 2.7MM SCREWS", "code_information": [{"code": "DBK 027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL BIT 2.5MM FOR 3.5MM SCREWS", "code_information": [{"code": "DBK 035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL BIT 3.0MM FOR 4.0MM SCREWS", "code_information": [{"code": "DBK 040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL BIT DISP 1.5MM", "code_information": [{"code": "DBK-020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL BIT DISP 1.8MM", "code_information": [{"code": "DBK-024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL BIT DISP 2.0MM/2.7MM", "code_information": [{"code": "DBK-027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL BIT DISP 3.5MM", "code_information": [{"code": "DBK-035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL CONTINOUSE COMPRESSION IMPLANTS", "code_information": [{"code": "DK-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1100.0, "discounted_cash": 385.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRILL PUSHLOCK SHORT 2.9MM", "code_information": [{"code": "AR-2923DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 184.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DUAFIT INST 17 DEG/10 DEG/ 0 DEG SINGLE USE", "code_information": [{"code": "A06-10401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2199.0, "discounted_cash": 769.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DX KNOTLESS FIBERTAK AR-8991DS", "code_information": [{"code": "AR-8991DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 826.0, "discounted_cash": 289.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DX SWIVELOCK SL 3.5MM X 8.5MM", "code_information": [{"code": "AR-8978DS-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 266.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ECTRA II PROCEDURE 4116", "code_information": [{"code": "4116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.39, "discounted_cash": 179.69, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ENDOSCOPY CARDINAL", "code_information": [{"code": "END441844A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ENDOSCOPY GASTRO RESECTION", "code_information": [{"code": "3200-D-EGR-D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1898.0, "discounted_cash": 664.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ENDOSCOPY PLANTAR FASCIOTOMY DISP", "code_information": [{"code": "3100-D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1953.48, "discounted_cash": 683.72, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ENDOVIVE SAFETY PEG 24F (8MM) M00509021", "code_information": [{"code": "M00509021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 254.94, "discounted_cash": 89.23, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ENT HEMOSTATIC POWDER ARISTA 2G HEMADERM 2 FLEXTIP", "code_information": [{"code": "ENT0001-2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 393.0, "discounted_cash": 137.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EVACUATOR 3 SPRNG 400 CC DRAIN 0043600", "code_information": [{"code": "43600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EXPANSION F ON-Q SILVERSOAKER PM020-A", "code_information": [{"code": "PM020-A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 46.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EXTENSION 110IN 37IN BREATHING CIRCUIT UNIVERSAL FLEX2", "code_information": [{"code": "XF37", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EXTENSION 2.8MM X 2.8MM LOW IMPEDANCE FOR SPINAL STIMULATION", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "37081-60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1204.5, "discounted_cash": 421.58, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EXTENSION 40 CM", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "37081-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1100.0, "discounted_cash": 385.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EXTENSION 75IN BREATHING CIRCUIT SNGL LIMB UNIVERSAL FLEX2", "code_information": [{"code": "XF75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.24, "discounted_cash": 6.03, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EXTREMITY SURG", "code_information": [{"code": "XKT1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1455.0, "discounted_cash": 509.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FALOPE RING BAND", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "FRB-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 56.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FEEDING TUBE ENDOVIVE PEG SAFETY PULL METHOD", "code_information": [{"code": "M00566461", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FIBERTAK SPEAR INSERTION STRAIGHT DISP", "code_information": [{"code": "AR-3600D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FIXATION RIGIDLOOP CORTICAL DISP", "code_information": [{"code": "232037", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1116.9, "discounted_cash": 390.92, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FIXATION SECONDARY ACL/PCL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1593", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 432.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FIXTN FXTN DEVINCLUDES PUSHER AND PLUNGER 6IN BREATH PIN 4.5 MM CANNULATED D", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "904837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.0, "discounted_cash": 402.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FREELINK REMOTE CONTROL", "code_information": [{"code": "SC-5552-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1805.0, "discounted_cash": 631.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FXTN DIST BICEPS TENDON ELBOW SYS TOGGLELOC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "909854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1926.0, "discounted_cash": 674.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GEL PLATELET", "code_information": [{"code": "SMI-PRPS", "type": "CDM"}], "standard_charges": [{"gross_charge": 2244.0, "discounted_cash": 785.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GELATIN POWDER ABSORBL SURGIFOAM LF", "code_information": [{"code": "1979", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GENE ANALYS D816 VARIANT", "code_information": [{"code": "81273", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 156.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 318.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 500.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 500.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 500.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 179.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 179.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT GENE TARGETED SEQ ANALYS", "code_information": [{"code": "81272", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 411.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 840.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1321.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1321.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1321.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 474.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 474.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT GENERATOR IMPLANTABLE PULSE WAVEWRITER ALPHA (BUNDLE) SC-1482", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "SC-1482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37698.0, "discounted_cash": 13194.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GENERATOR IMPLANTABLE PULSE WAVEWRITER ALPHA SC-1232", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 62000.0, "discounted_cash": 21700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GOWN XL WARMING UPPER AND LOWER FORCED AIR BLANKET BAIR PAWS", "code_information": [{"code": "84203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GUAGE PINIT PLATE", "code_information": [{"code": "9A09-3000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 306.0, "discounted_cash": 107.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GUIDE WIRE 2.0/2.4MM", "code_information": [{"code": "GWK 100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GUIDE WIRE 2.0MM/2.4MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "GWK-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GUIDE WIRE 3.0/3.5/4.0/4.5", "code_information": [{"code": "GWK 200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 410.0, "discounted_cash": 143.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GUIDE WIRE 3.0MM/3.5MM-4.0MM/4.5MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "GWK-011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GUIDEWIRE CANN DRIVER 1.1MM", "code_information": [{"code": "GWK 011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 579.0, "discounted_cash": 202.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GUN DELIVERY BONE AUGMENTATION MATERIAL", "code_information": [{"code": "2110-0039", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1313.0, "discounted_cash": 459.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GWN STANDARD WARMING FLEX GOWN BOOTIES BONNET PERSONAL BELONGINGS BAG AND SH", "code_information": [{"code": "84003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT HAEMATOLOGICAL CONCENTRATE SYSTEM PREPARATION BIOSURGE V WITH 12MM ALLOSYN BUTTON ABS-2016-05", "code_information": [{"code": "ABS-2016-05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2820.0, "discounted_cash": 987.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT HAMMERLOCK DRILL", "code_information": [{"code": "DK-H2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 341.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT HAMMERTOE TRUSS SYSTEM INSTRUMENT HTS-KIT001-SP", "code_information": [{"code": "L3925", "type": "HCPCS"}, {"code": "HTS-KIT001-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT HARVESTING TRANSTIBIAL WITHOUT SAW BLADE", "code_information": [{"code": "AR-1828S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.0, "discounted_cash": 50.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT HEMOSTATIC FLOSEAL 10CC COMPLETE", "code_information": [{"code": "1505291", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 173.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT HFX IQ IPG HFX-D", "code_information": [{"code": "C1822", "type": "HCPCS"}, {"code": "HFX-D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37100.0, "discounted_cash": 12985.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT HFX IQ IPG NIPG3000", "code_information": [{"code": "C1822", "type": "HCPCS"}, {"code": "NIPG3000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37100.0, "discounted_cash": 12985.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT HIP Q-FIX IMPLANT 1.8MM", "code_information": [{"code": "25-1811", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT HW INTER BALANCE ALIGMNT REPR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8978-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3338.0, "discounted_cash": 1168.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IB MINI PEEK CC FT W/ JUMPSTART AR-1787PJ-CP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1787PJ-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3241.16, "discounted_cash": 1134.41, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IBT KYPHON EXPRESS OSTEO INTRODUCER SYSTEM KEX152EB-A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KEX152EB-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5671.0, "discounted_cash": 1984.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IMP HAMMERTOE SMALL CANNULATED TOE TAC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HT-00001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3136.0, "discounted_cash": 1097.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IMPL LEAD 50CM AXIUM SLIM TIP", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "MN10450-50A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3460.0, "discounted_cash": 1211.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IMPLANT 18MM X 16MM FUSEFORCE STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS-1816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3700.0, "discounted_cash": 1295.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IMPLANT 8MM X 8MM FUSEFORCE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS-0808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3631.0, "discounted_cash": 1270.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IMPLANT CRANIOFACIAL CUSTOMIZED MIDFACE IMPLANT KIT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "5444-0-510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28374.0, "discounted_cash": 9930.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IMPLANT FUSEFORCE 12 X12 2MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS-1212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3698.0, "discounted_cash": 1294.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IMPLANT INSTRUMENT DISP 13MM CD-DB-1313-SA", "code_information": [{"code": "CD-DB-1313-SA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2211.0, "discounted_cash": 773.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INCISION SYSTEM PREVENA PEEL&PLACE PRE1001US", "code_information": [{"code": "PRE1001US", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1171.0, "discounted_cash": 409.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INFLATOR NUVENT", "code_information": [{"code": "181NFKIT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INFLATOR NUVENT AM SINUS DILATION SYSTEM", "code_information": [{"code": "18INFKIT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INNATE INSTRUMED FOR 3.6MM EXINN913600", "code_information": [{"code": "EXINN913600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1322.76, "discounted_cash": 462.97, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INST INSTAFIX ACCESSORY 3.5MM", "code_information": [{"code": "400-1135-SP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1205.0, "discounted_cash": 421.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INST NAIL ALLOAID", "code_information": [{"code": "C01-S0002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTAFIX 20 X 20MM FIXATION SYSTEM SHAPE MEMORY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400-3723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4295.0, "discounted_cash": 1503.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTAFIX 25 X 20MM FIXATION SYSTEM SHAPE MEMORY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400-3724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4295.0, "discounted_cash": 1503.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTAFIX 30 X 20MM 400-3725", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400-3725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4295.0, "discounted_cash": 1503.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTAFIX IMPLANT 25X20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400-3724-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4295.0, "discounted_cash": 1503.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTAFIX SIZERS", "code_information": [{"code": "400-7777-SP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.0, "discounted_cash": 159.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTR ACL RECONSTRUCTION ALLINSIDE DISP", "code_information": [{"code": "AR-1587S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1311.0, "discounted_cash": 458.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTR FOR 2.9MM PUSHLOCK W/ METAL SPEAR AND DRILL PUSHLOCK DISP", "code_information": [{"code": "AR-1923DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTR FOR 3.5 MM PUSHLOCK DISP", "code_information": [{"code": "AR-1926DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 184.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTR MINI FOR MINI SUTTAK BIO-SUTURETAK DISP", "code_information": [{"code": "AR-1322DSC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTRUMENT INNATE GUIDE WIRES CANNULATED DRILL BIT AND CANNULATED DRIVER", "code_information": [{"code": "EXINN914500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTRUMENT MOTOBAND CP", "code_information": [{"code": "1500-4500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1353.0, "discounted_cash": 473.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTRUMENT NOVASTEP SIZE 25", "code_information": [{"code": "SUI08006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3598.0, "discounted_cash": 1259.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTRUMENT OSSIOFIBER HAMMERTOE FISAXTION SYSTEM 2.9 X 19MM 10\u00c2\u00b0 OF20029191", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF20029191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3384.0, "discounted_cash": 1184.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTRUMENT PLATFORM", "code_information": [{"code": "140-9800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2680.0, "discounted_cash": 938.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTRUMENT SINGLE USE", "code_information": [{"code": "SUI01001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2748.45, "discounted_cash": 961.96, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTRUMENT SPINAL SIMPLICITY 17934", "code_information": [{"code": "17934", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTRUMENTATION TENFUSE SYS STERILE DISP", "code_information": [{"code": "TFF-KIT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1207.0, "discounted_cash": 422.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTRUMENTS FOR 3.0 AND 3.5MM SCREWS STERILE SINGLE USE P04S0001", "code_information": [{"code": "P04S0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2312.0, "discounted_cash": 809.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INSTURMENT 3-4", "code_information": [{"code": "M03S003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1793.0, "discounted_cash": 627.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INTRAFIX", "code_information": [{"code": "100-INTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INTRODUCER FOR PRECISION SPINAL CORD SIMULATOR SYSSINSTR", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "SC-4365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INVISIKNOT ANKLE FRACTURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72204834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4690.0, "discounted_cash": 1641.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IPG", "code_information": [{"code": "C1822", "type": "HCPCS"}, {"code": "NIPG2000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 46513.0, "discounted_cash": 16279.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IV START 1624 PVP PAD ALC 01-09001A", "code_information": [{"code": "1-09001A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IV START CHLORAPREP SEPP AMPULE", "code_information": [{"code": "50233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IV START CHLORASCRUB STANDARD", "code_information": [{"code": "1-9100PL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IV START LF STANDARD (00)072", "code_information": [{"code": "Jan-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IV START TEGADERM GAUZE SPONGE ALCOHOL PREP SYNTHETIC TOURNIQUET DRAPE 3/4 X 18IN", "code_information": [{"code": "1-1900A", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IVAS ELITE FRACTURE 8 GA 15MM 0808-815-800", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "808-815-800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4461.03, "discounted_cash": 1561.36, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT JUGGERLOC DISPOSABLE CANNULA", "code_information": [{"code": "110027357", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 441.0, "discounted_cash": 154.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT K-WIRE MEDIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KWK-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 410.0, "discounted_cash": 143.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT K-WIRE SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KWK-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT K-WIRE WRENCH/ GAUGE/WIRE 1.0MM MED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KWK 002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 431.0, "discounted_cash": 150.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT KINGWOOD ARTHRO PACK", "code_information": [{"code": "SO44AAKWA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT KNEE ANT CRUCIATE LIGAMENT RECONSTRUCTION STRL DISP", "code_information": [{"code": "232300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1482.0, "discounted_cash": 518.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT KYPHON KURVE", "code_information": [{"code": "VPK1003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 868.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LAG SCREW 3.5MM BIT DRILL 3.5MM", "code_information": [{"code": "LSK-035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LAMINOTOMY TRIAL", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "9771SS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 49440.0, "discounted_cash": 17304.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LARGE 5.6MM AND 7.4MM SCREWS F4-5674-000S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "F4-5674-000S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3096.0, "discounted_cash": 1083.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 1 X 16 50 CM 70 CMINFINION", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "SC-2316-50E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 1.5MM 1MM 65 CM SPECIFY 5-6-5 FOR SPINAL CORD STIMULATION", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "39565-65", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13947.0, "discounted_cash": 4881.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 28 CM 1.5MM 1.27MM QUADRIPOLAR TINED EXTENDED STRAIGHT LEADIN LINE CONN", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "3093-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7038.0, "discounted_cash": 2463.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 28 CM 3MM TINED QUADRIPOLAR FOR USE W/INTERSTIM II 3058 AND 3023 NEUROS", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3889-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7038.0, "discounted_cash": 2463.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 30CM 8 CONTACT", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-2218-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4062.0, "discounted_cash": 1421.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 50 CM CONTACT LINEAR ELECTRODE", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-2218-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4225.0, "discounted_cash": 1478.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 50 CM EIGHT CONTACT TRIAL FOR PRECISION SPINAL CORD SIMULATOR SYSS", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "SC-2218-50E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 50CM 4 X 8 SURGICAL", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-8352-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 60 CM NEUROSTIMULATOR OCTRODE", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3250.0, "discounted_cash": 1137.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 70 8 CONTACT", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-2218-70E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 70 CM LINEAR ELECTRODE TRIAL FOR PRECISION SPINAL CORD SIMULATOR SYSS", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-2218-70", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 70CM SURGICAL NEVRO", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "LEAD3005-70B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD 8MM X 50CM SHAPE 2 X 8 PADDLE SURG W/ PLATNALOCK TECHNOLGY FOR USE W/ P", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-8216-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9476.0, "discounted_cash": 3316.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD ANCHOR N300 NEVRO SENZA", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ACCK5300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD COVER EDGE 32 50CM 4 X 8", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-8336-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11227.0, "discounted_cash": 3929.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD COVER EDGE 32 70CM 4 X 8", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-8336-70", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11227.0, "discounted_cash": 3929.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD COVER EDGE X32 70CM 4 X 8", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-8352-70", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17510.0, "discounted_cash": 6128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD IMPLANT 1801", "code_information": [{"code": "1801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 236.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD LAMITRODE 44 60CM", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3244 LEAD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD NEURO 50CM SENSA", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "TLEAD 1058-50B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD NEURO 50CM SENSA BLUE", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "LEAD1058-50B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 950.0, "discounted_cash": 332.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD NEVRO BLUE PERC", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "LEAD1058-70B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 950.0, "discounted_cash": 332.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD PERC BLUE 70CM", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "TLEAD1058-70B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD SPINAL CORD STIMULATION WITHOUT EXTENSION VECTRIS", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "977A260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2784.0, "discounted_cash": 974.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD TEST STIMULATIONINTERSTIM", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "3065U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 653.0, "discounted_cash": 228.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD TRIAL 12 ELECTRODE PERCUTANEOUS SPACING 1MM", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "1121-60T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD TRIAL SPINAL CORD STIMULATION OCTRODE", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "3086", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1980.0, "discounted_cash": 693.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LIGAMENT AUGMENTATION REPAIRINTERNAL BRACE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1678-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2870.0, "discounted_cash": 1004.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LIGATION SMARTBAND SAFEGRIP MULTI-BAND SLK6LF", "code_information": [{"code": "SLK6LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 287.1, "discounted_cash": 100.49, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LIMB POSITIONER BERKETTE BEACH CHAIR", "code_information": [{"code": "100801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LINE ARTERIALINDWELLING CATH 20GA X 5IN", "code_information": [{"code": "AK-04510-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.31, "discounted_cash": 34.41, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LITHOTOMY", "code_information": [{"code": "PG440TKWA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 71.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MAGELLON AUTOLOGOUS PLATELET SEPARATOR SYSTEM", "code_information": [{"code": "MAR0MAX45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5876.0, "discounted_cash": 2056.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MENISCAL ROOT CINCH CRVD TIP AR-4550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2219.0, "discounted_cash": 776.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MILD MDK-0001", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "MDK-0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5624.0, "discounted_cash": 1968.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MILD MDK-0002", "code_information": [{"code": "MDK-0002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9526.5, "discounted_cash": 3334.28, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MILD PROCEDURE MDK-001", "code_information": [{"code": "MDK-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9526.5, "discounted_cash": 3334.28, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MINI BEAD OSTEO RESORBABLE 5CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8400-0511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1339.0, "discounted_cash": 468.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MINISTIM PNS 7CM SINGLE SYSTEM MOV-7-1-1", "code_information": [{"code": "C1816", "type": "HCPCS"}, {"code": "MOV-7-1-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23000.0, "discounted_cash": 8050.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MIS LATERAL INSTRUMENT 35-0001-000", "code_information": [{"code": "35-0001-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MIXER 8CC ORTHROBIOLOGICS CALCIUM PHOSPHATE CEMENT QUICKSET DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABS-3008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5871.0, "discounted_cash": 2054.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MIXING ALLOAID CARTILAGE C01 SCM01", "code_information": [{"code": "C01 SCM01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 793.55, "discounted_cash": 277.74, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MIXING BONE CEMENT W/ BOWL CARTRIDGE AND NOZZLE", "code_information": [{"code": "306563000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 317.0, "discounted_cash": 110.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MIXING CONNECTOR SPRAY TIP", "code_information": [{"code": "800-0252", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MOTOCLIP 18X14X14 SUPER ELASTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1442-1814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MOTOCLIP 20X20X20MM SUPER ELASTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1442-2020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MTRX 6CC HEMOSTATIC W/ PREFILLED SYRNG OF HEMOSTATIC MATRIX WHT APPLICATOR T", "code_information": [{"code": "1991", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 343.0, "discounted_cash": 120.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MTRX HEMOSTATIC W/ 10 ML SYRNG GELATIN MATRIX COMPONENT LYOPHILIZED THROMBIN", "code_information": [{"code": "1501824", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 982.0, "discounted_cash": 343.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NANONEEDLE HIGH FLOW OPERATIVE 125MM AR-3210-0051", "code_information": [{"code": "AR-3210-0051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 366.85, "discounted_cash": 128.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NDL 8GA BONE MARROW ASPIRATION", "code_information": [{"code": "21-5000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 197.0, "discounted_cash": 68.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NEBULIZER SM W/ PEDI MASK 7FT O2 TUBING", "code_information": [{"code": "8906-7-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NEEDLE EPIMED 4IN", "code_information": [{"code": "EPMD1040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.25, "discounted_cash": 83.74, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NEEDLE INSERTION 15CM", "code_information": [{"code": "ACCK1015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.25, "discounted_cash": 83.74, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NEEDLE NANO HIGH FLOW125MM AR-3210-0052", "code_information": [{"code": "AR-3210-0052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 893.08, "discounted_cash": 312.58, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NEOSYS SOLAFIX DISP INST", "code_information": [{"code": "G02-10001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1019.51, "discounted_cash": 356.83, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NEUROMOD LEAD SPACER", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "3550-P4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NEUROMODULATION 9771CLP", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "9771CLP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43000.0, "discounted_cash": 15050.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NEUROMODULATION 9771CLS", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "9771CLS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50760.0, "discounted_cash": 17766.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NEVRO SENZA CHARGER", "code_information": [{"code": "C1822", "type": "HCPCS"}, {"code": "CHGR1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT OATS DISPOSABLE 10MM SINGLE USE ABS-8981-10S", "code_information": [{"code": "ABS-8981-10S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1589.0, "discounted_cash": 556.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT OMNIA IPG 2500 NIPG2500", "code_information": [{"code": "C1822", "type": "HCPCS"}, {"code": "NIPG2500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33000.0, "discounted_cash": 11550.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT OMNIA PATIENT REMOTE PTRC2500", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "PTRC2500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT OMNICURVE 10G 20MM FRACTURE1032-020-000", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "1032-020-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT OPTIVAC TOTAL HIP 600-99-004", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "600-99-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 913.0, "discounted_cash": 319.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ORTHO PIN SCRW REP W/ 2 MM X 100 MM ABSORBL PIN WITHOUT METAL TIP KIRSCHNER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4152DS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ORTHOLOC 2 JOINT PREP INSTRUMENT STERILE 9914PK01", "code_information": [{"code": "9914PK01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 204.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT OT MED 3.5 ACCESSORY PINS/DRILL", "code_information": [{"code": "400-1135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1205.0, "discounted_cash": 421.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PACK 2.5MM DART-FIRE EDGE HEADED D1025000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1025000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 454.74, "discounted_cash": 159.16, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PACK EXTREMITIY CUSTOM KW", "code_information": [{"code": "PO44EXKWJ", "type": "CDM"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PAIN TRAY CARDINAL CUSTOM 0804A KWSH", "code_information": [{"code": "PAIN0804A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PAIN TRAY CARDINAL CUSTOM KWSH VER B", "code_information": [{"code": "PAIN0804B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PASSING SUT ULNAR COLLATERAL LIGAMENT STRL DISP", "code_information": [{"code": "AR-7715-4.5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2240.0, "discounted_cash": 784.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PATIENT CARE HANA PROFX", "code_information": [{"code": "6855", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PATIENT CARE JACKSON", "code_information": [{"code": "5808PV", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.0, "discounted_cash": 49.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PATIENT CARE WILSON FRAME", "code_information": [{"code": "5322PV", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PATIENT REMOTE NEVRO SENZA", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "PTRC1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PATIENT TRIAL SC-6500-52", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "SC-6500-52", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PATIENT TRIAL SC-6500-72 SC-6500-72", "code_information": [{"code": "SC-6500-72", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PEEK MENISCAL ROOT REPAIR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4550P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3115.0, "discounted_cash": 1090.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PEG 24FR 5 ML SAFETY W/ XYLOCAINE AMPULE ENDOVIVE DISP", "code_information": [{"code": "M00566481", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 497.0, "discounted_cash": 173.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PEG 24FR SAFETY PULL", "code_information": [{"code": "M00566741", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 836.0, "discounted_cash": 292.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PEG 24FR SIL PSH METH SFTY EVV PED", "code_information": [{"code": "M00566751", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PERCUTANEOUS GUIDE DRILL W/ PIN JUGGERKNOT", "code_information": [{"code": "912040P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PERCUTANEOUS INSERTION FOR SUTURETAK 3.0MM", "code_information": [{"code": "AR-1934PI-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PERCUTANEOUSINSERTION 2.4MM SHLDRINCLUDES 17GA SPINAL NDL 1.1 MM NITINOL WIR", "code_information": [{"code": "AR-1934PI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PFR PELVIC FLOOR REPAIR VAGINAL SUPPLY SYS", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "M0068317170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4606.0, "discounted_cash": 1612.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PICO 7 TWO DRESSING 10X30CM 66022003", "code_information": [{"code": "66022003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 213.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PICO 7 TWO DRESSING 10X40CM 66022004", "code_information": [{"code": "66022004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 213.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PIN 1.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "948230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 182.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PIN 2MM REUNITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "948231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 628.0, "discounted_cash": 219.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PIN FXTN RID BONE TENDON BONE BIOCRYL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1246.0, "discounted_cash": 436.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PIN INION 1.5-2MM OTPS ARTHROSCOPY BIODEGRADABLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PCK-7001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1555.0, "discounted_cash": 544.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PIN INION 2.0MM OTPS ARTHROSCOPY BIODEGRADABLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PCK-7002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1555.0, "discounted_cash": 544.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PIN ORTHOSORB 1.3MM LS STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110010742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PIN ORTHOSORB 2.0MM LS STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110010743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PIVOT PORTAL ENTRY", "code_information": [{"code": "CAT00241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 745.13, "discounted_cash": 260.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PLATELET-RICH PLASMA ANGEL", "code_information": [{"code": "ABS-10061T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PNEUMOTHORAX 8FR CATH SAFETY AK-01500", "code_information": [{"code": "AK-01500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 143.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PORTAL 9MM ACCESSORY W/ LOW PROFILE DRILL AND EZ SHUTTLE SUT LOOP", "code_information": [{"code": "CM-7609", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 961.0, "discounted_cash": 336.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT POSITIONER BEACH CHAIR HOLDER POSITIONER ARM TRIMANO STRL DISP", "code_information": [{"code": "AR-1644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT POSITIONER SHLDR MULTIFLEX SUPPORT ISOLATION PAD FOREHEAD TORSO STRAP WRIST CHIN", "code_information": [{"code": "5345", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.97, "discounted_cash": 37.79, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT POSITIONING FOR JACKSON TABLE", "code_information": [{"code": "NON081652", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.05, "discounted_cash": 24.87, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PREPARATIONINTRAMEDULLARY TOTAL HIP", "code_information": [{"code": "121010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 215.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROBE OPTABLATE CURVE 15MM SINGLE 9700-115-000", "code_information": [{"code": "9700-115-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10963.23, "discounted_cash": 3837.13, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROBE OPTABLATE DUAL 15MM 9700-015-200", "code_information": [{"code": "9700-015-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9579.06, "discounted_cash": 3352.67, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROCEDURAL 5 ML PERFLURO N OCTANE LIQ RETINALINTRAOPERATIVE PERFLUOROCARBON", "code_information": [{"code": "8065900163", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 905.0, "discounted_cash": 316.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROCEDURAL 7 ML PERFLURO N OCTANE LIQ RETINALINTRAOPERATIVE PERFLUOROCARBON", "code_information": [{"code": "8065900164", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1358.0, "discounted_cash": 475.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROCEDURE SUTURE LOCK-STITCH ARTHROSCOPY TRU-LOOP", "code_information": [{"code": "CM-9500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 733.0, "discounted_cash": 256.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROCLAIM ELITE 7 BATTERY 3663", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37904.0, "discounted_cash": 13266.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROCLAIM ELITE NON-RECHARGABLE", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31000.0, "discounted_cash": 10850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROGRAMMER PATIENT W/ REMOTE CONTROL AND REMOTE CONTROL CASEINSTR", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "SC-5500-4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2040.0, "discounted_cash": 714.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROGRAMMER STIMULATION PRECISION SPECTRA", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "SC-5532-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROGRAMMER STIMULATION WAVE WRITER", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "SC-5562-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROXIMAL TENODESIS SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1507.0, "discounted_cash": 527.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PULSE GENERATOR AND CHARGING MONTAGE MRI", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1210B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35638.0, "discounted_cash": 12473.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PULSE GENERATOR PRECISION MONTAGE MRI", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 58267.0, "discounted_cash": 20393.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PUSHLOCK DISPOSABLES 2.9MM SHORT", "code_information": [{"code": "AR-2923", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 192.0, "discounted_cash": 67.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PUSHLOCK PERCUTANEOUS INSERTION 2.9MM", "code_information": [{"code": "AR-1923PK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT QUICKSET 5CC RESORBABLE CALCIUM PHOSPHATE CEMENT DUAL CHMBRED SYRNG QUICKSET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABS-3005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3172.0, "discounted_cash": 1110.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT RADIOFREQUENCY ACTIVE TIP COOLED 17G 100MM X 4MM", "code_information": [{"code": "CRK-12100-4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1692.0, "discounted_cash": 592.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT RADIOFREQUENCY ACTIVE TIP COOLED 17G X 100MM X 4MM", "code_information": [{"code": "CRK-17-100-4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1692.0, "discounted_cash": 592.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT RADIOFREQUENCY ACTIVE TIP COOLED 17G X 75MM X 4MM", "code_information": [{"code": "CRK-17-75-4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1692.0, "discounted_cash": 592.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT REDUCTION FOG ELIMINATION DEV W/ ADHSV SPONGE", "code_information": [{"code": "NONFB100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.67, "discounted_cash": 1.63, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT REMOTE CONTROL FREELINK", "code_information": [{"code": "SC-5542-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1805.0, "discounted_cash": 631.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT REP ANT PELVIC FLOOR W/ ONE CAPIO SUT CAPTURING DEV ONE PINNACLE SYNTH MESH", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "831-705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4315.0, "discounted_cash": 1510.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT REP MINI W/ CANNULATED DRILL BIT GUIDEWIRE 0.045IN TIGHTROPE TIGHTROPE STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8911DS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1138.2, "discounted_cash": 398.37, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT REPAIR 1.1MM INTERMETATARSAL ANGLE MINI TIGHTROPE FT TI", "code_information": [{"code": "L8630", "type": "HCPCS"}, {"code": "AR-8919DS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1999.0, "discounted_cash": 699.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT REPAIR ACUTE AC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2439.0, "discounted_cash": 853.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT REPAIR PLATE 3.0 X 8.0MM STROPP PLANTAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1601-0000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2760.0, "discounted_cash": 966.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT REPAIR SYNDESMOSIS CANNULATED KNOTLESS TIGHTROPE SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8926SS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1813.0, "discounted_cash": 634.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT REPLACEMENT ULTRA: GLOBAL BILL", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "ULTRAKIT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29355.0, "discounted_cash": 10274.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT RESTORE ACL", "code_information": [{"code": "100-RES", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 498.0, "discounted_cash": 174.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT RF SINGLE PROBE COOLED 75MM", "code_information": [{"code": "SI-K-17-75-4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1692.0, "discounted_cash": 592.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT RFA MULTI-COOLED 17G X 100MM", "code_information": [{"code": "MCK2-17-100-4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1050.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT RSRVR 3/16IN 15FR 107 CM DRAINAGE WOUND SUCTION TROCAR FLAT JACKSON PRATT LF", "code_information": [{"code": "SU130-403D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SCP FOOT & ANKLE PLATES/ SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "514.303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5181.0, "discounted_cash": 1813.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SCP KNEE COMPLETE ACCUPORT END DELIVERY CANNULA", "code_information": [{"code": "414.503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7263.0, "discounted_cash": 2542.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SCREWS BONE FOR 3.0 AND 3.5 MM P04 S0003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P04 S0003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SEAL 0FR TO 7FR GRN SILICONE", "code_information": [{"code": "CS-G7", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.0, "discounted_cash": 56.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SEAL 6FR TO 12FR BLUE SILICONE", "code_information": [{"code": "CS-B612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SERIES I BLOOD DRAW AUTOLOGOUS CONDITIONED PLASMA", "code_information": [{"code": "ABS-10011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 562.0, "discounted_cash": 196.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SERIES II AUTOLOGOUS CONDITIONED PLASMA DOUBLE SYRNG SYS", "code_information": [{"code": "ABS-10012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1016.0, "discounted_cash": 355.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SHOULDER MCPULL POSITIONER EKM-MCP401", "code_information": [{"code": "EKM-MCP401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.65, "discounted_cash": 41.53, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SHOULDER Q-FIX 2.8MM", "code_information": [{"code": "25-2810", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1259.0, "discounted_cash": 440.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SHOULDER STABILIZATION EKM-CSD10573", "code_information": [{"code": "EKM-CSD10573", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.55, "discounted_cash": 53.39, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SIZE 4 TRIATHLON TIBIAL PREP 5555-2324", "code_information": [{"code": "5555-2324", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SLEEVE 0.9MM ULTRAINFUSION MICROSMOOTH", "code_information": [{"code": "8065750517", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SLEEVE 1.1INFUSION HIGH MICROSMOOTH", "code_information": [{"code": "8065742087", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SM PARTS 0.9MM MICROSMOOTH STRL DISP", "code_information": [{"code": "8065750159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SOL 6 ML SKIN SURG PREP W/ APPLICATOR DURAPREP STRL", "code_information": [{"code": "8635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SOLN 26 ML SKIN SURG PREP W/ APPLICATOR 3M HEATHCARE DURAPREP LF STRL", "code_information": [{"code": "8630", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SOLO W/ SOFT SPLASH SHIELD TIP AND SUCTION TUBING AND DUAL SPIKE ADAPTER SIM", "code_information": [{"code": "67590", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SOLUTION BSS PLUS 500ML", "code_information": [{"code": "65080050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPINAL CORD PATIENT TRIAL", "code_information": [{"code": "SC-6500-62", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPINAL CORD STIMULATOR PATIENT TRIAL PRECISION SPECTRA", "code_information": [{"code": "SC-6500-42", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPINEJACK 4.2 CASE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909-000-042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8108.0, "discounted_cash": 2837.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPINEJACK 5.0 CASE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909-000-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8108.0, "discounted_cash": 2837.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPINEJACK 5.8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909-000-058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8108.0, "discounted_cash": 2837.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPINEJACK PREPARATION 5.0MM 0909-100-050", "code_information": [{"code": "909-100-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2819.0, "discounted_cash": 986.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPLINT LG NASAL EXTERNAL THERMASPLINT", "code_information": [{"code": "1529120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPLINT LG NASAL EXTERNAL XOMED", "code_information": [{"code": "1528136", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPLINT MED NASAL EXTERNAL THERMASPLINT", "code_information": [{"code": "1529110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPLINT SM NASAL EXTERNAL XOMED", "code_information": [{"code": "1528116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "discounted_cash": 41.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPLITTER 2 X 8 30 CM", "code_information": [{"code": "SC-3400-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2707.0, "discounted_cash": 947.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SS FIBULINK SYNDESMOSIS REPAIR FGS-1000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FGS-1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3924.0, "discounted_cash": 1373.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT STAB FOR OR SPIDER 2 SHOULDER POSITIONER", "code_information": [{"code": "72203833", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 292.0, "discounted_cash": 102.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT STABLZN SHOULDER FOR SPIDER LIMB POSITIONER STRL DISP", "code_information": [{"code": "7210573", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.52, "discounted_cash": 63.18, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT STAPLE 10 X 10MM FUSEFORCE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFNS1010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1813.0, "discounted_cash": 634.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT STAPLE 12MM X 12MM FUSEFORCE NITINOL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFNS1212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1813.0, "discounted_cash": 634.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT STAPLE 8MM X 8MM FUSEFORCE NITINOL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFNS0808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1814.0, "discounted_cash": 634.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT STIMULATION SPINAL CORD PATIENT TRIAL PRECISION SPECTRA", "code_information": [{"code": "SC-6500-32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 214.0, "discounted_cash": 74.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT STNT 6FR X 24CM URET OPEN TIP PUSH CATH W/ ATTACHED SUT LUBRI FLEX", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "5556024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT STYLT 30CM 50CM 70CM AUDITORY BRAINSTEM W/ STEERING CAP AND STIFFER STYLET A", "code_information": [{"code": "SC-4395-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SUCT ENDO VALVE AIR WATER BIOPSY FOR OLYMPUS 140 160 180 240 261 GI ENDOSCOP", "code_information": [{"code": "100305", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURG 1.1 CM X 60 CM TRANSOBTURATOR PP SLING W/ FLAT CURVED AND HELICALINTROD", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "93-4400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1908.0, "discounted_cash": 667.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURG 10MM OSTEOCHONDRAL AUTOGRAFT TRANSFER SYS SM JOINT OATS", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "AR-8981-10S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURG ACL", "code_information": [{"code": "AR-992", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 696.0, "discounted_cash": 243.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURG METATARSAL STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "360-2800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 577.0, "discounted_cash": 201.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURG TALAR FIT LCKNG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "341-1000-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1524.0, "discounted_cash": 533.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURGICAL INSTRUMENT OR ACCESSORY FOR ORTHOPEDIC BONE FIXATION KWK 100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KWK 100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURGICAL INSTRUMENTS COLAG SINGLE USE P06 S0003", "code_information": [{"code": "P06 S0003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1062.55, "discounted_cash": 371.89, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURGICAL LEAD 50CM 2X8 ARTISAN MRI", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-8416-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8446.0, "discounted_cash": 2956.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURGICAL LEAD 50CM NEVRO", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "LEAD3005-50B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6283.0, "discounted_cash": 2199.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURGICAL LEAD 70CM 2X8 ARTISAN MRI", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-8416-70", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10506.0, "discounted_cash": 3677.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURGICAL PROCEDURE 23GA VALVED ENTRY SYSTEM 8065751657", "code_information": [{"code": "8065751657", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 848.0, "discounted_cash": 296.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURGINJECT OSTEOVATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "390-3000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SUSPENSION SHOULDER II", "code_information": [{"code": "72200195", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.0, "discounted_cash": 60.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SWIVELOCK SL 3.5 X 8.5MM DX", "code_information": [{"code": "AR-8978DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1089.0, "discounted_cash": 381.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SYRNG DEL ALIQUOT", "code_information": [{"code": "2090-0501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SYS 2MM TO 15MM 10GAINFLATABLE VERT AUGMENTATION W/ BLLN CATH ACCESS CANNULA", "code_information": [{"code": "705-115-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2096.0, "discounted_cash": 733.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SYS AUTOPLEX WITHOUT NDLS VERTAPLEX HV STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "607-687-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1625.0, "discounted_cash": 568.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TALAR-FIT SURGICAL", "code_information": [{"code": "341-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1670.0, "discounted_cash": 584.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TENDONOVA OCELOT DISPOSABLE UNIT 60MM DU5F60L-K", "code_information": [{"code": "DU5F60L-K", "type": "CDM"}], "standard_charges": [{"gross_charge": 1423.5, "discounted_cash": 498.23, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TENFUSE NAIL INST", "code_information": [{"code": "TFN-KIT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1482.0, "discounted_cash": 518.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TORQUE WRENCH", "code_information": [{"code": "ACCK6006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TRACH GAUZE DRESSING ONE PAIR VINYL GLVS 2 COTTON TIPPED APPLICATORS 2 PIPE", "code_information": [{"code": "3T4691", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TRANSDUCER 60IN PRESSURE MONITORING TRUWAVE LF STRL DISP", "code_information": [{"code": "PX260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.44, "discounted_cash": 113.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TRIAL PATIENT ETS BELT ETS BATTERY", "code_information": [{"code": "SC-6500-03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TRIATHLON CR FEMORAL PREP SIZE 5", "code_information": [{"code": "5555-2205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TRIATHLON CR TIBIAL PREP SIZE 5", "code_information": [{"code": "5555-2325", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 767.0, "discounted_cash": 268.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TRIMANO ELBOW", "code_information": [{"code": "AR-1646", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 127.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TROCAR 13GA VPK013D", "code_information": [{"code": "VPK013D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1717.24, "discounted_cash": 601.03, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TRUELOK ROCKER RAIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "56-24000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3486.0, "discounted_cash": 1220.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TUNNELER", "code_information": [{"code": "SC-4252", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TUNNELING TOOL 35CM DISP", "code_information": [{"code": "ACCK3035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TURNKEY FCS FOR ACUTE DORSAL FRACTURE DISLOCATION OF THE PIP JOINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS-400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2884.0, "discounted_cash": 1009.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT UNIVERSAL TENDONITIS PROCEDURE DISP", "code_information": [{"code": "L2-1500-02-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1372.0, "discounted_cash": 480.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT V.A.C VIA WOUND THERAPY SYSTEM 7DAY", "code_information": [{"code": "VIAKIT077D01/US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2470.0, "discounted_cash": 864.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT VENTILATOR ANESTHESIA BELLOWS ASSEMBLY LATEX FREE ADULT", "code_information": [{"code": "1500-3378-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1324.0, "discounted_cash": 463.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT VIPER PLANTAR PLATE REPAIR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8692DS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2470.0, "discounted_cash": 864.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT VIS ADPT GUIDE JII", "code_information": [{"code": "V0100112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2707.0, "discounted_cash": 947.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT VISIONAIRE BLOCKS FEMORAL/ TIBIAL SX JOURNEY II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "V0100082", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 432.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT VISIONAIRE CUT GUIDE JII SZ F5/T4", "code_information": [{"code": "V0200082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2707.0, "discounted_cash": 947.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT VITREKTOMY CANNULA 23G EKARDT ONE STEP", "code_information": [{"code": "1272.VF106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT W / FL ST TENODESIS GRAFT SIZING AR-1676ST", "code_information": [{"code": "AR-1676ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 886.0, "discounted_cash": 310.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT WIHT HEXALOBULAR SCREWS STANDARD CONDYLE 540-00-000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "540-00-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2876.0, "discounted_cash": 1006.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT WIRE KIRSCHNER DISTAL RADIUS", "code_information": [{"code": "KWK 900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT WOUND CLOSED WOUND DRAINAGE EVACUATED W/ TROCAR TUBE NDL 400 ML", "code_information": [{"code": "SU130-402D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT WOUND EVAC PVC W TROCR DBL 400MI SU130-401D", "code_information": [{"code": "SU130-401D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT WRENCH ICD EXCHANGE DEFIB", "code_information": [{"code": "5873W", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT X-SMALL HUMERUS C/M PIN/BUSHING REVISION 32-8105-027-01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "32-8105-027-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT-SENZA OMNIA IPG + 1 SURPASS LEAD 3005-50 OR 70 1080-SURGKIT", "code_information": [{"code": "C1822", "type": "HCPCS"}, {"code": "1080-SURGKIT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 49440.0, "discounted_cash": 17304.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KLF1 TARGETED SEQUENCING", "code_information": [{"code": "195U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 540.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KLHL11 ANTB SR/CSF ASY QUAL", "code_information": [{"code": "432U", "type": "CPT"}], "standard_charges": [{"minimum": 30.73, "maximum": 48.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROTOMY W/EXPLORATION 27310", "code_information": [{"code": "27310", "type": "CPT"}, {"code": "1481182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ITOTAL PATELLA IMPLANT LEFT 6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M5725060010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9167.0, "discounted_cash": 3208.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [{"code": "486", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13074.8, "maximum": 22446.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13074.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18699.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20569.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22446.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC", "code_information": [{"code": "485", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20740.6, "maximum": 35606.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20740.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29663.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32629.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35606.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC", "code_information": [{"code": "487", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9977.34, "maximum": 17128.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9977.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14269.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15696.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC", "code_information": [{"code": "488", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12018.18, "maximum": 20632.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12018.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17188.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18907.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20632.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC", "code_information": [{"code": "489", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7896.95, "maximum": 13557.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7896.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11294.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12423.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13557.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE RESURFACING SYSTEM UNICOMPARTMENTAL PARTIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "IUNI", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KNEE SYSTEM PERSONA CEM FEM/CEM TIB/ VE SURF/ NO PAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "98-0002-415-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11845.0, "discounted_cash": 4145.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KNEE VERILAST OXIPS FEM CMT TIB PSHI FLEX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71704210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE 2.75 CLEARCUT SLIT SAFETY ANGLED 8065772745", "code_information": [{"code": "8065772745", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.07, "discounted_cash": 28.02, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE 20GA MVR SIDEPORT", "code_information": [{"code": "965560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE 25GA MVR SIDEPORT", "code_information": [{"code": "965564", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 22.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE ANNULOTOMY 1600-06", "code_information": [{"code": "1600-06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1182.6, "discounted_cash": 413.91, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE FOR 4MM ENDOSCOPIC RELEASE SYSTEM", "code_information": [{"code": "9900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE GRAFT 10MM KNEE FOR CRUCIATE LIGAMENT RECONSTRUCTION STRL DISP", "code_information": [{"code": "232110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 56.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE LIGAMENT ANTEGRADE 200-1006", "code_information": [{"code": "200-1006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1372.0, "discounted_cash": 480.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE MVR 25GA", "code_information": [{"code": "8065912501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.73, "discounted_cash": 28.61, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE OPHTHALMIC 15DEG 1.52MM FULL HANDLE STANDARD ANGLEINCISIONAL BLADE A OK ST", "code_information": [{"code": "8065921501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE OPHTHALMIC 1MM SIDEPORT FULL HANDLE ANGLED SATIN FINISH SURGINCISIONAL BLA", "code_information": [{"code": "8065921540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE OPHTHALMIC 2.2MM SLIT SNGL BEVEL ANGL SURGINCISIONAL BLADEINTREPID CLEARCU", "code_information": [{"code": "8065992245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE OPHTHALMIC 2.3MM FULL HANDLE ANGLED BEVEL UP SURGINCISIONAL BLADE A OK SAT", "code_information": [{"code": "8065990002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.06, "discounted_cash": 17.87, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE OPHTHALMIC 2.4MM SLIT SNGL BEVEL ANGL SURGINCISIONAL BLADEINTREPID CLEARCU", "code_information": [{"code": "8065992445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.87, "discounted_cash": 29.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE OPHTHALMIC 2.8MM ANGLED SLIT KNIFE FULL HANDLE SATIN FINISH CLEARCUT HP ST", "code_information": [{"code": "8065992848", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE OPHTHALMIC 20GA 1.4MM BLADE WIDTH CORNEAL SCLERAL FULL HANDLE STRAIGHT SAT", "code_information": [{"code": "8065912001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE OPHTHALMIC 3.2MM FULL HANDLE ANGLED A OK SATINSLIT STRL DISP", "code_information": [{"code": "8065993261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE OPHTHALMIC 3.2MM SURG ANGLED SLIT FULL HANDLE SNGL BEVEL CLEARCUT SATINSLI", "code_information": [{"code": "8065993245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE OPHTHALMOLOGY 23GA A-OK CORNEAL V-LANCE SCLERAL MVR", "code_information": [{"code": "8065912301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE RETROGRADE LIGAMENT DISP", "code_information": [{"code": "200-1003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1062.55, "discounted_cash": 371.89, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE SLIT 2.0 CLEARCUT", "code_information": [{"code": "8065992045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.58, "discounted_cash": 33.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE SLIT 3.0MM WIDE", "code_information": [{"code": "962961", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE SURG 9MM GRAFT ACLINSTR", "code_information": [{"code": "232109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE SURGICAL DISP", "code_information": [{"code": "1600-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1182.6, "discounted_cash": 413.91, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE UROLOGY COLD STRAIGHT SNGL STEM FOR URETHROTOME STRL DISP", "code_information": [{"code": "27069K/6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 472.0, "discounted_cash": 165.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE WILLIAMS 2.7MM X 2.3MM ANGLED TRAPEZOID PRO TEK", "code_information": [{"code": "PG44820SS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KNOTLESS REPAIR SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3821.0, "discounted_cash": 1337.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KNOTLESS TENSIONTIGHT BUTTON IMPLANT SYS AR-2350", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1897.0, "discounted_cash": 663.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KRAS GENE ADDL VARIANTS", "code_information": [{"code": "81276", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 241.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 492.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KRAS GENE VARIANTS EXON 2", "code_information": [{"code": "81275", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 241.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 492.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 774.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KRAS OR NRAS GENE MUTATION", "code_information": [{"code": "G9843", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KWIRE .062 X 6IN THREADED K16150-06TN", "code_information": [{"code": "K16150-06TN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.36, "discounted_cash": 28.48, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE .7MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "22.27.607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE .9MM KW609", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KW609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 0.045 X 6IN THREADED STAINLESS STEEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210-40-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 0.062 X 6 DOUBLE ENDED 210-60-006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210-60-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.1 X 100MM TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5040.10/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.1 X 152MM DBLE END TROCAR TIP LEOS 76308832", "code_information": [{"code": "76308832", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.94, "discounted_cash": 78.38, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.1MM K-WIRE KW611", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KW611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.1MM X 100MM TROCAR TIP SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-192-1110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.1MM X 150MM TROCAR TIP SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-192-1115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.2MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NK011215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.4 X 152MM LEOS 76308841", "code_information": [{"code": "76308841", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.94, "discounted_cash": 78.38, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.6MM", "code_information": [{"code": "NK01161S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.6MM KW616", "code_information": [{"code": "KW616", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.4, "discounted_cash": 66.99, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 1.8MM OLIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6000-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 2.0MM ANC147", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ANC147", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 163.0, "discounted_cash": 57.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 3.2MM X 230MM DRILL TIPPED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "705232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 226.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE 5.0 OS900064B-NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS900064B-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 816.0, "discounted_cash": 285.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE COCR 1.1 X 105MM", "code_information": [{"code": "2312-11-105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE DOUBLE TROCAR 1.4 X 165 MM KWIR-DT-14165", "code_information": [{"code": "KWIR-DT-14165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.18, "discounted_cash": 45.56, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE OLIVE .062MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 42.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE OLIVE 1.6 90MM 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5045.47/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 233.0, "discounted_cash": 81.55, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE OLIVE THREADED 2MM X 30MM SN26", "code_information": [{"code": "SN26", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.75, "discounted_cash": 164.76, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE OLIVE THREADED PLATE K60-18T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K60-18T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE PEAR BAYONET 2.0X400MM DS-K400-20BNP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DS-K400-20BNP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KWIRE VILEX 1.1MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K100-115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KYPHECTOMY 1-2 SEGMENTS", "code_information": [{"code": "22818", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KYPHECTOMY 3 OR MORE", "code_information": [{"code": "22819", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L COLECTOMY/COLOPROCTOSTOMY", "code_information": [{"code": "44207", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L COLECTOMY/COLOPROCTOSTOMY", "code_information": [{"code": "44208", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7523", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7524", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT ART/GRFT ANGIO", "code_information": [{"code": "93459", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT ARTERY/VENTRICLE ANGIO", "code_information": [{"code": "93458", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT CATH CHD NM/ABN NT CNJ", "code_information": [{"code": "93595", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT CATH TRNSPTL PUNCTURE", "code_information": [{"code": "93462", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 10923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT GFT ANG W/ IVUS OR OCT", "code_information": [{"code": "C7525", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT GFT ANG W/FLOW RESRV", "code_information": [{"code": "C7526", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L VENTRIC PACING LEAD ADD-ON", "code_information": [{"code": "33225", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L/S RATIO FETAL LUNG", "code_information": [{"code": "83661", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 88.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 88.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 88.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABEL KIT ASSEMBLY PATIENT RECORD 519150", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "519150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1352.0, "discounted_cash": 473.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LABYRINTHECTOMY;TRANSCANAL 69905", "code_information": [{"code": "69905", "type": "CPT"}, {"code": "1481183", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABYRINTHECTOMY;WITH MASTOIDECTOMY 69910", "code_information": [{"code": "69910", "type": "CPT"}, {"code": "1481184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTATED RINGER'S INJECTION USP 500 mL", "code_information": [{"code": "759303", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "LACTATED RINGERS 1000ML", "code_information": [{"code": "795309", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 20.92, "discounted_cash": 7.32, "setting": "both", "billing_class": "facility"}]}, {"description": "LACTATED RINGERS 1000ML BAG", "code_information": [{"code": "409-7953-09", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LACTATED RINGERS INJ USP 500ML 2B1073Q", "code_information": [{"code": "2B1073Q", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LACTOFERRIN FECAL (QUAL)", "code_information": [{"code": "83630", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 79.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 79.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 79.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTOFERRIN FECAL (QUANT)", "code_information": [{"code": "83631", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 78.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 78.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 78.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAIV VACC PANDEMIC INTRANASL", "code_information": [{"code": "90664", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAIV3 VACCINE INTRANASAL", "code_information": [{"code": "90660", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAIV4 VACCINE INTRANASAL", "code_information": [{"code": "90672", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMELLAR BDY FETAL LUNG", "code_information": [{"code": "83664", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 77.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 77.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 77.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY ARM CRADLE FOAM POSITIONER", "code_information": [{"code": "FP-LARMC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LAMINECTOMY CERVICAL 1 -2 SEGMENTS 63001", "code_information": [{"code": "63001", "type": "CPT"}, {"code": "1481185", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY CERVICAL 3 OR MORE SEGMENTS 63015", "code_information": [{"code": "63015", "type": "CPT"}, {"code": "1481186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXC.INTRASPINAL NEOPLASM INTRADURAL INTRAMEDULLARY THORACOLUMBAR 63287", "code_information": [{"code": "63287", "type": "CPT"}, {"code": "1481187", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 14796.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXCISION INTRASPINAL NEOPLASM;COMBINED EXTRADURAL-INTRADURAL LESION 63290", "code_information": [{"code": "63290", "type": "CPT"}, {"code": "1481188", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 14796.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXCISION INTRASPINAL NEOPLASM;INTRADURAL EXTRAMEDULLARY CERVICAL 63280", "code_information": [{"code": "63280", "type": "CPT"}, {"code": "1481189", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXCISION INTRASPINAL NEOPLASM;INTRADURAL EXTRAMEDULLARY LUMBAR 63282", "code_information": [{"code": "63282", "type": "CPT"}, {"code": "1481190", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 14796.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXCISION INTRASPINAL NEOPLASM;INTRADURAL EXTRAMEDULLARY THORACIC 63281", "code_information": [{"code": "63281", "type": "CPT"}, {"code": "1481191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXCISION INTRASPINAL NEOPLASM;INTRADURAL INTRAMEDULLARY CERVICAL 63285", "code_information": [{"code": "63285", "type": "CPT"}, {"code": "1481192", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXCISION INTRASPINAL NEOPLASM;INTRADURAL INTRAMEDULLARY THORACIC 63286", "code_information": [{"code": "63286", "type": "CPT"}, {"code": "1481193", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXCISION INTRASPINAL NEOPLASM;INTRADURAL SACRAL 63283", "code_information": [{"code": "63283", "type": "CPT"}, {"code": "1481194", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY FACECTOMY UNI DURING POST. ARTHRODESIS LUMBAR 63052", "code_information": [{"code": "63052", "type": "CPT"}, {"code": "45999708", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1025.59, "maximum": 8450.0, "gross_charge": 2119.0, "discounted_cash": 741.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1025.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY FACECTOMY UNI. DURING POST. ARTHRO. LUMBAR EA. ADD. SEG. 63053", "code_information": [{"code": "63053", "type": "CPT"}, {"code": "45999686", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 13581.0, "discounted_cash": 4753.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 6573.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY FACETECTOMY AND FORAMINOTOMY SINGLE VERTEBRAL SEGMENT;CERVICAL 63045", "code_information": [{"code": "63045", "type": "CPT"}, {"code": "1481195", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY FACETECTOMY AND FORAMINOTOMY SINGLE VERTEBRAL SEGMENT;LUMBAR 63047", "code_information": [{"code": "63047", "type": "CPT"}, {"code": "1481196", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY FACETECTOMY AND FORAMINOTOMY SINGLE VERTEBRAL SEGMENT;THORACIC 63046", "code_information": [{"code": "63046", "type": "CPT"}, {"code": "1481197", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY FOR IMPLANT OF NEUROSTIMULATOR ELECTRODES PLATE/PADDLE EPIDURAL 63655", "code_information": [{"code": "63655", "type": "CPT"}, {"code": "1481198", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 14796.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY LUMBAR 1 -2 SEGMENTS 63005", "code_information": [{"code": "63005", "type": "CPT"}, {"code": "1481199", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY LUMBAR 3 OR MORE SEGMENTS 63017", "code_information": [{"code": "63017", "type": "CPT"}, {"code": "1481200", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY LUMBAR WITH DECOMPRESSION 63012", "code_information": [{"code": "63012", "type": "CPT"}, {"code": "1481201", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY SACRAL 63011", "code_information": [{"code": "63011", "type": "CPT"}, {"code": "1481202", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY THORACIC 1 -2 SEGMENTS 63003", "code_information": [{"code": "63003", "type": "CPT"}, {"code": "1481203", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY THORACIC 3 OR MORE SEGMENTS 63016", "code_information": [{"code": "63016", "type": "CPT"}, {"code": "1481204", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY WITH RELEASE OF TETHERED SPINAL CORD LUMBAR 63200", "code_information": [{"code": "63200", "type": "CPT"}, {"code": "1481205", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 14796.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY WITH RHIZOTOMY;1 OR 2 SEGMENTS 63185", "code_information": [{"code": "63185", "type": "CPT"}, {"code": "1481206", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 14796.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY WITH RHIZOTOMY;MORE THAN 2 SEGMENTS 63190", "code_information": [{"code": "63190", "type": "CPT"}, {"code": "1481207", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 14796.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY/FACETECTOMY AND FORAMINOTOMY UNI OR BI W/DEC SPINE 63048", "code_information": [{"code": "63048", "type": "CPT"}, {"code": "1643982", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 6255.0, "discounted_cash": 2189.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3027.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL LESION EXTRADURAL;CERVICAL 63265", "code_information": [{"code": "63265", "type": "CPT"}, {"code": "1481208", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL LESION EXTRADURAL;LUMBAR 63268", "code_information": [{"code": "63268", "type": "CPT"}, {"code": "1481209", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL LESION EXTRADURAL;SACRAK 63267", "code_information": [{"code": "63267", "type": "CPT"}, {"code": "1481210", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL LESION EXTRADURAL;THORACIC 63266", "code_information": [{"code": "63266", "type": "CPT"}, {"code": "1481211", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL LESION INTRADURAL;CERVICAL 63270", "code_information": [{"code": "63270", "type": "CPT"}, {"code": "1481212", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL LESION INTRADURAL;LUMBAR 63272", "code_information": [{"code": "63272", "type": "CPT"}, {"code": "1481213", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 14796.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL LESION INTRADURAL;SACRAL 63273", "code_information": [{"code": "63273", "type": "CPT"}, {"code": "1481214", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL LESION INTRADURAL;THORACIC 63271", "code_information": [{"code": "63271", "type": "CPT"}, {"code": "1481215", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL NEOPLASM EXTRADURAL;CERVICAL 63275", "code_information": [{"code": "63275", "type": "CPT"}, {"code": "1481216", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL NEOPLASM EXTRADURAL;LUMBAR 63277", "code_information": [{"code": "63277", "type": "CPT"}, {"code": "1481217", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 14796.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL NEOPLASM EXTRADURAL;SACRAL 63278", "code_information": [{"code": "63278", "type": "CPT"}, {"code": "1481218", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY;EXCISION INTRASPINAL NEOPLASM EXTRADURAL;THORACIC 63276", "code_information": [{"code": "63276", "type": "CPT"}, {"code": "1481219", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOPLASTY CERVICAL W/DEC. SPINAL CORD 2 OR MORE SEG 63050", "code_information": [{"code": "63050", "type": "CPT"}, {"code": "1807656", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 699.27, "maximum": 8450.0, "gross_charge": 2119.0, "discounted_cash": 741.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1025.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 699.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOPLASTY CERVICAL W/DEC. SPINAL CORD W/RECON POST BONY ELEMENTS 63051", "code_information": [{"code": "63051", "type": "CPT"}, {"code": "1807657", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1839.09, "maximum": 8450.0, "gross_charge": 5573.0, "discounted_cash": 1950.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2697.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1839.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY (HEMI) W/DEC. NERVE INC. PART FACETECTOMY/FORAMINOTOMY EXC. HERN. DISC EA. CER. SP. 63043", "code_information": [{"code": "63043", "type": "CPT"}, {"code": "30902896", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 6255.0, "discounted_cash": 2189.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3027.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY (HEMI) W/DEC. NERVE INC. PART FACETECTOMY/FORAMINOTOMY EXC. HERN. DISC EA. LUM. SP. 63044", "code_information": [{"code": "63044", "type": "CPT"}, {"code": "2156866", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 6255.0, "discounted_cash": 2189.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3027.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY HEMI. W/DEC. PART. FACET/FORAMINOTOMY AND OR EXC. DISC EA ADD SEG. CERV/LUM 63035", "code_information": [{"code": "63035", "type": "CPT"}, {"code": "1863135", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 6507.0, "discounted_cash": 2277.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3149.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY W/DEC. INC. PART FACET/FORAMINOTOMY EXC. HERN. DISC 1 INT.SP LUMBAR C9757", "code_information": [{"code": "C9757", "type": "HCPCS"}, {"code": "45870286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 13431.0, "discounted_cash": 4700.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 6500.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY W/DECOM. REPAIR BONE ANCHORED CLOSURE DEVICE 1 INTERSPACE LUMBAR 63032", "code_information": [{"code": "63032", "type": "CPT"}, {"code": "46587655", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 0.01, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY W/DECOMP./FACETECTOMY/FORAMINOTOMY/EXCISION OF HER.DISC/LUMBAR", "code_information": [{"code": "63035", "type": "CPT"}, {"code": "1481220", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 6507.0, "discounted_cash": 2277.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3149.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY W/DECOMP.OF NERVE ROOTS W/EXCISION OF HERNIATED DISC/LUMBAR 63030", "code_information": [{"code": "63030", "type": "CPT"}, {"code": "1481221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6253.0, "discounted_cash": 2188.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3026.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY/HEMILAMINECTOMY DISCECTOMY CERVICAL 63020", "code_information": [{"code": "63020", "type": "CPT"}, {"code": "1481222", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP CLOSE ENTEROSTOMY", "code_information": [{"code": "44227", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY PART W/ILEUM", "code_information": [{"code": "44205", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY W/PROCTECTOMY", "code_information": [{"code": "44211", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP COLOSTOMY", "code_information": [{"code": "44188", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ENTERECTOMY", "code_information": [{"code": "44202", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ESOPH LENGTHENING", "code_information": [{"code": "43283", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP GASTR BYPASS INCL SMLL I", "code_information": [{"code": "43645", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP GASTRIC BYPASS/ROUX-EN-Y", "code_information": [{"code": "43644", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ILEO/JEJUNO-STOMY", "code_information": [{"code": "44187", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP IMPL ELECTRODE ANTRUM", "code_information": [{"code": "43647", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP INS DEVICE FOR RT", "code_information": [{"code": "49327", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP INSERT TUNNEL IP CATH", "code_information": [{"code": "49324", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP JEJUNOSTOMY", "code_information": [{"code": "44186", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP MOBIL SPLENIC FL ADD-ON", "code_information": [{"code": "44213", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP MYOTOMY HELLER", "code_information": [{"code": "43279", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PARAESOPH HER RPR W/MESH", "code_information": [{"code": "43282", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PARAESOPHAG HERN REPAIR", "code_information": [{"code": "43281", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PART COLECTOMY W/STOMA", "code_information": [{"code": "44206", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PLACE GASTR ADJ DEVICE", "code_information": [{"code": "43770", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 16000.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7146.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11242.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11242.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11242.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PROCTOPEXY W/SIG RESECT", "code_information": [{"code": "45402", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP RADICAL HYST", "code_information": [{"code": "58548", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 11473.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REMOVAL OF RECTUM", "code_information": [{"code": "45395", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REMOVE RECTUM W/POUCH", "code_information": [{"code": "45397", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REPLACE GASTR ADJ DEVICE", "code_information": [{"code": "43773", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 16000.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7146.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11242.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11242.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11242.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP RESECT S/INTESTINE ADDL", "code_information": [{"code": "44203", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REVISE GASTR ADJ DEVICE", "code_information": [{"code": "43771", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 11187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REVISE/REMV ELTRD ANTRUM", "code_information": [{"code": "43648", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP RMVL GASTR ADJ ALL PARTS", "code_information": [{"code": "43774", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP RMVL GASTR ADJ DEVICE", "code_information": [{"code": "43772", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 11187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP SLEEVE GASTRECTOMY", "code_information": [{"code": "43775", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 16000.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7146.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11242.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11242.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11242.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11187.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP W/OMENTOPEXY ADD-ON", "code_information": [{"code": "49326", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP.SUPRACERVICAL HYST.UTERUS 250 G OR LESS W/REM.TUBES/OVARY 58542", "code_information": [{"code": "58542", "type": "CPT"}, {"code": "1481223", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 11473.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP.SUPRACERVICAL HYST.UTERUS GREATER THAN 250 G W/REM.OF TUBES/OVARY 58544", "code_information": [{"code": "58544", "type": "CPT"}, {"code": "1481224", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 11473.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP.TOTAL HYST.250 G OR LESS W/REMOVALTUBES/OVARY 58571", "code_information": [{"code": "58571", "type": "CPT"}, {"code": "1481225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 11473.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP.TOTAL HYST.GREATER THAN 250 G W/REM.OF TUBES/OVARY 58573", "code_information": [{"code": "58573", "type": "CPT"}, {"code": "1481226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3471.0, "maximum": 11473.0, "gross_charge": 12978.0, "discounted_cash": 4542.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 6281.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP.VAGINAL HYST.UTERUS 250 G OR LESS W/REMOVAL OF TUBES/OVARY 58552", "code_information": [{"code": "58552", "type": "CPT"}, {"code": "1481227", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 11473.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP.VAGINAL HYST.UTERUS GREATER THAN 250 G WITH REMOVAL OF TUBES/OVARY 58554", "code_information": [{"code": "58554", "type": "CPT"}, {"code": "1481228", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 11473.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARASCOPY WITH LYSIS OF ADHESIONS 58660", "code_information": [{"code": "58660", "type": "CPT"}, {"code": "1481230", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARASCOPY WITH LYSIS OF ADHESIONS AND EXCISION OF LESIONS 58662", "code_information": [{"code": "58662", "type": "CPT"}, {"code": "1481231", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARASCOPY WITH LYSIS OF ADHESIONS AND FULGURATION OF OVIDUCTS 58670", "code_information": [{"code": "58670", "type": "CPT"}, {"code": "1481232", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARASCOPY WITH LYSIS OF ADHESIONS AND OCCLUSION OF OVIDUCTS 58671", "code_information": [{"code": "58671", "type": "CPT"}, {"code": "1481233", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARASCOPY WITH LYSIS OF ADHESIONS AND REMOVAL OF ADNEXAL STRUCTURES 58661", "code_information": [{"code": "58661", "type": "CPT"}, {"code": "1481234", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARASCOPY WITH LYSIS OF ADHESIONS AND SALPINGOSTOMY 58673", "code_information": [{"code": "58673", "type": "CPT"}, {"code": "1481235", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER CRYOSURG", "code_information": [{"code": "47371", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER TUMOR RF", "code_information": [{"code": "47370", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTOENTEROSTOMY", "code_information": [{"code": "47570", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50947", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50948", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL COLECTOMY", "code_information": [{"code": "44204", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVAL DONOR KIDNEY", "code_information": [{"code": "50547", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44210", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44212", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPE PROC RECTUM", "code_information": [{"code": "45499", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC", "code_information": [{"code": "418", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10274.19, "maximum": 17638.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10274.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14694.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16163.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17638.23, "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": 14747.02, "maximum": 25316.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14747.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21091.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23200.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25316.96, "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": 8000.97, "maximum": 13735.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8000.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11443.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12587.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13735.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC COLPOPEXY 57425", "code_information": [{"code": "57425", "type": "CPT"}, {"code": "1481236", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC LIGATION OF VARICOCELE 55550", "code_information": [{"code": "55550", "type": "CPT"}, {"code": "1481239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC MYOMECTOMY 250 G OR LESS 58545", "code_information": [{"code": "58545", "type": "CPT"}, {"code": "1481237", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2284.96, "maximum": 9357.0, "gross_charge": 4721.0, "discounted_cash": 1652.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2284.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC MYOMECTOMY GREATER THAN 250 G 58546", "code_information": [{"code": "58546", "type": "CPT"}, {"code": "1481240", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC PROC", "code_information": [{"code": "45400", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC SUPRACERVICAL HYSTERECTOMY 58541", "code_information": [{"code": "58541", "type": "CPT"}, {"code": "1481245", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 11473.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC SUPRACERVICAL HYSTERECTOMY FOR UTERUS GREATER THAN 250 G 58543", "code_information": [{"code": "58543", "type": "CPT"}, {"code": "1481242", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 11473.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC TOTAL HYSTERECTOMY 250 G OR LESS 58570", "code_information": [{"code": "58570", "type": "CPT"}, {"code": "1481244", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 11473.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC TREATMENT OF ECTOPIC PREG. W/SALPINGECTOMY AND OOPHRECTOMY 59151", "code_information": [{"code": "59151", "type": "CPT"}, {"code": "2156864", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY W/O SALPINGECTOMY AND/OR OOPHRECTOMY 59150", "code_information": [{"code": "59150", "type": "CPT"}, {"code": "15213988", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC VAGINAL HYSTERECTOMY FOR UTERUS 250 G OR LESS 58550", "code_information": [{"code": "58550", "type": "CPT"}, {"code": "1481248", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3471.0, "maximum": 11473.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC VAGINAL HYSTERECTOMY FOR UTERUS GREATER THAN 250 G 58553", "code_information": [{"code": "58553", "type": "CPT"}, {"code": "1481249", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 11473.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ADRENALECTOMY", "code_information": [{"code": "60650", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY DIAGNOSTIC 49320", "code_information": [{"code": "49320", "type": "CPT"}, {"code": "1481250", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY FIMBRIOPLASTY", "code_information": [{"code": "58672", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY GASTROSTOMY", "code_information": [{"code": "43653", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY INCISION AND DRAINAGE LYMPHOCELE 49323", "code_information": [{"code": "49323", "type": "CPT"}, {"code": "1481251", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ISLET CELL TRANS", "code_information": [{"code": "G0342", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38571", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38572", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SPLENECTOMY", "code_information": [{"code": "38120", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SURGICAL W/REVISION PREVIOUS INTRAPERITONEAL CATH W/REM. OBSTRUCTIVE MAT. 49325", "code_information": [{"code": "49325", "type": "CPT"}, {"code": "25454581", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2986.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SURGICAL;ORCHIECTOMY 54690", "code_information": [{"code": "54690", "type": "CPT"}, {"code": "1481252", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SURGICAL;ORCHIECTOMY FOR INTRA-ABDOMINAL TESTIS 54692", "code_information": [{"code": "54692", "type": "CPT"}, {"code": "1481253", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43651", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43652", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY W/ASPIRATION OF CAVITY OR CYST 49322", "code_information": [{"code": "49322", "type": "CPT"}, {"code": "1481254", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY W/RETROPERITONEAL LYMPH NODE BIOPSY SINGLE OR MULTIPLE 38570", "code_information": [{"code": "38570", "type": "CPT"}, {"code": "1578700", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 9735.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY-SLING OPERATION FOR STRESS INCONTINENCE 51992", "code_information": [{"code": "51992", "type": "CPT"}, {"code": "1482124", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY-URETHRAL SUSPENSION FOR STRESS INCONTINENCE 51990", "code_information": [{"code": "51990", "type": "CPT"}, {"code": "1482346", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY; URETEROLITHOTOMY 50945", "code_information": [{"code": "50945", "type": "CPT"}, {"code": "1482328", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROTOMY ISLET CELL TRANSP", "code_information": [{"code": "G0343", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPIDUS PLATE LC ALPHA 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7100-LC18-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5265.0, "discounted_cash": 1842.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPIPLASTY SYSTEM 2 KIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9394.0, "discounted_cash": 3287.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPIPLASTY SYSTEM 3.0MM INTERFRAG SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 432.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPIPLASTY SYSTEM 4A ANATOMIC MULTIPLANAR SK39", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK39", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9579.0, "discounted_cash": 3352.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPRASCOPIC PROGRIP ANATAMICAL LFT 15X10 LPG1510AL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "LPG1510AL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1124.0, "discounted_cash": 393.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPRO-SHARK FASCIAL CLOSURE DEVICE", "code_information": [{"code": "P10176", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPS ABLTJ UTERINE FIBROIDS", "code_information": [{"code": "58674", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS ESOPHGL SPHNCTR AGMNTJ", "code_information": [{"code": "43284", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS 1LD", "code_information": [{"code": "675T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS EA", "code_information": [{"code": "676T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT PRM ISDSS", "code_information": [{"code": "674T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 6045.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS ISLET CELL TRANSPLANT", "code_information": [{"code": "585T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS PELVIC LYMPHADEC", "code_information": [{"code": "38573", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS 1ST LD", "code_information": [{"code": "677T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS EA ADD", "code_information": [{"code": "678T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS RMVL LEAD ISDSS", "code_information": [{"code": "679T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS SURG PRST8ECT RPBIC RAD", "code_information": [{"code": "55866", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS SURG PRST8ECT SMPL STOT", "code_information": [{"code": "55867", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS TOT HYST RESJ MAL", "code_information": [{"code": "58575", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGE CAPACITY FORCEPS Large Capacity Biopsy Forceps 133-4667 Alligator Blue 230 2.8", "code_information": [{"code": "BF40286", "type": "CDM"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE CAPACITY FORCEPS Large Capacity Biopsy Forceps With Spike 133-4666 Alligator Blue 230 2.8", "code_information": [{"code": "BF40306", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE PEC BUTTON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 896.0, "discounted_cash": 313.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGSC W/LASER DSTRJ LES", "code_information": [{"code": "31572", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGSC W/NJX AUGMENTATION", "code_information": [{"code": "31574", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGSC W/REMOVAL LESION", "code_information": [{"code": "31578", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGSC W/RMVL FOREIGN BDY(S)", "code_information": [{"code": "31577", "type": "CPT"}], "standard_charges": [{"minimum": 1416.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1416.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGSC W/THER INJECTION", "code_information": [{"code": "31573", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGEAL FUNCTION STUDIES", "code_information": [{"code": "92520", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY CRICOID SPLIT", "code_information": [{"code": "31587", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY FX RDCTJ FIXJ", "code_information": [{"code": "31584", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31551", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31552", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31553", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31554", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL WEB", "code_information": [{"code": "31580", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY MEDIALIZATION", "code_information": [{"code": "31591", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/ARYTENOIDECTOM", "code_information": [{"code": "31560", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE W/VC INJ", "code_information": [{"code": "31570", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY I&R", "code_information": [{"code": "92615", "type": "CPT"}], "standard_charges": [{"minimum": 149.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY VID", "code_information": [{"code": "92614", "type": "CPT"}], "standard_charges": [{"minimum": 301.95, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 301.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 474.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 474.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 474.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31528", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31529", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT DX EXCEPT NEWBORN 31525", "code_information": [{"code": "31525", "type": "CPT"}, {"code": "1643987", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT OP. W/EXC. TUMOR AND/OR STRIPPING VOCAL CORD OR EPIGLOTTIS 31540", "code_information": [{"code": "31540", "type": "CPT"}, {"code": "2013585", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT OP. W/SCOPE W/SUBMUCOSAL REM. OF NON-NEO. LESION VOCAL CORD RECON.W/FLAP 31545", "code_information": [{"code": "31545", "type": "CPT"}, {"code": "2013583", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT OPERTIVE W/FOREIGN BODY REMOVAL 31530", "code_information": [{"code": "31530", "type": "CPT"}, {"code": "1697274", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT W/ OR W/O TRACHEOSCOPY DIAG. W/MICROSCOPE OR TELESCOPE 31526", "code_information": [{"code": "31526", "type": "CPT"}, {"code": "9213616", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT W/INJECTION INTO VOCAL CORD THERAPEUTIC W/MICROSCOPE 31571", "code_information": [{"code": "31571", "type": "CPT"}, {"code": "15213989", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FLEXIBLE DIAGNOSTIC 31575", "code_information": [{"code": "31575", "type": "CPT"}, {"code": "9167914", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 2297.0, "discounted_cash": 803.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1111.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FLEXIBLE W/BIOPSY 31576", "code_information": [{"code": "31576", "type": "CPT"}, {"code": "1830934", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR ASPIRATION", "code_information": [{"code": "31515", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR TREATMENT", "code_information": [{"code": "31527", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY TELESCOPIC", "code_information": [{"code": "31579", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB & OP SCOPE", "code_information": [{"code": "31531", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY WITH BIOPSY", "code_information": [{"code": "31510", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP REMVE CART + SCOP", "code_information": [{"code": "31561", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER FIBER BARE 550M", "code_information": [{"code": "HB-550M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER SU 550UM", "code_information": [{"code": "8000231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER PROBE 25G CVD", "code_information": [{"code": "7625.ALCU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 490.0, "discounted_cash": 171.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER PROBE ILLUMINATED 23GA CURVED", "code_information": [{"code": "7510-ALC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 152.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER SURGERY EYE STRANDS", "code_information": [{"code": "67031", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1874.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52647", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASSO SUT 90 DEGREE CURVE STRAIGHT QUICKPASS LASSO", "code_information": [{"code": "AR-6068-90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 481.0, "discounted_cash": 168.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LATERAL ACCESS SYSTEM AC01-90050", "code_information": [{"code": "AC01-90050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1191.0, "discounted_cash": 416.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LATERAL CANTHOPEXY 21282", "code_information": [{"code": "21282", "type": "CPT"}, {"code": "9467892", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LATERAL RETINACULAR RELEASE OPEN 27425", "code_information": [{"code": "27425", "type": "CPT"}, {"code": "1481257", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LATERAL SUPPORT KIT 181-720", "code_information": [{"code": "181-720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1345.0, "discounted_cash": 470.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LAVAGE BY CANNULATION MAXILLARY SINUS 31000", "code_information": [{"code": "31000", "type": "CPT"}, {"code": "1923083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 598.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAVAGE BY CANNULATION SPHENOID SINUS 31002", "code_information": [{"code": "31002", "type": "CPT"}, {"code": "34768885", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.82, "maximum": 8450.0, "gross_charge": 1386.0, "discounted_cash": 485.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LDR PROSTATE BRACHY COMP RAT", "code_information": [{"code": "G0458", "type": "HCPCS"}], "standard_charges": [{"minimum": 8027.0, "maximum": 8027.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD 16 TRICENTRUS 3292", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 3850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD CABLE CROCODILE CLIP ELECTRODE 48IN AREO-LL", "code_information": [{"code": "48755018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD COMPACT NEUROMOD 1 X 8 EDTRONIC TRIAL", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "977D260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD ECG 3 WIRE MULTI LINK", "code_information": [{"code": "2021141-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 476.52, "discounted_cash": 166.78, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD KIT 4 CONTACT 40CM TINED 72007", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "72007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD KIT 70CM 17 CONTACT INFINION", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "SC-2317-70", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8240.0, "discounted_cash": 2884.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD KIT 8 CONTACT 60CM TRIAL 72003", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "72003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD KIT AXONICS 1201 Lead", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "1201 Lead", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6186.0, "discounted_cash": 2165.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD LINEAR ST 50CM 8 CONTACT KIT M365SC2218500", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "M365SC2218500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4062.0, "discounted_cash": 1421.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD NEURO STIM TRIAL 50CM SLIM TIP L", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "MN10350-50A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5540.0, "discounted_cash": 1939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD NEUROSTIMULATOR 3MM X 60 CM PENTA", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11536.0, "discounted_cash": 4037.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD SNS", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7038.0, "discounted_cash": 2463.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD SNS 38 CM SACRAL NERVE STIMULATIONINTERSTIM", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7038.0, "discounted_cash": 2463.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD STIMULATION", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD STIMULATION FOR OBSTRUCTIVE SLEEP APNEA 45CM 4063-45 CM", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "4063-45 CM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4017.0, "discounted_cash": 1405.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD STIMULATION IMPLANT INSPIRE SLP APNEA", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "4063", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4017.0, "discounted_cash": 1405.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD SURESCAN SPINAL CORD STIM", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "977C165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9616.0, "discounted_cash": 3365.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD WIRE DISPOSABLE", "code_information": [{"code": "302775-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 629.46, "discounted_cash": 220.31, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD WITH SURE SCAN MRI COMAPTIBLE TINED 978B128", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "978B128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7426.0, "discounted_cash": 2599.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LEADS PROCLAIM PLUS 5 DUAL OCTRODE SYSTEM 222PP5OCTSY33", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "222PP5OCTSY33", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43500.0, "discounted_cash": 15225.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEADS SURGICAL PADDLE 65CM 2X8 CONFIGURATION", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "977C265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9616.0, "discounted_cash": 3365.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFORT I-1 PIECE W/ GRAFT", "code_information": [{"code": "21145", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT I-1 PIECE W/O GRAFT", "code_information": [{"code": "21141", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT I-2 PIECE W/ GRAFT", "code_information": [{"code": "21146", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT I-2 PIECE W/O GRAFT", "code_information": [{"code": "21142", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT I-3/> PIECE W/ GRAFT", "code_information": [{"code": "21147", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT II ANTERIOR INTRUSION", "code_information": [{"code": "21150", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT II W/BONE GRAFTS", "code_information": [{"code": "21151", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/ LEFORT I", "code_information": [{"code": "21155", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHD W/ LEFORT I", "code_information": [{"code": "21160", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHDW/O LEFORT I", "code_information": [{"code": "21159", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/O LEFORT I", "code_information": [{"code": "21154", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFT HRT CATH W/VENTRCLGRPHY", "code_information": [{"code": "93452", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEG PAIN NO VAS", "code_information": [{"code": "G9949", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEG PAIN VAS 6-20WK <= 3", "code_information": [{"code": "G2140", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEG PAIN VAS 6-20WK > 3", "code_information": [{"code": "G2141", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEG PAIN VAS 9-15MO <= 3", "code_information": [{"code": "G2146", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEG PAIN VAS 9-15MO > 3", "code_information": [{"code": "G2147", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEG VEIN FUSION", "code_information": [{"code": "34530", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGGINGS CONVERTORS 48 X 31 DYNJP2460A", "code_information": [{"code": "DYNJP2460A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LEGION CONSTRAINED INSERT W/JOURNEY LOCK SZ 3-4 11MM 71425473", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71425473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12102.0, "discounted_cash": 4235.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA AMP PROB", "code_information": [{"code": "87541", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA DIR PROB", "code_information": [{"code": "87540", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA QUANT", "code_information": [{"code": "87542", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 60.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 60.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMOPHILIA AG IF", "code_information": [{"code": "87278", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PS NP FEM SZ 2 LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3546.0, "discounted_cash": 1241.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LEGION SCW LWDG S5 15D X 10P 71421746", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71421746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3391.2, "discounted_cash": 1186.92, "setting": "both", "billing_class": "facility"}]}, {"description": "LEGION TIB BASE W/JOURNEY LOCK SZ 2 R 71933576", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71933576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6484.0, "discounted_cash": 2269.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LEGION TIB BASE W/JOURNEY LOCK SZ 4 L 71933570", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71933570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7170.0, "discounted_cash": 2509.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEGIONELLA ANTIBODY", "code_information": [{"code": "86713", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 61.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 61.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 61.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEISHMANIA ANTIBODY", "code_information": [{"code": "86717", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEN IOL DCB00 +8.0D DCB00 +8.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB00 +8.0D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 10.0D DCB0000100", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000100", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 10.5D DCB0000105", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000105", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 11.0D DCB0000110", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000110", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 11.5D DCB0000115", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000115", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 12.0D DCB0000120", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000120", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 13.0D DCB0000130", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000130", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 13.5D DCB0000135", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000135", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 14.0D DCB0000140", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000140", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 14.5D DCB0000145", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000145", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 15.0D DCB0000150", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000150", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 15.5D DCB0000155", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000155", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 16.0D DCB0000160", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000160", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 16.5D DCB0000165", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000165", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 17.0D DCB0000170", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000170", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 17.5D DCB0000175", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000175", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 18.0D DCB0000180", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000180", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 18.5D DCB0000185", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000185", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 19.0D DCB0000190", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000190", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 19.5D DCB0000195", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000195", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 20.0D DCB0000200", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000200", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 20.5D DCB0000205", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000205", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 21.0D DCB0000210", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000210", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 21.5D DCB0000215", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000215", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 22.0D DCB0000220", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000220", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 22.5D DCB0000225", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000225", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 23.0D DCB0000230", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000230", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 23.5D DCB0000235", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000235", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 24.0D DCB0000240", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000240", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 24.5D DCB0000245", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000245", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 25.0D DCB0000250", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000250", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 25.5D DCB0000255", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000255", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 26.0D DCB0000260", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000260", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 26.5D DCB0000265", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000265", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 27.0D DCB0000270", "code_information": [{"code": "V2630", "type": "HCPCS"}, {"code": "DCB0000270", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 27.5D DCB0000275", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000275", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 28.0D DCB0000280", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000280", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 28.5D DCB0000285", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000285", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 29.0D DCB0000290", "code_information": [{"code": "DCB0000290", "type": "CDM"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 29.5D DCB0000295", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000295", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 30.0D DCB0000300", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000300", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 30.5D DCB0000305", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000305", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 31.0D DCB0000310", "code_information": [{"code": "DCB0000310", "type": "CDM"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 31.5D DCB0000315", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000315", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 32.0D DCB0000320", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000320", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 32.5D DCB0000325", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000325", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 33.0D DCB0000330", "code_information": [{"code": "DCB0000330", "type": "CDM"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 33.5D DCB0000335", "code_information": [{"code": "DCB0000335", "type": "CDM"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 34.0D DCB0000340", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000340", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 5.0D DCB0000050", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000050", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 5.5D DCB0000055", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000055", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 6.0D DCB0000060", "code_information": [{"code": "DCB0000060", "type": "CDM"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 6.5D DCB0000065", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000065", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 7.0D DCB0000070", "code_information": [{"code": "DCB0000070", "type": "CDM"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 7.5D DCB0000075", "code_information": [{"code": "DCB0000075", "type": "CDM"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 8.0D DCB0000080", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000080", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 8.5D DCB0000085", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000085", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 9.0D DCB0000090", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000090", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 9.5D DCB0000095", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000095", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN TORIC IOL SN6AT5 17.0 D", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 17.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENGTHEN RADIUS & ULNA", "code_information": [{"code": "25393", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF HAND TENDON", "code_information": [{"code": "26478", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42226", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42227", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH BONE", "code_information": [{"code": "27466", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDON", "code_information": [{"code": "27393", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27394", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27395", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OR SHORTENING OF TENDON LEG OR ANKLE 27685", "code_information": [{"code": "27685", "type": "CPT"}, {"code": "1481258", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHNING OF TENDON HAND 26476", "code_information": [{"code": "26476", "type": "CPT"}, {"code": "1481259", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS ACRYSOF MULTI STL PCL IOL L13.0MM 6.0MM 5DEG MONO MA60MA +1.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60MA +1.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS CCWTT0.220 CLAREON PANOPTIX UVA CCWTT0 +22.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCWTT0 +22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS CLAREO PANOPTI TRIFOCAL IOL 23.5 CNWTT0 23.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS CLAREON BLF TORIC CNW0T4 20.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T4 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS CLAREON PANOPTIX CNWTT0 20.5 CNWTT0 20.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS CLAREON PANOPTIX UV IOL 20.0D T13.0MM B6.0MM CCWTT0 20.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCWTT0 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS CLAREON TORIC UVA 15.5 CCW0T6 15.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CCW0T6 15.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS CLAREON TORIC UVA 23.5 CCW0T3 23.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCW0T3 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS CLAREON VIVITY CNWET0 22.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWET0 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS CLAREON VIVITY TORIC 20.0 CNWET3 20.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWET3 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS CLAREON VIVITY TORIC HYDROPHOBIC CNWET4 20.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNWET4 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS CLAREON W/AUTONOME DELIVERY SYSTEM CCA0T0.220", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CCA0T0.220", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS DIRECT IMAGE FLAT VTRCTMY DISP", "code_information": [{"code": "VFD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.63, "discounted_cash": 27.17, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS ENVISTA ENVY EN PLKUS21.50D ENU2150", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ENU2150", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1998.0, "discounted_cash": 699.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS ENVISTA ENVY TORIC 19.5 ETNU250+195", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ETNU250+195", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS ENVISTA ENVY TORIC 20.00D ETNU250+200", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ETNU250+200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS GONIOSCOPIC IPRISM S LEFT", "code_information": [{"code": "SGL5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 230.0, "discounted_cash": 80.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 10.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 10.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 10.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 10.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 11.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 11.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 11.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 11.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 12.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 12.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 12.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 12.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 13.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 13.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 14.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 14.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 14.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 14.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 15.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 15.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 15.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 16.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 16.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 16.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 16.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 17.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 17.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 17.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 18.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 18.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 19.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 19.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 20.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 20.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 21.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 21.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 22.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 22.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 23.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 23.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 24.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 24.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 24.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 25.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 25.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 25.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 26.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 26.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 26.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 26.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 28.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 28.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 28.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 28.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 29.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 29.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 29.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 29.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 30.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 30.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 31.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 31.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 32.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 32.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 32.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 32.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 33.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 33.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 5.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 5.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 6.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 6.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 6.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 6.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 7.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 7.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 8.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 8.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 8.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 8.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 9.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 9.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS INTRAOCULAR TECNIS SZ 9.5 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 9.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IO 1.0D 6.0 X 13.0MM ACRYSOF EXPAND ACRYLIC POST CHAMBER MA60MA.-010", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60MA.-010", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IO ANTERIOR ASYMMETRIC BOCNVEXL 13MM 6MM +11.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 11.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IO ANTERIOR ASYMMETRIC BOCNVEXL 13MM 6MM +12.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 12.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IO ANTERIOR ASYMMETRIC BOCNVEXL 13MM 6MM +19.5", "code_information": [{"code": "MA60AC 14.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IO ANTERIOR ASYMMETRIC BOCNVEXL 13MM 6MM +8.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 8.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +10.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 10.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +10.0 DIOPT TORIC 400 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT400 10.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +11.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 11.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +11.5 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 11.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1792.0, "discounted_cash": 627.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +12.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000012.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +12.0 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 12.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1792.0, "discounted_cash": 627.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +12.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 12.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +12.5 DIOPT TORIC 150 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT150 12.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +13.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000 13.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +13.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000 13.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +14.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000 14.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +14.0 DIOPT TORIC 150 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT150 14.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +14.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000014.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +15.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000015.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +15.0 DIOPT TORIC 150 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT150 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1405.0, "discounted_cash": 491.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +15.0 DIOPT TORIC 225 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT225 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +15.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000015.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +15.5 DIOPT TORIC 225 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT225 15.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +16.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 16.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +16.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000 16.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +16.5 DIOPT TORIC 300 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT300 16.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +17.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000017.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +17.0 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 17.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 652.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +17.0 DIOPT TORIC 300 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT300 17.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +17.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 17.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +17.5 DIOPT TORIC 150 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT150 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +18.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000018.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +18.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000 18.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +18.5 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 652.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +18.5 DIOPT TORIC 300 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT300 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +19.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000190", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +19.0 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1792.0, "discounted_cash": 627.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +19.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB00 19.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +19.5 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 652.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +20.0 D DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB00 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 286.0, "discounted_cash": 100.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +20.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 20.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +20.0 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1792.0, "discounted_cash": 627.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +20.0 DIOPT TORIC 225 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT225 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +20.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000020.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +20.5 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 652.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +20.5 DIOPT TORIC 150 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT150 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +21.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000210", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +21.0 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 652.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +21.0 DIOPT TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT400U 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +21.0 DIOPT TORIC 150 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT150 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1405.0, "discounted_cash": 491.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +21.0 DIOPT TORIC 225 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT225 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +21.5 D DIOPT AMO", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZC000021.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +21.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000215", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +21.5 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 652.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +21.5 DIOPT TORIC 225 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT225 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +21.5 DIOPT TORIC 300 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT300 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +22.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000220", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +22.0 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 652.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +22.0 DIOPT TORIC 225 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT225 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +22.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000225", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +22.5 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1792.0, "discounted_cash": 627.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +22.5 DIOPT TORIC 225 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT225 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +22.5 DIOPT TORIC 400 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT400 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +23.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000230", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +23.0 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 652.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +23.0 DIOPT TORIC 225 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT225 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +23.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000235", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +23.5 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 652.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +23.5 DIOPT TORIC 225 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT225 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +24.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000024.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +24.0 DIOPT TORIC 225 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT225 24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +24.0 DIOPT TORIC 300 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT300 24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +24.0 DIOPT TORIC 400 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT400 24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +24.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000024.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +24.5 DIOPT MULTIFOCAL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZMB00 24.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 652.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +25.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000025.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +25.5 D DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000 25.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +25.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZC000025.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +26.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000026.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +26.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 26.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +27.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB00 27.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +27.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 27.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +28.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000 28.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +28.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 28.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +29.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 29.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +29.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 29.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +30.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 30.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +31.0 DIOPT TORIC 225 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT225 31.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +31.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 31.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +31.5 DIOPT TORIC 150 CYLINDER", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ZCT150 31.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +33.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000 33.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +5.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB00 5.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 286.0, "discounted_cash": 100.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +6.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000 6.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +8.5 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000 8.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL +9.0 DIOPT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCBOO 09.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL -3.0D 6.0 X 13.0MM ACRYSOF EXPAND ACRYLIC POST CHAMBER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ma60ma-3.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL -4.0D 6.0 X 13.0MM ACRYSOF EXPAND ACRYLIC POST CHAMBER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60MA -4.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL -5.0D 6.0 X 13.0MM ACRYSOF EXPAND ACRYLIC POST CHAMBER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ma60ma-5.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 10 D +15 DIOPTER MODIFIED C BICONVEX 13MM 6MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIO", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 5.5MM +5 ANT CHMBR CONVEXOPLANO", "code_information": [{"code": "V2630", "type": "HCPCS"}, {"code": "MTA4U0 5.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 5.5MM +8 ANT CHMBR CONVEXOPLANO", "code_information": [{"code": "V2630", "type": "HCPCS"}, {"code": "MTA4U0 8.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 5.5MM +9 ANT CHMBR CONVEXOPLANO", "code_information": [{"code": "V2630", "type": "HCPCS"}, {"code": "MTA4U0 9.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +1 MENISCUS MULTI PIECE ACRYSOF", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MN60MA 1.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +11 ASPHERIC SNGL PIECE", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 11.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +11.5 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 11.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +12 ASPHERIC ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 12.0D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +12.5 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 12.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +13 ASPHERIC ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 13.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +13.5 ASPHERIC ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 13.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +14 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 14.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +14.5 ASPHERIC ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 14.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +15 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 15.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +15.5 ASPHERIC ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 15.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +16 ASPHERIC ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 16.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +16.5 ASPHERIC ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 16.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +17 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 17.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +17.5 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 17.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +17.5 ASPHERIC SNGL PIECE", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 17.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +18 ASPHERIC ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 18.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +18.5 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 18.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +19 ASPHERIC ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 19.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +19.5 ANT ASYMMETRIC BOCNVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 19.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +2 MENISCUS MULTI PIECE ACRYSOF", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MN60MA 2.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +20 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 20.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +20.0 ANT ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +20.5 ANT ASYMMETRIC BICONVEX", "code_information": [{"code": "V2630", "type": "HCPCS"}, {"code": "MA60AC 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +21 APODIZED DIFFRACTIVE ASPHERIC", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "SN6AD1 21.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1917.0, "discounted_cash": 670.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +21 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 21.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +21 ASPHERIC SNGL PIECE", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 21.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +21.5 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 21.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +22 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WL 22.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +22 ASPHERIC SNGL PIECE", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 22.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +22.5 ANT ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 22.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +22.5 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 22.5D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +23 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 23.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +23 MULTIFACIAL APODIZED DIFFRACTIVE ASPHERIC ACRYSOF IQ RESTO", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "SN6AD1 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1917.0, "discounted_cash": 670.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +23.5 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 23.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +24 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 24.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +24.5 ANT ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 24.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +24.5 ANT ASYMMETRIC BICONVEX MA60AC.245", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC.245", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +24.5 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 24.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +25 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 25.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +25.5 ASPHERIC ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 25.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +26 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 26.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +26.5 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 26.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +27 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 27.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +27.5 ASPHERIC ASYMMETRIC BICONVEX NAT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "IOL 27.5 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +29 ASPHERIC SNGL PIECE", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 29.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +3 MENISCUS MULTI PIECE ACRYSOF", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MN60MA 3.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +31 ASPHERIC ASYMMETRIC BICONVEX", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 31.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +6 ASPHERIC ASYMMETRIC BICONVEX ACRYSOF", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 6.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +6.5 ASPHERIC ACRYSOF", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 6.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +7 ANT ASYMMETRIC BICONVEX SNGL PIECE ACRYSOF", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SA60AT 7.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +7 ASPHERIC ACRYSOF", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 7.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +8 +1.5 CYLNDR BIONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 8.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +8 ASPHERIC ACRYSOF", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 8.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +9 ASPHERIC ASYMMETRIC BICONVEX ACRYSOF", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 9.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM +9.5 +2.25 CYLNDR BICONVEX TORIC ASPHERIC IQ", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 9.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM 0DEG +19.5 MULTI FOCAL APODIZED DIFFRACTIVE ASPHERIC ACRYSOF I", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "SN6AD1 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1917.0, "discounted_cash": 670.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM 0DEG +20 MULTI FOCAL APODIZED DIFFRACTIVE ASPHERIC ACRYSOF IQ", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "SN6AD1 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1844.0, "discounted_cash": 645.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM 0DEG +20.5 MULTI FOCAL APODIZED DIFFRACTIVE ASPHERIC ACRYSOF I", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "SN6AD1 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1917.0, "discounted_cash": 670.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM 0DEG +22 MULTI FOCAL APODIZED DIFFRACTIVE ASPHERIC ACRYSOF IQ", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "SN6AD1 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1844.0, "discounted_cash": 645.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM 0DEG +22.5 MULTI FOCAL APODIZED DIFFRACTIVE ASPHERIC ACRYSOF I", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "SN6AD1 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2029.0, "discounted_cash": 710.15, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM 0DEG +23.5 MULTI FOCAL APODIZED DIFFRACTIVE ASPHERIC ACRYSOF I", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "SN6AD1 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1917.0, "discounted_cash": 670.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM 0DEG +6 +4.5 CYLNDR BICONVEX TORIC ASPHERIC ACRYSOF IQ", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT7 6.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM 0DEG +6.5 +2.25 CYLNDR BICONVEX TORIC ASPHERIC ACRYSOF IQ", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 6.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 13MM 6MM 0DEG +7.5 +4.5 CYLNDR BICONVEX TORIC ASPHERIC ACRYSOF IQ", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT7 7.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 2.0D 6.0 X 13.0MM ACRYSOF EXPAND ACRYLIC POST CHAMBER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60MA 2.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 29.0 CNA0T0 29.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 29.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 29.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 29.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 3 PC POSTERIOR CHAMBER CT LUCIA 602 14.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CT LUCIA 602 14.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 3 PC POSTERIOR CHAMBER CT LUCIA 602 15.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CT LUCIA 602 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 30.0+", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000 30.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +18.5 DIOPT SNGL PIECE ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +19 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNG", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +19.0 DIOPT SNGL PIECE ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +19.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT S", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +19.5 DIOPT SNGL PIECE ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +2.0 DIOPT SNGL PIECE ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +20 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNG", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +20.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT S", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +20.5 DIOPT SNGL PIECE ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +21 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNG", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +21.0 DIOPT SNGL PIECE ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +21.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT S", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM +22.0 DIOPT SNGL PIECE +3.75 CYLNDR ACRYSOF NAT TOR", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +10 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 10.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +12 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 12.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +13 DIOPT +3.75 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 13.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +14 DIOPT +4.5 CYLNDR BICONVEX TORIC ASPHERIC N", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT7 14.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +14.5 DIOPT +4.5 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT7 14.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 10290.0, "discounted_cash": 3601.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +17 DIOPT +4.5 CYLNDR BICONVEX TORIC ASPHERIC N", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT7 17.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +18 DIOPT +3.75 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +2.25 CYLNDR BICONVEX TORIC ASPHERIC NAT SNGL P", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +22 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +22.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC N", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +23 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +23.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC N", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +24 DIOPT +3.75 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +24.5 DIOPT +3.75 CYLNDR BICONVEX TORIC ASPHERI", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 24.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +25 DIOPT +3.75 DIOPT BICONVEX TORIC ASPHERIC N", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT6 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +25.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC N", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 25.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +26.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC N", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 26.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +27.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC N", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 27.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +28.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC N", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 28.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +30 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 30.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +4.5 CYLNDR BICONVEX TORIC ASPHERIC NAT SNGL PI 18.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT7 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6.0MM OPTIC SZ 13MM LEN +4.5 CYLNDR BICONVEX TORIC ASPHERIC NAT SNGL PI 21.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT7 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM 13MM +21.0 DIOPT ANT BICONVEX OPTIC 10 DEGREE HAPTIC ANGULATION 118", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM 13MM +25.0 DIOPT ANT BICONVEX OPTIC 10 DEGREE HAPTIC ANGULATION 118", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM 13MM +30.0 DIOPT ANT BICONVEX OPTIC 10 DEGREE HAPTIC ANGULATION 118", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 30.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM 13MM ANT BICONVEX ASYMMETRIC MULTI PIECE FOLDABLE 10 DEGREE HAPTIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 16.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM DIOPT 14.5 BICONVEX TORIC ASPHERIC ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 14.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM DIOPT 15.0 BICONVEX TORIC ASPHERIC ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 15.0 D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM DIOPT 15.5 BICONVEX TORIC ASPHERIC ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 15.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM DIOPT 17.5 BICONVEX TORIC ASPHERIC ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM DIOPT 20.0 BICONVEX TORIC ASPHERIC ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM DIOPT 23.0 BICONVEX TORIC ASPHERIC ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM DIOPT 25.5 BICONVEX TORIC ASPHERIC ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 25.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM DIOPT 27.5 BICONVEX TORIC ASPHERIC ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 27.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM DIOPT 28.0 BICONVEX TORIC ASPHERIC ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 28.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM DIOPT 9.0 BICONVEX TORIC ASPHERIC ACRYSOF IQ TORIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 9.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM HAPTIC 5DEG DIOPT 5.0 MENISCUS NAT ACRYSOF MULTIPIECE EXPAND", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MN60MA 5.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM +10.5 DIOPT POST CHMBR FOLDABLE BICONVEX SNGL PIECE ANT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB0000 10.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN +20.5 DIOPT SNGL PIECE NAT TORIC +5.25 CYLNDR ACRYSO", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT8 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN +21.5 DIOPT SNGL PIECE NAT TORIC +5.25 CYLNDR ACRYSO", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT8 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN +22.5 DIOPT SNGL PIECE NAT TORIC +5.25 CYLNDR ACRYSO", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT8 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN +23.0 DIOPT SNGL PIECE NAT TORIC +5.25 CYLNDR ACRYSO", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT8 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN +23.5 DIOPT SNGL PIECE NAT TORIC +5.25 CYLNDR ACRYSO", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT8 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN +27.0 DIOPT SNGL PIECE NAT TORIC +5.25 CYLNDR ACRYSO", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT8 27.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN +31.0 DIOPT FOLDABLE ANT BICONVEX OPTIC 0 DEGREE HAP", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SA60AT 31.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN +35.0 DIOPT FOLDABLE ANT BICONVEX OPTIC 0 DEGREE HAP", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SA60AT 35.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN SNGL PIECE NAT TORIC +5.25 CYLNDR +13.5 DIOPT ACRYSO", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT9 13.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN SNGL PIECE NAT TORIC +5.25 CYLNDR +17.5 DIOPT ACRYSO", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT9 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN SNGL PIECE NAT TORIC +5.25 CYLNDR +18.0 DIOPT ACRYSO", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT9 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC 13MM LEN SNGL PIECE NAT TORIC +5.25 CYLNDR +21.5 DIOPT ACRYSO", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT9 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM +11.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNG", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 11.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM +12 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNGL", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 12.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM +13.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNG", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 13.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM +14 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNGL", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 14.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM +14.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNG", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 14.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM +15 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNGL", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM +16 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNGL", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 16.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM +16.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNG", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 16.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM +17 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNGL", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 17.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM +17.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNG", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM +18.5 DIOPT +3 CYLNDR BICONVEX TORIC ASPHERIC NAT SNG", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +12.5 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 12.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +13 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 13.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +14 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 14.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +14.5 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 14.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +15 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +15.5 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 15.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +16 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 16.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +16.5 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 16.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +17 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 17.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +17.5 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +18 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +18.5 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +20 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +20.5 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +21 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 21.0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +21.85 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +22 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +22.5 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +23 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +23.5 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +24 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +24.5 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 24.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +25 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +25.5 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 25.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +26 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 26.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +27 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 27.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL 6MM OPTIC SZ 13MM LEN +30 DIOPT +2.25 CYLNDR BICONVEX TORIC ASPHERIC NA", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 30.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSO MULTIPIECE MA60AC 9.5 MA60AC 9.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 9.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF 13.0MM L 6.0MM MENISCUS OPTIC 5 D MONOFLEX MN60MAN030", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MN60MAN030", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF 13.0MM L 6.0MM MENISCUSOPTIC 5D MONOFLEX MA60MAN030", "code_information": [{"code": "MA60MAN030", "type": "CDM"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF 19.5 WAVEFRONT SINGLE-PIECE ACRYLIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SA60WF 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF 22.5 WAVEFRONT SINGLE-PIECE ACRYLIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SA60WF 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF 23.0 BICONVEX FOLDABLE MULTIPIECE ANTERIOR DIOPTER", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF 25.5 BICONVEX OPTIC MA60AC 25.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 25.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +16.5 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +16.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +17.5 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +18.0 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +18.5 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +19.0 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +19.5 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +20.5 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +21.5 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +22.0 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +22.5 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +23.0 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +23.5 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +24.0 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +25.0 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF IQ +26.0 ASPHERIC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AU00T0 +26.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF MA60AC 21.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACRYSOF MULTIPIECE 13.0MM L 6.0MM ANTERIOR 9.0 MA60AC.090", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC.090", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 11.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 11.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 11.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 13.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 13.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 13.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 14.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 14.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 14.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 15.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 15.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 15.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 16.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 16.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 16.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 18.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 18.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 18.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 18.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 19.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 19.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 20.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 20.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 20.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 20.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 21.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 21.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 21.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 21.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 22.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 22.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 22.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 22.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 23.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 23.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 23.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 23.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 24.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 24.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 24.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 25.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 25.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 25.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 25.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 25.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 26.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 26.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 26.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 26.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 26.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 26.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 27.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 27.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 27.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 28.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 28.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 28.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 28.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 28.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 28.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 29.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 29.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 29.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 29.5 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 29.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 29.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 30.0 ACRYSOF IQ IOL WITH THE ULTRASERT PRE-LOADED DELIVERY SYSTEM 30.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 30.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ACU0T0 6.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ACU0T0 6.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ANTERIOR ASYMMETRIC BOCNVEXL 12.5 MA60AC 12.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 12.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ANTERIOR ASYMMETRIC BOCNVEXL 13MM 6MM +11.5 MA60AC.115", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC.115", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ANTERIOR ASYMMETRIC BOCNVEXL 13MM 6MM +17.0 MA60AC.170", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC.170", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL AO60 +19.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AO60 +19.0D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL AO60 +25.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AO60 +25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL AS UVA PANOPTIX TRIFOCAL LENS 21.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "TFAT00 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2050.0, "discounted_cash": 717.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROHOBIC PRE-LOAD CNA0T0 6.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 6.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC 19.0 PRE-LOADED DELIVERY SYSTEM CNA0T0 19.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC 6.5 CNA0T0 6.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 6.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC 9.0 CNA0T0 9.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 9.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC 10.0 PRE-LOAD SYSTEM 10.0 CNA0T0 10.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 10.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC 22.0 PRE-LOADED DELIVERY SYSTEM CNA0T0 22.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC 22.5 PRE-LOADED DELIVERY SYSTEM CNA0T0 22.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC 24.0 PRE-LOADED DELIVERY SYSTEM CNA0T0 24.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC 24.5 PRE-LOADED DELIVERY SYSTEM CNA0T0 24.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 24.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC 9.0 PRE-LOAD SYSTEM 9.0 CNA0T0 9.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 9.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC CNA0T0 20.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC CNA0T0 29.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 29.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 15.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 15.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 17.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 18.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 18.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 20.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 20.5D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 21.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 21.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 23.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 23.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 23.5D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 25.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 25.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 25.5D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD SYSTEM CCWTT0 20.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCWTT0 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC CNA0T0 7.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 7.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD CNA0T0 12.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 12.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD CNA0T0 27.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 27.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD CNA0T0 27.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 27.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD CNA0T0 28.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 28.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD DELIVERY SYSTEM 26.5 CNA0T0 265", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 265", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD SYSEM CNA0T0 11.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 11.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD SYSEM CNA0T0 12.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 12.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD SYSEM CNA0T0 13.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 13.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD SYSEM CNA0T0 14.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 14.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD SYSEM CNA0T0 14.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 14.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD SYSEM CNA0T0 15.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD SYSEM CNA0T0 16.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 16.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD SYSEM CNA0T0 17.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 17.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOAD SYSEM CNA0T0 26.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 26.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHERIC HYDROPHOBIC PRE-LOADED CNA0T0 13.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 13.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON ASPHRERIC HYDROPHOBIC 11.0D PRE-LOADED DELIVERY SYTEM CNA0T0.110", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0.110", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON BLF TORIC 18.5 CNW0T5 185", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T5 185", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1040.0, "discounted_cash": 364.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON CCA0T0 21.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CCA0T0 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON CCW0T4 18.5 CCW0T4 18.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCW0T4 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON CCW0T4 19.0 CCW0T4 19.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CCW0T4 19.0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON CCW0T4 20.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CCW0T4 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON CCW0T7 21.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCW0T7 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON CNW0T3 22.0 CNW0T3 22.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T3 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIC 23.0 CNWTT0 23.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIC CNWTT0 16.0 CNWTT0 16.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 16.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIC TORIX TRIFOCAL CNWTT3 +12.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT3 +12.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIC TORIX TRIFOCAL CNWTT3 21.0 CNWTT3 21.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT3 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIC TORIX TRIFOCAL CNWTT3 23.5 CNWTT3 23.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT3 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIC TRIFOCAL PXYAT0 25.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "PXYAT0 25.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2130.0, "discounted_cash": 745.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX 17.5 CNWTT0 17.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX 19.0 CNWTT0 19.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX 19.5 CNWTT0 19.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX 21.0 CNWTT0 21.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX 25.5D CNWTT0 255", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 255", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX CNWTT0 15.5 CNWTT0 15.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 15.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX CNWTT0 16.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 16.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX CNWTT0 20.0 CNWTT0 20.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX CNWTT0 25.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX PRE-LOAD DELIVERY SYSTEM 15.0 CCWTT0 15.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCWTT0 15.0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX PRE-LOAD DELIVERY SYSTEM 18.0 CCWTT0.180", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCWTT0.180", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX PRE-LOAD DELIVERY SYSTEM 18.5 CCWTT0 185", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCWTT0 185", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX PRE-LOAD DELIVERY SYSTEM 21.5 CCWTT0 21.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCWTT0 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX PRE-LOAD DELIVERY SYSTEM 26.5 CCWTT0.265", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CCWTT0.265", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX TORIC CNWTT4 12.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT4 12.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX TORIC CNWTT4 12.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT4 12.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX TORIC CNWTT4 23.0 CNWTT4 23.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT4 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON PANOPTIX UV 14.0 CCWTT0.140", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCWTT0.140", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON TORIC 15.0 CNW0T6 15.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T6 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON TORIC 19.5 CNW0T6 19.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T6 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON TORIC CCA0T3 19.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCA0T3 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON TORIC CCW0T6 16.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCW0T6 16.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON TORIC CNW0T5 17.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T5 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1010.0, "discounted_cash": 353.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON TORIC CNW0T6 21.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T6 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON TORIC CNW0T6 23.0 CNW0T6 23.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T6 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON TORIC CNW0T7 19.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T7 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON TORIC CNW0T8 15.0 CNW0T8 15.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T8 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON TORIC CNW0T8 23.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T8 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON VIVITY 23.0 CNWET0 23.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWET0 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON VIVITY CNWET0 190", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWET0 190", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON VIVITY CNWET0.235", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWET0.235", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYS CCA0T0 18.5", "code_information": [{"code": "CCA0T0 18.5", "type": "CDM"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 16.5 CCA0T0.165", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCA0T0.165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 19.0 CCA0T0.190", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCA0T0.190", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 19.5 CCA0T0.195", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCA0T0.195", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 20.0 CCA0T0.200", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCA0T0.200", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 20.5 CCA0T0.205", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCA0T0.205", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 21.0 CCA0T0.210", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCA0T0.210", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 22.5 CCA0T0.225", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CCA0T0.225", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 23.0 CCA0T0.230", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCA0T0.230", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 23.5 CCA0T0.235", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCA0T0.235", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 24.0 CCA0T0.240", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCA0T0.240", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 25.5 CCA0T0.255", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CCA0T0.255", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYSTEM 26.5 CCA0T0.265", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CCA0T0.265", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CLAREON W/AUTONOME DELIVERY SYTM 17.5 CCA0T0.175", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CCA0T0.175", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CNA0T0 16.0 CLAREON ASPHERIC HYDROPHOBIC ACRYLIC PRE-LOAD DELIVERY SYSTEM CNA0T0 16.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 16.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CNA0T0 19.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CNA0T0 30.0 CLAREON ASPHERIC CNA0T0 30.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 30.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CNA0T0 8.5 PRE-LOAD CNA0T0 8.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 8.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CNW0T4 22.5 CNW0T4 22.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T4 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CNW0T5 2.0 CLAREON BLF TORIC 00380652402408", "code_information": [{"code": "3.80652E+11", "type": "CDM"}], "standard_charges": [{"gross_charge": 1010.0, "discounted_cash": 353.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CNW0T5 20.0 CLAREON BLF TORIC CNW0T 5 20.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T 5 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1010.0, "discounted_cash": 353.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CNW0T5 25.0 CLAREON BLF TORIC CNW0T5 25.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T5 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CT LUCIA 22.0 CT LUCIA 22.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CT LUCIA 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CT LUCIA 22.5 CT LUCIA 22.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CT LUCIA 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CT LUCIA 602 17.0 003500-0050-666", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3500-0050-666", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL CT LUCIA 602 18.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CT LUCIS 602 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL EAU 20.0 ENVISTA ASPIRE EAU 20.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "EAU 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL EAU 20.5 ENVISTA ASPIRE EAU 20.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "EAU 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA 21.0 EEU2150", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "EEU2150", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ASPIRE 20.50 EAU2050", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "EAU2050", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ASPIRE EAU 13.5 EAU1350", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "EAU1350", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ASPIRE EAU 15.0 EAU 15.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "EAU 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ASPIRE EAU 15.5 EAU 15.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "EAU 15.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ASPIRE EAU 19.5 EAU 19.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "EAU 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ASPIRE EAU2150", "code_information": [{"code": "EAU2150", "type": "CDM"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ASPIRE EAU2300", "code_information": [{"code": "EAU2300", "type": "CDM"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ASPIRE TORIC ETAU250+115", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ETAU250+115", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 367.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA EAU2200", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "EAU2200", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA EEU2000 20.0 EEU2000 20.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "EEU2000 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ENVY EN PLKUS21.00 ENU2100", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ENU2100", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1998.0, "discounted_cash": 699.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ENVY TORIC 19.0 ETNU300+190", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ETNU300+190", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ENVY TORIC 20.5 ETNU250+205", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ETNU250+205", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA ETAU125+135", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ETAU125+135", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 367.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA HYDROPHOBIC ACRYLIC INTRACULAR LENS", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E +22.00D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA HYDROPHOBIC ACRYLIC INTRACULAR LENS +20.50D MX60E +20.50D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E +20.50D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA HYDROPHOBIC ACRYLIC INTRAOCULAR LENS 24.00D MX60E +24.00D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E +24.00D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ENVISTA HYDROPHOBIC ACRYLIC IOL ENU1950+19.50D", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ENU1950+19.50D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ETNU300+205", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "ETNU300+205", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL EYEHANCE TOR DIU225 19.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "DIU225 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1205.0, "discounted_cash": 421.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL EYEHANCE TOR DIU225 19.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "DIU225 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1170.0, "discounted_cash": 409.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL EYEHANCE TORIC DIU225 16.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "DIU225 16.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1170.0, "discounted_cash": 409.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL HYDROPHOBIC ACRYLIC FOLDABLE UV CNWTT0 18.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNWTT0 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL HYDROPHOBIC ACRYLIC FOLDABLE UV CNWTT0 18.5 CNWTT0 18.5", "code_information": [{"code": "CNWTT0 18.5", "type": "CDM"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL IMP", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZC00BD", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 107.0, "discounted_cash": 37.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL LI61AO +22.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "LI61AO +22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MA60AC 10.5 MA60AC 10.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 10.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MA60AC 16.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 16.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MA60AC 17.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 17.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MA60AC 17.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MA60AC 28.5 MA60AC 28.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 28.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MA60AC.260, ACRYSOF SOFT ACRYLIC MULTIPIECE STERILE PCL (IOL/PC), 13.0MM L, 6.0MM ANTERIORA", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 26.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MONOFACAL HYDROPHOBIC ACRYLIC INTRAOCULAR CT LUCIA 18.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CT LUCIA 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MONOFOCAL HYDROPHOBIC ACRYLIC +21.0D CT LUCIA 602.US/+21.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CT LUCIA 602.US/+21.0D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MONOFOCALINTRAOCULAR LENS CT LUCIA 602.US/+23.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CT LUCIA 602.US/+23.0D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MTA4UO 15.0", "code_information": [{"code": "V2630", "type": "HCPCS"}, {"code": "MTA4UO 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MTA4UO 5.0", "code_information": [{"code": "V2631", "type": "HCPCS"}, {"code": "MTA4UO 5.0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MTA5UO 14.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MTA5UO 14.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MULTIFLEX 13.0MM L 5.5MM OPTIC 10.0 POWER MTA4U0.100", "code_information": [{"code": "MTA4U0.100", "type": "CDM"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E +24.50D ENVISTA HYDROPHOBIC ACRYLIC INTRACULAR", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E +24.50D", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 14 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 14", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 14.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 14.5 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 14.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 14.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 16.5 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 16.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 16.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 17 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 17", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 17.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 17.5 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 17.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 18 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 18", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 18.5 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 18.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 19 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 19", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 19.5 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 19.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 20 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 20", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 20.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 21 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 21", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 21.5 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 21.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 22.5 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 22.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 23 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 23", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 23.5 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 23.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 25 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 25", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 25.5 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 25.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 25.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 26 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 26", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 26.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 26.5 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 26.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 26.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 27 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 27", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 27.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 28 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 28", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 28.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 29 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 29", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 29.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL MX60E 29.5 GLISTENING-FREE HYDROPHOBIC ACRYLIC 6.0MM 29.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MX60E 29.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ODYSSEY TECNIS SIMPLICITY DRN00V 14.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "DRN00V 14.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ODYSSEY TECNIS SIMPLICITY DRN00V 22.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "DRN00V 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL ODYSSEY TECNIS SIMPLICITY DRV00V 15.0 DRN00V 15.0", "code_information": [{"code": "DRN00V 15.0", "type": "CDM"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL PCB00 13.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 13.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL PRELOAD PCB00 27.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 27.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL PRELOAD PCB00 5.5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 5.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL RAYONE ASPHERIC 16.00 RAO600C 16.00", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "RAO600C 16.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL RAYONE ASPHERIC 17.00 RAO600C 17.00", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "RAO600C 17.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL RAYONE ASPHERIC 19.50 RAO600C 19.50", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "RAO600C 19.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL RAYONE ASPHERIC 20.00 RAO600C 20.00", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "RAO600C 20.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL RAYONE ASPHERIC 21.50 RAO600C 21.50", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "RAO600C 21.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL RAYONE ASPHERIC 23.00 RAO600C 23.00", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "RAO600C 23.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL RAYONE ASPHERIC 24.00 RAO600C 24.00", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "RAO600C 24.00", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 10.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 10.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 11.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 11.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 12.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 12.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 17.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 20.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 22.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 23 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 23", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 23.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 24.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 24.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 26.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 26.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 27.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 27.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 28.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 28.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 29.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 29.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 99.05, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 7.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 7.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 8.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 8.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN60WF 9.5 ALCON LENS IOL SN60WF MONOFOCAL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 9.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SN6AT3 31.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 31.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 5.5MM X 13MM SNGL ANT CHMBR CONVEXOPLANO 0.5 MM HAPTIC ANGULATION 11 10.0", "code_information": [{"code": "V2630", "type": "HCPCS"}, {"code": "MTA4U0 10.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 5.5MM X 13MM SNGL ANT CHMBR CONVEXOPLANO 0.5 MM HAPTIC ANGULATION 11 18.5", "code_information": [{"code": "V2630", "type": "HCPCS"}, {"code": "MTA4U0185", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 5.5MM X 13MM SNGL ANT CHMBR CONVEXOPLANO OPTIC 0.5 MM HAPTIC ANGULAT 22.5", "code_information": [{"code": "V2630", "type": "HCPCS"}, {"code": "MTA4U0225", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +10.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 10.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +11.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 11.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +12.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 12.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +13.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 13.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +13.5 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 13.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +14.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 14.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +16.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 16.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +17.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 17.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +18.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +19.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +20.5 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +21.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +22.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +22.5 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +23.5 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 23.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +24.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +24.5 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 24.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +25.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +26.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 26.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +26.5 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 26.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13.0MM NAT TORIC +1.50 CYLNDR DIOPT +27.0 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 27.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6.0MM X 13MM NAT TORIC +1.50 CYLNDR DIOPT +21.5 ACRYSOF", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT3 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM +9.5 DIOPT BICONVEX POST CHMBR ANT ASHPERIC SURFACE FOL", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB000 9.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ANT ASYMMETRIC BICONVEX ANGULATION 0D CO 23.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60AT 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ANT ASYMMETRIC BICONVEX HAPTIC ANGULATION 0 DEGREE A CO 24.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN60AT 24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ANT ASYMMETRIC BICONVEX HAPTIC ANGULATION 0 DEGREE A CO 31.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60AT 31.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ANT ASYMMETRIC BICONVEX HAPTIC ANGULATION 0 DEGREE A CO 32.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60AT 32.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ANT ASYMMETRIC BICONVEX HAPTIC ANGULATION 0 DEGREE A CO 33.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60AT 33.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ANT ASYMMETRIC BICONVEX HAPTIC ANGULATION 0 DEGREE A CO 34.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60AT 34.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ANT ASYMMETRIC BICONVEX HAPTIC ANGULATION 0 DEGREE A CO 35.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60AT 35.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ASPHERIC HAPTIC ANGULATION 0 DEGREE A CONSTANT 118.7 DI 15.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ASPHERIC HAPTIC ANGULATION 0 DEGREE A CONSTANT 118.7 DI 17.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 17.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ASPHERIC HAPTIC ANGULATION 0 DEGREE A CONSTANT 118.7 DI 23.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ASPHERIC HAPTIC ANGULATION 0 DEGREE A CONSTANT 118.7 DI 25.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 574.0, "discounted_cash": 200.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ASPHERIC HAPTIC ANGULATION 0 DEGREE A CONSTANT 118.7 DI 28.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 28.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ASPHERIC HAPTIC ANGULATION 0 DEGREE A CONSTANT 118.7 DI 30.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 30.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ASPHERIC HAPTIC ANGULATION 0 DEGREE A CONSTANT 118.7 DI24.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 24.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ASPHERIC NAT HAPTIC ANGULATION 0 DEGREE A CONSTANT 118. 10.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 10.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM ASPHERIC NAT HAPTIC ANGULATION 0 DEGREE A CONSTANT 118. 14.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "SN60WF 14.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM LEN 13MM DIOPTIC -01.0 MENISCUS MULTIPIECE HAPTIC ANGULATION 5 D", "code_information": [{"code": "MN60MAN010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL SZ 6MM X 3MM DIOPT 21.5 MULTIFOCAL SNGL PIECE PROPRIETARY SYMMETRIC BIO", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "SN6AD1 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1917.0, "discounted_cash": 670.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS +21.5 DIOPTER BICONVEX POST CHAMBER ANT ASHPERIC 1 PIECE", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "ZCB00 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS MULTIFOCAL 21.0 DIOPTER", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "ZLB00U0210", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1803.0, "discounted_cash": 631.05, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY EYHANCE U 21.0D DIB00U0210", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0210", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY EYHANCE U 22.0D DIB00U0220", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0220", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY EYHANCE U 23.5D DIB00U0235", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0235", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY EYHANCE U 25.0D DIB00U0250", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0250", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 05.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0050", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 06.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0060", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 10.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0105", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 12.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0120", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 13.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0130", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 13.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0135", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 14.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0140", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 15.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0150", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 15.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0155", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 16.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0160", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 16.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0165", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 17.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0170", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 17.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0175", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 18.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0180", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 18.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0185", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 19.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0190", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 19.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0195", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 20.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0200", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 20.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0205", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 21.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0215", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 22.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0225", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 23.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0230", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 24.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0240", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 24.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0245", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 25.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0255", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 26.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0260", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 26.5D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0265", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 27.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0270", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 29.0D", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0290", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SIMPLICITY TECNIS EYHANCE U 30.0D DIB00U0300", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DIB00U0300", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SMPLCTY DELTA 1PC CLR MONO 12.5 DCB0000125", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000125", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TECNIS SZ 27.0 ITEC PRELOADED MONOFOCAL 1 PIECE POSTERIOR", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "PCB00 27.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORC LL SMPCY ODYSSEY DRT150 18.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "DRT150 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORC LL SMPCY ODYSSEY DRT150 22.50", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "DRT150 22.50", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC 6MM OPTIC SZ 13.5MM 3.00 D CYLINDER SN6AT5.135", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5.135", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON 15.5 CNA0T3.155", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T3.155", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON 18.0 CNW0T3 18.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T3 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON 18.5 CNW0T3 18.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T3 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON 20.5 CNW0T3 20.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T3 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON 21.0 CNA0T3 21.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T3 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON 21.0 CNW0T3 21.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T3 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON 22.0 CNW0T4 22.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T4 22.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON BLF 21.0 CNW0T4 21.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T4 21.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON BLF 21.5 CNW0T4 21.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T4 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON BLF CNW0T9 23.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T9 23.0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T3 19.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNA0T3 19.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T3 19.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T3 19.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T3 22.5 CNA0T3 22.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T3 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T4 20.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T4 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T4 22.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T4 22.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T4 23.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T4 23.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 990.0, "discounted_cash": 346.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T4 27.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T4 27.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T4 9.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNA0T4 9.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T4.085", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T4.085", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T5 20.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T5 20.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T5 21.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T5 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNA0T6 18.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNA0T6 18.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNW0T3 15.5 CNW0T3 15.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T3 15.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNW0T3 21.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T3 21.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON CNW0T3 25.0 CNW0T3 25.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T3 25.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON UV FILTER CCA0T4 15.0", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CCA0T4 15.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL TORIC CLAREON VIVITY 19.0 CNWET6 190", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNWET6 190", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS IOL WITH THE AUTONOMEAUTOMATED PRE-LOADED DELIVERY SYSTEM 28.0 CNA0T0 28.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "CNA0T0 28.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS ION 6MM OPTIC 13MM LEN SNGL PIECE NAT TORIC +5.25 CYLNDR +29.0 DIOPT ACRYSO", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT9 29.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS KONTUR 14MM 8.6 BC AMBIO", "code_information": [{"code": "V2790", "type": "HCPCS"}, {"code": "AK-1408", "type": "CDM"}, {"code": "810", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 414.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS MA60AC 18.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "MA60AC 18.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS OPHTHALMOLOGY 30DEG STANDARD CONTACT HIGH MAGNIFICATION VITREORETINAL DIRECT IMAGE", "code_information": [{"code": "VMD10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS SURGICAL VOLK HR MAGNIFY", "code_information": [{"code": "VMD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS TEC EYHANCE TOR II SMPLCTY 22.0D CYL2.25 DIU225U220", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "DIU225U220", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1170.0, "discounted_cash": 409.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS TEC EYHANCE TOR II SMPLCTY 22.5D CYL2.25 DIU225U225", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "DIU225U225", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1170.0, "discounted_cash": 409.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS TEC EYHANCE TOR II SMPLCTY 24.5D CYL1.50 DIU150U245", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "DIU150U245", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1190.0, "discounted_cash": 416.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS TORIC IOL CLAREON BLF 15.5 CNW0T4 155", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T4 155", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS TORIC IOL CLAREON BLF 17.5 CNWOT4 175 CNW0T4 17.5", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "CNW0T4 17.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS TORIC IOL CLAREON BLF 19.5 CNW0T4 195", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "CNW0T4 195", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS TORIC IQ SN6AT5 32.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT5 32.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS TORIQ IQ SN6AT4 19.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "SN6AT4 19.0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS VITRECTOMY FLAT", "code_information": [{"code": "1284.DD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "LEPTOSPIRA ANTIBODY", "code_information": [{"code": "86720", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKACYTE TRANSFUSION", "code_information": [{"code": "86950", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE ASSESSMENT FECAL", "code_information": [{"code": "89055", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE HISTAMINE RELEASE", "code_information": [{"code": "86343", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE PHAGOCYTOSIS", "code_information": [{"code": "86344", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 41.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 41.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEV 1 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0380", "type": "HCPCS"}], "standard_charges": [{"minimum": 274.96, "maximum": 432.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 274.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEV 2 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0381", "type": "HCPCS"}], "standard_charges": [{"minimum": 443.43, "maximum": 696.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 443.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 696.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 696.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 696.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEV 3 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0382", "type": "HCPCS"}], "standard_charges": [{"minimum": 732.68, "maximum": 1151.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 732.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1151.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1151.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1151.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEV 4 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0383", "type": "HCPCS"}], "standard_charges": [{"minimum": 1109.34, "maximum": 1743.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1109.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1743.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1743.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1743.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEV 5 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0384", "type": "HCPCS"}], "standard_charges": [{"minimum": 1641.75, "maximum": 2579.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1641.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2579.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2579.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2579.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEEN/SHUNT PATENCY EXAM", "code_information": [{"code": "78291", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 973.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1530.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1530.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1530.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 474.27, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 504.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LG PN NOT MEAS W/ VAS 1YR PO", "code_information": [{"code": "M1052", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LGN CK/HK HEMI SZ 3-4 LL/RM 10MM 71423421", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7562.5, "discounted_cash": 2646.88, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN HM ST 5-6 5MM LTLA RTMED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421147", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4481.0, "discounted_cash": 1568.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN OX CONSTRAINED FEM 8 RT 71421178", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21136.0, "discounted_cash": 7397.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN POS FEM WDG 5MM SZ7-8 LNG 71421807", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3665.0, "discounted_cash": 1282.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LGN REV TIBIA BASE SZ 8 RT 71424018", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8448.0, "discounted_cash": 2956.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LGX MS 12 CM PS IZ", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "72404250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18105.0, "discounted_cash": 6336.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 0.5% 50ML VIAL", "code_information": [{"code": "MED0109", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% (MPF) 2ML", "code_information": [{"code": "MED0553", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% 20ML VIAL", "code_information": [{"code": "MED0113", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% 30ML VIAL", "code_information": [{"code": "MED0114", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% 50ML VIAL", "code_information": [{"code": "MED0115", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% INJ 2ML", "code_information": [{"code": "MED0110", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% INJ SOLN 10 ML", "code_information": [{"code": "MED0112", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% PF 30ML", "code_information": [{"code": "MED0376", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% PF 5ML VIAL", "code_information": [{"code": "MED0111", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 10ML VIAL", "code_information": [{"code": "MED0118", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 20ML VIAL", "code_information": [{"code": "MED0119", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 50ML VIAL", "code_information": [{"code": "MED0120", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% PF 5 ML VIAL", "code_information": [{"code": "MED0117", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% TOP JELLY 5 ML", "code_information": [{"code": "MED0122", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2%/XYLOCAINE 2ML", "code_information": [{"code": "MED0116", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 4% PF INJ 5 ML", "code_information": [{"code": "MED0121", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE TOP 4% SOL 50 ML", "code_information": [{"code": "MED0655", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 0.5%-1:200,000 50ML VIAL", "code_information": [{"code": "MED0123", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 1% 10ML VIAL", "code_information": [{"code": "MED0124", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 1% 20ML VIAL", "code_information": [{"code": "MED0125", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 1% 30ML VIAL", "code_information": [{"code": "MED0126", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 1.5% PF INJ 30ML", "code_information": [{"code": "MED0127", "type": "CDM"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 2% 20ML VIAL", "code_information": [{"code": "MED0130", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 2% 30ML VIAL", "code_information": [{"code": "MED0131", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 2% 50ML VIAL", "code_information": [{"code": "MED0220", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 2% DENTAL CARTRIDGE 1.7ML INJ", "code_information": [{"code": "MED0128", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 2% PF 10ML", "code_information": [{"code": "MED0129", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LIFT BUTTOCK 15835", "code_information": [{"code": "15835", "type": "CPT"}, {"code": "1481260", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR 27427", "code_information": [{"code": "27427", "type": "CPT"}, {"code": "1481261", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR 27428", "code_information": [{"code": "27428", "type": "CPT"}, {"code": "1481262", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR OPEN 27429", "code_information": [{"code": "27429", "type": "CPT"}, {"code": "1481263", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGASURE BLUNT TIP LAPAROSCOPIC 14.5 X 5MM", "code_information": [{"code": "LF1637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1293.0, "discounted_cash": 452.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE BLUNT TIP LAPAROSCOPIC 20 X 5MM", "code_information": [{"code": "LF1644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1384.0, "discounted_cash": 484.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE LAPROSCOPIC 23CM MARYLAND JAW OPEN DEVICE", "code_information": [{"code": "LF1723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE MARYLAND JAW 5MM-37 CM", "code_information": [{"code": "LF1737", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1323.0, "discounted_cash": 463.05, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE RETRACT L-HOOK 37CMLIGASURE LF5637", "code_information": [{"code": "LF5637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1323.86, "discounted_cash": 463.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGATE ESOPHAGUS VEINS", "code_information": [{"code": "43400", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS OPEN", "code_information": [{"code": "37761", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS RADICAL", "code_information": [{"code": "37760", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE OVIDUCT(S) ADD-ON", "code_information": [{"code": "58611", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/DIVIDE/EXCISE VEIN", "code_information": [{"code": "37785", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/STAPLE ESOPHAGUS", "code_information": [{"code": "43405", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP LONG LEG VEIN", "code_information": [{"code": "37722", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP SHORT LEG VEIN", "code_information": [{"code": "37718", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION NASAL SINUS ARTERY", "code_information": [{"code": "30915", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF A-V FISTULA", "code_information": [{"code": "37607", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF ABDOMEN ARTERY", "code_information": [{"code": "37617", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF CHEST ARTERY", "code_information": [{"code": "37616", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF EXTREMITY ARTERY", "code_information": [{"code": "37618", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF INF VENA CAVA", "code_information": [{"code": "37619", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37600", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37605", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37606", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37615", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK VEIN", "code_information": [{"code": "37565", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SALIVARY DUCT", "code_information": [{"code": "42665", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SHUNT", "code_information": [{"code": "49428", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OR BIOPSY TEMPORAL ARTERY 37609", "code_information": [{"code": "37609", "type": "CPT"}, {"code": "2034643", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION TUBAL 58600", "code_information": [{"code": "58600", "type": "CPT"}, {"code": "1481265", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION UPPER JAW ARTERY", "code_information": [{"code": "30920", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATOR BAND 2.8MM X 8.6MM TO 11.5MM MULTIPLE SPEEDBAND SUPERVIEW SUPER 7", "code_information": [{"code": "M00542250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 564.9, "discounted_cash": 197.72, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGATOR CRH OREGAN SYSTEM WITH LG CRH ANOSCOPE 11-4120", "code_information": [{"code": "Nov-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.47, "discounted_cash": 82.06, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGATOR SPEED BAND BX 2 M00542251", "code_information": [{"code": "M00542251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 582.0, "discounted_cash": 203.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT CABLE PHANTOM ML 10' STERILE ML-0046S", "code_information": [{"code": "ML-0046S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 569.0, "discounted_cash": 199.15, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT MAT DISP", "code_information": [{"code": "LB-133", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1624.0, "discounted_cash": 568.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT SHIELD CORNEAL 8MM", "code_information": [{"code": "581062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT SOURCE 60MM DISP STRL", "code_information": [{"code": "48851313A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3384.0, "discounted_cash": 1184.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LIMB EXERCISE TEST", "code_information": [{"code": "95875", "type": "CPT"}], "standard_charges": [{"minimum": 327.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 327.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMB NERVE SURGERY ADD-ON", "code_information": [{"code": "64783", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "956", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23419.55, "maximum": 40205.55, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23419.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 33495.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36844.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40205.55, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMITED AUTOPSY", "code_information": [{"code": "88036", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1185.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1864.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1864.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1864.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 149.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 149.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED AUTOPSY", "code_information": [{"code": "88037", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 963.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1514.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1514.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1514.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 132.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 132.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED VISUAL FIELD XM", "code_information": [{"code": "92081", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER 38/50 OR3O DUAL MOBILITY 71358202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71358202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8714.0, "discounted_cash": 3049.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER 44MM ID 56MM OD OXINIUM DH DUAL MCBILITY 71358205", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71358205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9306.0, "discounted_cash": 3257.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACETABULAR 36MM NEUTRAL HXE-PLUS NON HOODED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "931-36-752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2974.0, "discounted_cash": 1040.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACETABULAR G7 36MM SZE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "10000857", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3468.0, "discounted_cash": 1213.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACETABULAR G7 40MM SZ G", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "10000865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7334.0, "discounted_cash": 2566.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 28MM X 46MM 20DEG XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71334946", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3010.0, "discounted_cash": 1053.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 28MM X 48MM 20DEG R3 XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71334948", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2894.0, "discounted_cash": 1012.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 28MM X 52MM 0DEG XLPE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71337552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 867.0, "discounted_cash": 303.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 32MM X 48MM 20DEG XLPE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71337648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1644.0, "discounted_cash": 575.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 32MM X 50MM 20DEG XLPE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71337650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3387.0, "discounted_cash": 1185.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 36MM X 52MM 20DEG XLPE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3010.0, "discounted_cash": 1053.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 36MM X 54MM 20DEG XLPE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3160.0, "discounted_cash": 1106.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 36MM X 56MM 0DEG R3 XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71332756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3387.0, "discounted_cash": 1185.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 36MM X 56MM 20DEG XLPE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2894.0, "discounted_cash": 1012.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 36MM X 58MM 20DEG XLPE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335758", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3010.0, "discounted_cash": 1053.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 36MM X 62MM 0DEG R3 XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71332762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2894.0, "discounted_cash": 1012.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 36MM X 62MM 20DEG R3 XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3387.0, "discounted_cash": 1185.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 36MM X 64MM 20DEG R3 XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2894.0, "discounted_cash": 1012.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 38MM SZ D MODULAR DUAL MOBILITY COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "626-00-38D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER ACTBLR 42MM SZ E MODULAR DUAL MOBILITY COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "626-00-42E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3250.0, "discounted_cash": 1137.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER CEMENTLESS 48MM MODULAR DUAL MOBILITYINSERT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "626-00-48G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER DUAL MOBILITY METAL EMPOWR 951-01-46H", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "951-01-46H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER GLOVE SURGICAL KEVLAR LG", "code_information": [{"code": "5200-08-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER GLOVE SURGICAL KEVLAR XLG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5200-10-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER HIP ACETABULAR 36 X 60MM R3 XLPE 20DEG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3010.0, "discounted_cash": 1053.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER HUMERAL INSERT 39+3MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9503M-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2987.0, "discounted_cash": 1045.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER NEUTRAL G7 40MM H", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "10000866", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5719.0, "discounted_cash": 2001.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER OR30 DUAL MOBILITY 44/58 71358206", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71358206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7262.0, "discounted_cash": 2541.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER OR3O DUAL MOBILITY XLPE INSERT 28/38 71358215", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71358215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5865.0, "discounted_cash": 2052.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER POLY ALTRX +4 10DEG 32MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1221-32-148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3221.0, "discounted_cash": 1127.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER SURG 0DEG 36MMINSERT TRIDENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "623-00-36D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER SURG 36MM X 54MM XLPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71332754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3387.0, "discounted_cash": 1185.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER TRAY STERILIZATION ABSORBENT TOWEL NONSTERILE DISPOSABLE 20 X 25IN", "code_information": [{"code": "10502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER TRIDENT X3 0O 32 MM ID 5.9 MM 723-00-32D", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "723-00-32D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER TRIDENT X3 0O 36 MM ID 3.9 MM 723-00-36D", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "723-00-36D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER TRIDENT X3 0O 36 MM ID 5.9 MM 723-00-36E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "723-00-36E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER TRIDENT X3 0O 36 MM ID 7.9 MM 723-00-36F", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "723-00-36F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER TRIDENT X3 0O 36 MM ID 9.4 MM 723-00-36G", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "723-00-36G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LINGUAL FRENECTOMY", "code_information": [{"code": "D7962", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOPRO BLD ELECTROPHORETIC", "code_information": [{"code": "83700", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 45.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 45.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 45.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOPROTEIN BLD HR FRACTION", "code_information": [{"code": "83701", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 42.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 135.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 135.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 135.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOPROTEIN BLD QUAN PART", "code_information": [{"code": "83704", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 48.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 49.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 49.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOPRTN DIR MEAS SD LDL CHL", "code_information": [{"code": "83722", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 49.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 49.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOSUCTION ABDOMEN 15877", "code_information": [{"code": "15877", "type": "CPT"}, {"code": "1481267", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOSUCTION ARM 15878", "code_information": [{"code": "15878", "type": "CPT"}, {"code": "1481268", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOSUCTION HEAD & NECK 15876", "code_information": [{"code": "15876", "type": "CPT"}, {"code": "1481269", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOSUCTION LOWER EXTREMITY 15879", "code_information": [{"code": "15879", "type": "CPT"}, {"code": "1481270", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIQUID ADHSV 2 ML X 3 ML SURG BANDAGE ADHSV TIP VIAL MASTISTOL LF STRL", "code_information": [{"code": "523-48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "LIQUID MASTISOL 052348", "code_information": [{"code": "52348", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "LISTERIA MONOCYTOGENES", "code_information": [{"code": "86723", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHOTRIPSY 50590", "code_information": [{"code": "50590", "type": "CPT"}, {"code": "1481271", "type": "CDM"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18082.0, "gross_charge": 19506.0, "discounted_cash": 6827.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 18082.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 16287.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 14288.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5913.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9303.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9303.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9303.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 5624.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 5624.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11235.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 9440.9, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11235.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITT ICR 1 TRAJ 1 SMPL LES", "code_information": [{"code": "61736", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITT ICR MLT TRJ MLT/CPLX LS", "code_information": [{"code": "61737", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER", "code_information": [{"code": "80076", "type": "CPT"}, {"code": "1233827", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 51.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER & SPLEEN IMAGE/FLOW", "code_information": [{"code": "78216", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 456.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 262.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 279.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER AND SPLEEN IMAGING", "code_information": [{"code": "78215", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 774.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1218.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1218.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1218.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 378.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 403.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DIS 10 ASSAYS W/ASH", "code_information": [{"code": "2M", "type": "CPT"}], "standard_charges": [{"minimum": 1283.67, "maximum": 2018.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1283.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DIS 10 ASSAYS W/NASH", "code_information": [{"code": "3M", "type": "CPT"}], "standard_charges": [{"minimum": 1283.67, "maximum": 2018.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1283.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DS 10 BIOCHEM ASY SRM", "code_information": [{"code": "166U", "type": "CPT"}], "standard_charges": [{"minimum": 724.9, "maximum": 2018.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1283.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 724.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 724.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DS ALYS 3 BMRK SRM ALG", "code_information": [{"code": "81517", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1283.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 253.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 253.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER ELASTOGRAPHY", "code_information": [{"code": "91200", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING", "code_information": [{"code": "78201", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 373.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 398.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING WITH FLOW", "code_information": [{"code": "78202", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 811.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1275.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1275.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1275.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 411.57, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 438.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LLIF 23MMX50MM 0DEG 16MM 60-235000-16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "60-235000-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5948.0, "discounted_cash": 2081.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LMA AIRWAY UNIQUE SILICONE CUFF PILOT BALLOON SZ 2.5 105300-000025", "code_information": [{"code": "105300-000025", "type": "CDM"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LMTD OPH EXAM GENERAL ANES", "code_information": [{"code": "92019", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LNGVTY&MRTLTY RSK MRNA 18GEN", "code_information": [{"code": "294U", "type": "CPT"}], "standard_charges": [{"minimum": 382.5, "maximum": 1094.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC", "code_information": [{"code": "496", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12083.27, "maximum": 20743.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12083.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17281.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19009.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20743.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC", "code_information": [{"code": "495", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22153.68, "maximum": 38032.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22153.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31684.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34852.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38032.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "497", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8829.47, "maximum": 15158.01, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8829.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12628.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13890.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15158.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC", "code_information": [{"code": "498", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15716.65, "maximum": 26981.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15716.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22478.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24726.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26981.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "499", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7293.52, "maximum": 12521.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7293.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10431.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11474.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12521.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCKING SCREW 3.5X12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P73ST112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 979.0, "discounted_cash": 342.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LOCKING THIRD TUBULAR PLATE,TI,7H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9943T-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 183.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LONG ACT INHAL BRONCHDIL PRE", "code_information": [{"code": "G9695", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LONG CHAIN FATTY ACIDS", "code_information": [{"code": "82726", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LONG INHAL BRONCHDIL NO PRES", "code_information": [{"code": "G9699", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOOP CUTTING 27FR X .35MM ANGLED STRL DISP", "code_information": [{"code": "27050F/6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP ELECTRODE HF-RESECTION 24FR LARGE", "code_information": [{"code": "WA22603D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1322.0, "discounted_cash": 462.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP FIBERTAPE 24IN 8IN SURG WOUND CLOSURE", "code_information": [{"code": "AR-7275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 42.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP LLETZ ELECTRODE 10MM X 10MM ES09", "code_information": [{"code": "ES09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP LLETZ ELECTRODE 15MM X 12MM ES53", "code_information": [{"code": "ES53", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP LLETZ ELECTRODE 15MM X 8MM ES10", "code_information": [{"code": "ES10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP LLETZ ELECTRODE 20MM 12MM ES42", "code_information": [{"code": "ES42", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP SPARE BRUCKER MESSROGHLI SUPRALOOP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "26183MC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP SPARE XL SUPRALOOP", "code_information": [{"code": "26183MD/6-GYN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 752.0, "discounted_cash": 263.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP TIGERTAPE 24IN 8IN SURG WOUND CLOSURE", "code_information": [{"code": "AR-7275T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 230.0, "discounted_cash": 80.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP VESSEL MINI RED STERION STRL", "code_information": [{"code": "11001PBX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP VESSEL RED MINI LOOP DYNJVL12ZZ", "code_information": [{"code": "DYNJVL12ZZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.38, "discounted_cash": 1.88, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP WIRE NUMBER 2 COLLAGEN COATED FIBERLOOP", "code_information": [{"code": "AR-7234B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOPS BLUE MAXI STERILS 1 X 406MM", "code_information": [{"code": "11012PBX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC CAGE ROI-C CERVICAL 12X15.5 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MC1458P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC IMPLANT CERVICAL 13X16X6 MM 7DEG 403-23606L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "403-23606L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC IMPLANT CERVICAL 13X16X7 MM 7DEG 403-23607L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "403-23607L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC IMPLANT CERVICAL 13X16X8 MM 7DEG 403-23608L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "403-23608L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC IMPLANT LATERAL PEEK 18X45X10 MM 8DEG 3203-21045SL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3203-21045SL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC IMPLANT LATERAL PEEK 18X50X10 MM 8DEG 3203-21050SL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3203-21050SL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC IMPLANT LATERAL PEEK 18X50X12 MM 8DEG 3203-21250SL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3203-21250SL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC IMPLANT LATERAL PEEK 18X55X10 MM 8DEG 3203-21055SL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3203-21055SL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 2310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC IMPLANT LATERAL PEEK 22X55X12 MM 8DEG 3203-21255ML", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3203-21255ML", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LOUDNESS BALANCE TEST", "code_information": [{"code": "92562", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5271", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5272", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5273", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5274", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5275", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5276", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5277", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5278", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW EXTEMITY NEUR EXAM DOCUM", "code_information": [{"code": "G8404", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW EXTEMITY NEUR NOT PERFOR", "code_information": [{"code": "G8405", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW FREQUENCY NON-THERMAL US", "code_information": [{"code": "97610", "type": "CPT"}], "standard_charges": [{"minimum": 770.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW NTSTY ESWT CORPUS CVRNSM", "code_information": [{"code": "864T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW PECARN PED HEAD TRAUMA", "code_information": [{"code": "G9593", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW RECUR PROST CA", "code_information": [{"code": "G9706", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW-LEVEL LASER THERAPY", "code_information": [{"code": "552T", "type": "CPT"}], "standard_charges": [{"minimum": 98.25, "maximum": 1723.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 154.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 154.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 154.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "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": 14147.84, "maximum": 24288.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14147.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20234.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22257.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24288.33, "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": 21108.01, "maximum": 36237.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21108.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 30189.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 33207.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 36237.21, "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": 11263.89, "maximum": 19337.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11263.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16109.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17720.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19337.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY FLAP 15738", "code_information": [{"code": "15738", "type": "CPT"}, {"code": "1481272", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY STUDY", "code_information": [{"code": "93925", "type": "CPT"}], "standard_charges": [{"minimum": 974.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 974.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1530.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1530.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1530.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY STUDY", "code_information": [{"code": "93926", "type": "CPT"}], "standard_charges": [{"minimum": 495.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 495.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LPOPRTN BLD W/5 MAJ CLASSES", "code_information": [{"code": "52U", "type": "CPT"}], "standard_charges": [{"minimum": 48.76, "maximum": 135.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 135.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 135.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 135.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LPT GREAT TOE SIZING SET 4871000", "code_information": [{"code": "4871000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1223.0, "discounted_cash": 428.05, "setting": "both", "billing_class": "facility"}]}, {"description": "LR 3000ML BAG", "code_information": [{"code": "MED0270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LU GNOTYP BCAM EXON 3", "code_information": [{"code": "196U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 266.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUBRICATING JELLY 120GM TUBE", "code_information": [{"code": "MED0133", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LUBRICATING JELLY IN FLIP-TOP TUBE 4 OZ. MDS032290Z", "code_information": [{"code": "MDS032290Z", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "LUGOLS 30ML SOLUTION", "code_information": [{"code": "MED0134", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 167.0, "discounted_cash": 58.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LUNG BX PLUG W/DEL SYS", "code_information": [{"code": "C2613", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG CX BX RPT NO DOC CLASS", "code_information": [{"code": "G9421", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG FUNCTION TEST (MBC/MVV)", "code_information": [{"code": "94200", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERF&VENTILAT DIFERENTL", "code_information": [{"code": "78598", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1201.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1889.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1889.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1889.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 556.27, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 591.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION DIFFERENTIAL", "code_information": [{"code": "78597", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 752.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1183.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1183.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1183.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 356.92, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 379.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION IMAGING", "code_information": [{"code": "78580", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 918.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1443.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1443.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1443.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 430.87, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 458.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT DOUBLE", "code_information": [{"code": "32853", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT SINGLE", "code_information": [{"code": "32851", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32852", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32854", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILAT&PERFUS IMAGING", "code_information": [{"code": "78582", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1281.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2015.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2015.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2015.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 596.48, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 634.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILATION IMAGING", "code_information": [{"code": "78579", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 737.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1158.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1158.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1158.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 352.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 375.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VOLUME REDUCTION", "code_information": [{"code": "32491", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNGCX BX RPT DOCS CLASS", "code_information": [{"code": "G9418", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUX-DX INSERTABLE CARDIAC M301", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "M301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LVEF <= 40% OR LVSD", "code_information": [{"code": "G8923", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LVEF <=40%", "code_information": [{"code": "G8694", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LVEF <=40% OR DEP LV SYS FCN", "code_information": [{"code": "G8934", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LVEF <=40% OR MOD/SEV L VSF", "code_information": [{"code": "M1150", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LVEF NOT PERFORMED", "code_information": [{"code": "G8396", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LVEF>=40% DOC NORMAL OR MILD", "code_information": [{"code": "G8395", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LW GNOTYP ICAM4 EXON 1", "code_information": [{"code": "197U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 266.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LWR XTR VASC STDY BILAT", "code_information": [{"code": "93924", "type": "CPT"}], "standard_charges": [{"minimum": 630.98, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 630.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 991.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 991.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 991.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DIS DNA AMP PROBE", "code_information": [{"code": "87476", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DIS DNA DIR PROBE", "code_information": [{"code": "87475", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DISEASE ANTIBODY", "code_information": [{"code": "86617", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DISEASE ANTIBODY", "code_information": [{"code": "86618", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH CHORIOMENINGITIS AB", "code_information": [{"code": "86727", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH SYSTEM IMAGING", "code_information": [{"code": "78195", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1354.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2129.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2129.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2129.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 632.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 673.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY ARM/LEG", "code_information": [{"code": "75801", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1072.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2755.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY ARMS/LEGS", "code_information": [{"code": "75803", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1072.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4779.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY TRUNK", "code_information": [{"code": "75805", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1720.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4779.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY TRUNK", "code_information": [{"code": "75807", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPHAZURIN 1% (10 mg/mL) (ISOSULFAN BLUE) 5ML", "code_information": [{"code": "MED0135", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.0, "discounted_cash": 544.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LYMPHOCYTE CULTURE MIXED", "code_information": [{"code": "86821", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 56.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 146.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 146.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 146.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 52.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 52.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTE TRANSFORMATION", "code_information": [{"code": "86353", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 75.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 125.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 196.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 196.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 196.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 70.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 70.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTOTOXICITY ASSAY", "code_information": [{"code": "86805", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 236.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 483.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 759.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 759.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 759.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 272.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 272.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTOTOXICITY ASSAY", "code_information": [{"code": "86806", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 121.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 190.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 190.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 190.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 68.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 68.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [{"code": "821", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13110.08, "maximum": 22506.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13110.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18750.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20625.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22506.75, "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": 34622.61, "maximum": 59438.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34622.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49517.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54469.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59438.42, "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": 7612.87, "maximum": 13069.41, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7612.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10888.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11976.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13069.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "841", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9864.19, "maximum": 16934.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9864.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14107.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15518.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16934.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "840", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19590.3, "maximum": 33631.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19590.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28018.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30820.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33631.68, "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": 14382.65, "maximum": 24691.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14382.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20570.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22627.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24691.43, "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": 27384.45, "maximum": 47012.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27384.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39165.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43082.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 47012.3, "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": 8525.32, "maximum": 14635.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8525.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12193.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13412.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14635.86, "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": 6673.05, "maximum": 11455.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6673.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9543.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10498.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11455.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYNC 2.3 DRILL BIT", "code_information": [{"code": "XDB01003D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 928.0, "discounted_cash": 324.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LYNC DISTAL RASP XRA01002", "code_information": [{"code": "XRA01002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 709.0, "discounted_cash": 248.15, "setting": "both", "billing_class": "facility"}]}, {"description": "LYNC M10 IMPLANT CM010011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CM010011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2837.0, "discounted_cash": 992.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN INIT DAY", "code_information": [{"code": "32561", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN SUBQ DAY", "code_information": [{"code": "32562", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS ABDOMINAL ADHESIONS LAPAROSCOPIC 44180", "code_information": [{"code": "44180", "type": "CPT"}, {"code": "1481277", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS INTRANASAL SYNECHIA 30560", "code_information": [{"code": "30560", "type": "CPT"}, {"code": "1582406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS OF ADHESIONS 58740", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "1481278", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS OF EXCISION OF PENILE POST CIRC. ADHESIONS 54162", "code_information": [{"code": "54162", "type": "CPT"}, {"code": "1657191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS OF LABIAL ADHESIONS 56441", "code_information": [{"code": "56441", "type": "CPT"}, {"code": "1481279", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Lactate Dehydrogenase", "code_information": [{"code": "83615", "type": "CPT"}, {"code": "633770", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 28.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Lipase Level", "code_information": [{"code": "83690", "type": "CPT"}, {"code": "633776", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 349.0, "discounted_cash": 122.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 129.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Lipid Panel", "code_information": [{"code": "80061", "type": "CPT"}, {"code": "633777", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 41.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Lithium Level", "code_information": [{"code": "80178", "type": "CPT"}, {"code": "633778", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 33.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Liver And/Or Bone Marrow Biopsy With Removal Of Spleen And Lymph Nodes", "code_information": [{"code": "49220", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Low-density lipoprotein receptor-related protein 4 (LRP4), antibody identification by immunofluorescence, using live cells, reported as positive or negative", "code_information": [{"code": "546U", "type": "CPT"}], "standard_charges": [{"minimum": 30.73, "maximum": 48.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Lower extremity fascial plane block, unilateral; by continuous infusion(s), including imaging guidance, when performed", "code_information": [{"code": "64474", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance, when performed", "code_information": [{"code": "64473", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Lower respiratory tract infectious agent detection, 18 bacteria, 8 viruses, and 7 antimicrobial-resistance genes, amplified probe technique, including reverse transcription for RNA targets, each analyte reported as detected or not detected with semiquanti", "code_information": [{"code": "528U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 140.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Luteinizing Hormone", "code_information": [{"code": "83002", "type": "CPT"}, {"code": "633779", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 349.0, "discounted_cash": 122.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 129.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M. GENITALIUM AMP PROBE", "code_information": [{"code": "87563", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M.AVIUM-INTRA DNA AMP PROB", "code_information": [{"code": "87561", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M.AVIUM-INTRA DNA DIR PROB", "code_information": [{"code": "87560", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M.AVIUM-INTRA DNA QUANT", "code_information": [{"code": "87562", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M.PNEUMON DNA AMP PROBE", "code_information": [{"code": "87581", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M.PNEUMON DNA DIR PROBE", "code_information": [{"code": "87580", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M.PNEUMON DNA QUANT", "code_information": [{"code": "87582", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 378.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 771.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1213.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1213.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1213.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 435.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 435.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M.TUBERCULO DNA AMP PROBE", "code_information": [{"code": "87556", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 167.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 167.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 167.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 60.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 60.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M.TUBERCULO DNA DIR PROBE", "code_information": [{"code": "87555", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 107.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 107.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 107.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M.TUBERCULO DNA QUANT", "code_information": [{"code": "87557", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M/L EXPANDABLE 10X38X28MM 4DEG 1663042", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1663042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2750.0, "discounted_cash": 962.5, "setting": "both", "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS ISHQUANT/SEMIQ", "code_information": [{"code": "88373", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 192.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 192.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 192.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 64.43, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 68.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS ISHQUANT/SEMIQ", "code_information": [{"code": "88374", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 361.66, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 384.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS SKELETAL MUSC", "code_information": [{"code": "88355", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 96.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 103.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYSISHQUANT/SEMIQ", "code_information": [{"code": "88369", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 202.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 152.25, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 161.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 135.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 135.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MA Mam Ducto/Galactogram 1 Duct Lt 77053", "code_information": [{"code": "77053", "type": "CPT"}, {"code": "17175627", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1029.0, "discounted_cash": 360.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 520.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 382.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 529.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 639.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 88.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 94.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MA Mam Ducto/Galactogram 1 Duct Rt 77053", "code_information": [{"code": "77053", "type": "CPT"}, {"code": "17175637", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1029.0, "discounted_cash": 360.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 520.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 382.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 529.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 639.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 88.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 94.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAC BLADE 3 8703", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "8703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1158.0, "discounted_cash": 405.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MAC PGMT OPT DNS MEAS HFP", "code_information": [{"code": "506T", "type": "CPT"}], "standard_charges": [{"minimum": 140.28, "maximum": 220.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 140.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 220.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 220.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 220.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MACKOOL CATARACT SUPPORT SYSTEM MH-1005", "code_information": [{"code": "MH-1005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 155.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MACROSCOPIC EXAM ARTHROPOD", "code_information": [{"code": "87168", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MACROSCOPIC EXAM PARASITE", "code_information": [{"code": "87169", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAG CTRLD CAPSULE ENDOSCOPY", "code_information": [{"code": "651T", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 5561.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3537.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5561.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5561.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5561.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNET PATIENT 1210 1210", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "1210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MAGNETIC IMAGE BONE MARROW", "code_information": [{"code": "77084", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1007.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1584.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1584.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1584.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 590.04, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 627.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETIC IMAGE JAW JOINT", "code_information": [{"code": "70336", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 474.29, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 504.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNEVIST INJ SOL 5 ML", "code_information": [{"code": "MED0136", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MAIN HEMO IN-CNTR", "code_information": [{"code": "G0049", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [{"code": "654", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17657.73, "maximum": 30313.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17657.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25254.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27779.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 30313.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITH MCC", "code_information": [{"code": "653", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33208.31, "maximum": 57010.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33208.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 47495.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52244.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57010.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "655", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12654.46, "maximum": 21724.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12654.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18098.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19908.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21724.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITH CC", "code_information": [{"code": "164", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16154.01, "maximum": 27732.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16154.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23103.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25414.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27732.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITH MCC", "code_information": [{"code": "163", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30456.36, "maximum": 52286.01, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30456.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43559.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47915.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52286.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "165", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11658.68, "maximum": 20015.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11658.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16674.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18341.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20015.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITH CC", "code_information": [{"code": "184", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6331.79, "maximum": 10870.12, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6331.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9055.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9961.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10870.12, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITH MCC", "code_information": [{"code": "183", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9482.79, "maximum": 16279.59, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9482.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13562.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14918.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16279.59, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "185", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4713.72, "maximum": 8092.28, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4713.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6741.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7415.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8092.28, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [{"code": "369", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6552.61, "maximum": 11249.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6552.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9371.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10308.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11249.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [{"code": "368", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11856.38, "maximum": 20354.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11856.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16957.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18652.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20354.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "370", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4550.69, "maximum": 7812.41, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4550.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6508.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7159.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7812.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [{"code": "372", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6261.23, "maximum": 10748.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6261.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8954.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9850.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10748.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [{"code": "371", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10530.89, "maximum": 18078.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10530.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15061.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16567.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18078.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "373", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4529.4, "maximum": 7775.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4529.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6478.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7125.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7775.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITH CC", "code_information": [{"code": "141", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13419.71, "maximum": 23038.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13419.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19193.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21112.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23038.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [{"code": "140", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24197.57, "maximum": 41541.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24197.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34607.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38068.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41541.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "142", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9763.82, "maximum": 16762.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9763.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13964.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15360.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16762.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC", "code_information": [{"code": "809", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7441.94, "maximum": 12775.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7441.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10643.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11707.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12775.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC", "code_information": [{"code": "808", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13296.22, "maximum": 22826.31, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13296.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19016.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20918.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22826.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "810", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5850.02, "maximum": 10043.03, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5850.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8366.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9203.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10043.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT", "code_information": [{"code": "469", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18771.53, "maximum": 32226.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18771.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26847.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29532.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32226.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC", "code_information": [{"code": "470", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11559.52, "maximum": 19844.83, "estimated_discounted_cash": 41238.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11559.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16532.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18185.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19844.83, "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": 14512.21, "maximum": 24913.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14512.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20755.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22831.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24913.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR MALE PELVIC PROCEDURES WITH CC/MCC", "code_information": [{"code": "707", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11692.74, "maximum": 20073.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11692.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16723.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18395.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20073.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "708", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9070.97, "maximum": 15572.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9070.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12973.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14270.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15572.6, "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": 12536.45, "maximum": 21521.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12536.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17929.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19722.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21521.98, "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": 8575.21, "maximum": 14721.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8575.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12264.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13490.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14721.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "595", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12266.37, "maximum": 21058.31, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12266.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17543.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19297.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21058.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "596", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6050.76, "maximum": 10387.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6050.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8653.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9519.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10387.65, "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": 15507.39, "maximum": 26622.34, "estimated_discounted_cash": 24732.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15507.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22178.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24396.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26622.34, "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": 29722.75, "maximum": 51026.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29722.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 42509.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46760.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51026.59, "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": 10404.97, "maximum": 17862.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10404.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14881.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16369.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17862.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [{"code": "506", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9024.74, "maximum": 15493.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9024.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12907.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14198.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15493.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33750", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33755", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33762", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33766", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33767", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT & GRAFT", "code_information": [{"code": "33764", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALARIA ANTIBODY", "code_information": [{"code": "86750", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.0, "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": 6822.08, "maximum": 11711.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6822.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9757.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10732.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11711.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC", "code_information": [{"code": "435", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10665.93, "maximum": 18310.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10665.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15254.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16780.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18310.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC", "code_information": [{"code": "437", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5449.76, "maximum": 9355.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5449.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7794.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8573.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9355.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "755", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6869.53, "maximum": 11793.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6869.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9824.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10807.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11793.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "754", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11108.77, "maximum": 19071.01, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11108.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15887.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17476.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19071.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "756", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5586.63, "maximum": 9590.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5586.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7990.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8789.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9590.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "723", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6642.03, "maximum": 11402.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6642.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9499.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10449.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11402.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "722", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10417.75, "maximum": 17884.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10417.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14899.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16389.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17884.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "724", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3942.39, "maximum": 6768.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3942.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5638.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6202.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6768.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [{"code": "598", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6769.77, "maximum": 11622.01, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6769.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9682.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10650.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11622.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITH MCC", "code_information": [{"code": "597", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10000.45, "maximum": 17168.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10000.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14302.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15733.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17168.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "599", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4084.13, "maximum": 7011.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4084.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5841.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6425.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7011.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANAGER THERAPY PERSONAL FORINTRATHECAL DRUG DEL", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "8835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1703.0, "discounted_cash": 596.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MANIFOLD CARTRIDGE 11G VERTEPORT X4", "code_information": [{"code": "605-411-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 745.0, "discounted_cash": 260.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MANIFOLD CEMENT 11G VERTEPORT X4", "code_information": [{"code": "605-411-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MANIPULAT PALM CORD POST INJ", "code_information": [{"code": "26341", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION ELBOW UNDER ANESTHESIA 24300", "code_information": [{"code": "24300", "type": "CPT"}, {"code": "6868779", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 750.2, "maximum": 8450.0, "gross_charge": 1550.0, "discounted_cash": 542.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 750.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION FINGER JOINT 26340", "code_information": [{"code": "26340", "type": "CPT"}, {"code": "1481280", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION GRAFT SUT EXPRESSBRAID", "code_information": [{"code": "110003539", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 67.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MANIPULATION HIP JOINT 27275", "code_information": [{"code": "27275", "type": "CPT"}, {"code": "1481281", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF ANKLE UNDER GENERAL ANESTHESIA 27860", "code_information": [{"code": "27860", "type": "CPT"}, {"code": "2401693", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF KNEE UNDER GENERAL ANESTHESIA 27570", "code_information": [{"code": "27570", "type": "CPT"}, {"code": "1481282", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF SPINE", "code_information": [{"code": "22505", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION UNDER ANESTHESIA SHOULDER JOINT 23700", "code_information": [{"code": "23700", "type": "CPT"}, {"code": "1481283", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION-WRIST-UNDER ANESTHESIA 25259", "code_information": [{"code": "25259", "type": "CPT"}, {"code": "1482411", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATOR INJECTOR MANIPUJECTOR KRONNER UTERINE 6003", "code_information": [{"code": "6003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "MANIPULATOR UTERINE 4.5 ML HARRIS KRONNER CURVED RIGID DOUBLE LUMENED HUMI", "code_information": [{"code": "ZSI1151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MANIPULATOR UTERINE 7CMINSTR", "code_information": [{"code": "UM201", "type": "CDM"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MANIPULATOR UTERINE 9CM CLEARVIEW LONG", "code_information": [{"code": "UM202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MANIPULATOR VCARE DX UTERINE 60-6080-000A", "code_information": [{"code": "60-6080-000A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MANUAL CELL COUNT EACH", "code_information": [{"code": "85032", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL DIFF WBC COUNT B-COAT", "code_information": [{"code": "85009", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL PREP AND INSERTION DRUG DELIVERY DEVICE DEEP 20700", "code_information": [{"code": "20700", "type": "CPT"}, {"code": "45581517", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3485.0, "discounted_cash": 1219.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1686.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL RETICULOCYTE COUNT", "code_information": [{"code": "85044", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL THERAPY 1/> REGIONS", "code_information": [{"code": "97140", "type": "CPT"}], "standard_charges": [{"minimum": 125.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 125.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUALPATIENT 36500", "code_information": [{"code": "36500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MAP TACHYCARDIA ADD-ON", "code_information": [{"code": "93609", "type": "CPT"}], "standard_charges": [{"minimum": 1287.37, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1287.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2023.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2023.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2023.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO COMMUNITY", "code_information": [{"code": "G9152", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO PHYSICIAN", "code_information": [{"code": "G9153", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO STATE", "code_information": [{"code": "G9151", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAPLE SYRUP UR DS MNTR QUAN", "code_information": [{"code": "381U", "type": "CPT"}], "standard_charges": [{"minimum": 242.22, "maximum": 380.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 380.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 380.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 380.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARCAINE 0.75% SPINAL 2ML", "code_information": [{"code": "MED0139", "type": "CDM"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER REFLECTIVE SZ 5 PASSIVE SPHERZ", "code_information": [{"code": "PM8005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN DUAL TIPINK TIME OUT SLEEVE AND RULER FOURIN ONE PEN W/ TIME OUT SLE", "code_information": [{"code": "1041-NNS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN EXTRA FINE SURG ROLLER LF STRL DISP", "code_information": [{"code": "31145827", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN GENTIAN VIOLETINK SURG REG TIP W/ 6IN RULER AND 6 BLANK LABEL LF STR", "code_information": [{"code": "DYNJSM02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN MINI NON-STERILE", "code_information": [{"code": "DYNJSMINI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN REGTIP BARRL W RULER&LBL 250GPRL", "code_information": [{"code": "250GPRL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN RULER 151-R 25 BX 31145892", "code_information": [{"code": "31145892", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SURG GENTIAN VIOLET SKIN STANDARD TIP W/ FLEXIBLE RULER DEVON LF STRL", "code_information": [{"code": "31145777", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKERS NAVIO FLAT PFSDV0016", "code_information": [{"code": "PFSDV0016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKERS: STERILE FINE TIP SKIN MARKER WITH RULER AND LABELS DYNJSM04", "code_information": [{"code": "DYNJSM04", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION ODON CYST", "code_information": [{"code": "D7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST 56440", "code_information": [{"code": "56440", "type": "CPT"}, {"code": "1481284", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION OF URETHRAL DIVERTICULUM MALE OR FEMALE 53240", "code_information": [{"code": "53240", "type": "CPT"}, {"code": "42635451", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASK AF531 MED. FL FACE 4PT HEADGEAR FULL FACE 73-1072622", "code_information": [{"code": "73-1072622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANES 4 SM SWTDRM AR CSH ADJ INFL VLV TRDRP SHP SCNT", "code_information": [{"code": "1242", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANES BUBBLE GUM SCENTED CUSHION CASE OF 50 MASKS SWEET DREAMS PEDI", "code_information": [{"code": "1145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA SZ 6 LG NASAL ORAL WITHOUT STRP ADLT DISP", "code_information": [{"code": "1065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.31, "discounted_cash": 2.21, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK BASIC PROCEDURE FACE WITH EAR LOOPS NON27378", "code_information": [{"code": "NON27378", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK BREATHING MED CONCENTRATION ELONGATED ANESTHESIA LF PEDI", "code_information": [{"code": "1042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK BREATHING SZ 4 ANESTHESIA LF PEDI", "code_information": [{"code": "1045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ELONGATED ADULT HUD1083", "code_information": [{"code": "A7015", "type": "HCPCS"}, {"code": "HUD1083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE CLR TENT UNDER THE CHIN DESIGN VINYL FOR HIGH HUMIDITY AEROSOL THERAPY", "code_information": [{"code": "1388", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE LRG C-PAP STAND ELBOW 4 POINT", "code_information": [{"code": "73-1061723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE MED C-PAP STAND ELBOW 4 POINT", "code_information": [{"code": "73-1061722", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE ONE SZ FITS MOST 5FT TUBING TENT CORRUGATED ADJ ELASTIC HEAD STRP VINY", "code_information": [{"code": "1222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 2 ANES ADJINFLATION VALVE TEARDROP SHAPE BUBBLE GUM SCENTED SWEET D", "code_information": [{"code": "1125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 2 BUBBLE GUM SCENTED SWEET DREAMS LF PEDI DISP", "code_information": [{"code": "1122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.36, "discounted_cash": 2.58, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 2 ORANGE SOFT CUSHIONINFLTBLINFANT ANESTHESIA BREATHING PEDI", "code_information": [{"code": "1022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 3 SOFT CUSHIONINFLATABLE TODDLER ANESTHESIA BREATHING PEDI", "code_information": [{"code": "1032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 3 TODDLER BUBBLE GUM SCENT SWEET DREAMS PEDI", "code_information": [{"code": "1132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE TENT DISP W/6FT CORE", "code_information": [{"code": "1221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FULL FACE DISPOSABLE LARGE 73-1072623", "code_information": [{"code": "73-1072623", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FULL FACE DISPOSABLE SMALL 73-1072621", "code_information": [{"code": "73-1072621", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK INFANT SZ 2 BUBBLEGUM K1122", "code_information": [{"code": "K1122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.36, "discounted_cash": 2.58, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARGE HEADGEAR FULL FACE 73-1061735", "code_information": [{"code": "73-1061735", "type": "CDM"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARGE NIV NON-VENTED FULL FACE AIRLIFE", "code_information": [{"code": "NIV041L", "type": "CDM"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SIZE 2 LMA LMA125020", "code_information": [{"code": "LMA125020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 2.5 CHILD LF", "code_information": [{"code": "ALAA025SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 3 CHILD LF ALAA030SU", "code_information": [{"code": "ALAA030SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 4 ADULT LF ALAA040SU", "code_information": [{"code": "ALAA040SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 5 ADULT LF ALAA050SU", "code_information": [{"code": "ALAA050SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK MED HEADGEAR FULL FACE 73-1061734", "code_information": [{"code": "73-1061734", "type": "CDM"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK MED NON-VENTED FULL FACE AIRLIFE", "code_information": [{"code": "NIV041M", "type": "CDM"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NEBULIZER 7FT W/ TUBING PEDI", "code_information": [{"code": "4486", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NEBULIZER ANTI-SPI ADULT 7FT", "code_information": [{"code": "4485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK O2 ADULT CLR MED W/ 7FT TU", "code_information": [{"code": "1041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK O2 VNYL ADLT ELNG NREB TBG FLP VLV LF DISP 7FT", "code_information": [{"code": "1061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.06, "discounted_cash": 1.42, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN 7 FT TUBING MEDIUM CONCENTRATION SAFETY VENT CHECK VALVE LF ADULT", "code_information": [{"code": "HCS4600B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN MEDIUM-CONCENTRATION 7 SC RHO41U", "code_information": [{"code": "RHO41U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN MEDIUM-CONCENTRATION 7SC RH041U", "code_information": [{"code": "RH041U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN MEDN ELONGATED ADULT 3280RHO41U", "code_information": [{"code": "3280RHO41U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN NON REBREATHING ELONGATED ADLT DISP", "code_information": [{"code": "1059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.12, "discounted_cash": 1.44, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PROCEDURE INSTA GARD BLUE W/WRA AT7511-WE", "code_information": [{"code": "AT7511-WE", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PROCEDURE SECURE GARD BLUE AT71021", "code_information": [{"code": "AT71021", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK RESP N95 NIOSH APPROVED SMALL 1860S", "code_information": [{"code": "1860S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.18, "discounted_cash": 1.11, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK RESUSCITATOR 2600ML 40IN TUBING MED MASK SEBS W/ BAG SPUR II LF ADLT DISP", "code_information": [{"code": "520211000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK RESUSCITATOR CHILD TODDLER MASK W/ BAG SPUR II LF PEDI DISP", "code_information": [{"code": "530613000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK RESUSCITATOR MED MASK PORT W/ BAG SPUR II LF ADLT DISP", "code_information": [{"code": "520611000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK SURG DUCKBILL FOGFREE ANTIGLAR", "code_information": [{"code": "AT54635-I", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK SURGICAL FOG FREE FOAM", "code_information": [{"code": "AT71235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MASS SPECTROMETRY QUAL/QUAN", "code_information": [{"code": "83789", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 34.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASSAGE THERAPY", "code_information": [{"code": "97124", "type": "CPT"}], "standard_charges": [{"minimum": 128.73, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 128.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 202.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 202.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 202.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST MOD RAD", "code_information": [{"code": "19307", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST RAD URBAN TYPE", "code_information": [{"code": "19306", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST RADICAL", "code_information": [{"code": "19305", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITH CC/MCC", "code_information": [{"code": "582", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9994.98, "maximum": 17158.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9994.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14294.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15724.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17158.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "583", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9376.94, "maximum": 16097.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9376.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13411.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14752.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16097.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY PARTIAL 19301", "code_information": [{"code": "19301", "type": "CPT"}, {"code": "1481287", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY SIMPLE 19303", "code_information": [{"code": "19303", "type": "CPT"}, {"code": "1481290", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTISOL LIQUID ADHESIVE UD (MEDID)", "code_information": [{"code": "MED0606", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69601", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69603", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69604", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY COMPLETE 69502", "code_information": [{"code": "69502", "type": "CPT"}, {"code": "1481293", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY MODIFIED RADICAL 69505", "code_information": [{"code": "69505", "type": "CPT"}, {"code": "1481294", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY RADICAL 69511", "code_information": [{"code": "69511", "type": "CPT"}, {"code": "1481295", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOPEXY 19316", "code_information": [{"code": "19316", "type": "CPT"}, {"code": "1481296", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAT SUCTION 36IN X 56IN THE SUCTIONER", "code_information": [{"code": "USA-X10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 267.0, "discounted_cash": 93.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX 3 X 3.5CM KERECIS OMEGA3 WOUND ACELLULAR DERMAL 50200S01B0D", "code_information": [{"code": "Q4158", "type": "HCPCS"}, {"code": "50200S01B0D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1561.0, "discounted_cash": 546.35, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX 6CM X 9CM DYNAMIC 31049", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "31049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7942.2, "discounted_cash": 2779.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX ALLOAID HYDRATED ACELLUALR DERMAL MATRIX 4 X 4 CM 0.83MM ADMH 4X4", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ADMH 4X4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX BIOCARTILAGE 1CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ABS-1010-BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2124.64, "discounted_cash": 743.62, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX BONE 7MM X 11MM X 14MM 7DEG PUROS IMP", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "7.01268.021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2420.0, "discounted_cash": 847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX DERMAL 5 CM X 5 CM ACELLULAR DERMANSPAN", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "48-1100505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5274.0, "discounted_cash": 1845.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX DURA DURAL PATCH COLLAGEN 1INX1IN DP-1011", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "DP-1011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 899.42, "discounted_cash": 314.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX HD 3MM 4CM X 6CM TDT346-TS", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "TDT346-TS", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 7931.0, "discounted_cash": 2775.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX HYDRATED ACELLULAR DERMAL 4 X 4 CM 1.50MM SD.090.0404", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "SD.090.0404", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 3080.0, "discounted_cash": 1078.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX HYDRATED ACELLULAR DERMAL 5 X 10CM 1.04MM SD.090.0510", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "SD.090.0510", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 13854.0, "discounted_cash": 4848.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX REGENERATION DURAGEN PLUS 1X3 DP-1013", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "DP-1013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX REPAIR .3ML CELLULAR OVATION", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PS31030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1823.0, "discounted_cash": 638.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX REPAIR SOFT TISSUE ACELLULAR COLLAGEN MEMBRANE TISSUEMEND", "code_information": [{"code": "C9358", "type": "HCPCS"}, {"code": "6495-9-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6151.0, "discounted_cash": 2152.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX SIMPLIDERM HYDRATED ACELLULAR DERMAL SIZE 4 X 4 CM; 0.83MM SD.070.0404", "code_information": [{"code": "Q4126", "type": "HCPCS"}, {"code": "SD.070.0404", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MAVIX 10CC BIOLOGIC", "code_information": [{"code": "A6010", "type": "HCPCS"}, {"code": "XOB10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6901.0, "discounted_cash": 2415.35, "setting": "both", "billing_class": "facility"}]}, {"description": "MAVIX 2CC XOB02", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "XOB02", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2462.0, "discounted_cash": 861.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MAXCESS-C USAGE FEE 7992600", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7992600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1358.18, "discounted_cash": 475.36, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO- SET SECONDARY MED LL LVR LOCK 2H7462", "code_information": [{"code": "2H7462", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-ADHESIVE SKIN DERMABOND ADVANCED 0.7 DNX12", "code_information": [{"code": "DNX12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-ADHESIVE SKIN TOPICAL EXCED LIQUBAND LX6", "code_information": [{"code": "LX6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-CUTTER ETS FLEX ARTICNG LINEAR 45MM ATS45", "code_information": [{"code": "ATS45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 181.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-DSPNG PIN MULTI ACCESS MINISPIKE", "code_information": [{"code": "412012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.0, "discounted_cash": 43.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-ELECTRODE ADULT POLYHESIVE PAT RETRN E7507", "code_information": [{"code": "E7507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-GLOVE BIOGEL PL ULTRATOUCH G SZ 7.5", "code_information": [{"code": "42175", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-GLOVE SURGICAL ORTHOSYNTHESTEEMPF7.5", "code_information": [{"code": "2D73ET75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-HIBICLENS 4 OZ FOAM 24/CS 57541", "code_information": [{"code": "57541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-JELCO IV CATHETER 22X1 4050", "code_information": [{"code": "4050", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-LIQUID ADHESIVE 2/3CC 0496-0523-48", "code_information": [{"code": "496-0523-48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-NEEDLE 22GX3\" YELLW HUB STRL SNG USE 405171", "code_information": [{"code": "405171", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-RELOAD ENDO STITCH SURGDAC GRN 0 48 173024", "code_information": [{"code": "173024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-RELOAD ENDOSTITCH SURGDAC GRN 2-0 48 173023", "code_information": [{"code": "173023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-RELOAD LNEAR CUTTR BLU 75MM 75STAPLE TCR75", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TCR75", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 106.8, "discounted_cash": 37.38, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SOLUTION SOD CHLOR 0.9% IRG 1000ML 2F7124", "code_information": [{"code": "2F7124", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 11.31, "discounted_cash": 3.96, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SOLUTION SOD CHLOR INJ 0.9% 50ML 2B1306", "code_information": [{"code": "2B1306", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.95, "discounted_cash": 3.13, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SOLUTION SODIUM CHLOR INJ 0.9% 100ML 2B0043", "code_information": [{"code": "2B0043", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SOLUTION SODIUM CHLORID INJECT 50ML 2B0042", "code_information": [{"code": "2B0042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SOLUTION SODUM CHLRDE 0.9% IRG 250ML 2F7122", "code_information": [{"code": "2F7122", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SOLUTN SODIUM CHLOR INJ 0.9% 100 ML 2B1307", "code_information": [{"code": "2B1307", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.8, "discounted_cash": 3.08, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SPONGE SURGIFOAM ABSORABLE GELATIN 1972", "code_information": [{"code": "1972", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STAPLER HEAD FIXED 35 REG STRL DISP PXR35", "code_information": [{"code": "PXR35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STAPLER HEAD FIXED 35 WIDE STRL DISP PXW35", "code_information": [{"code": "PXW35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.55, "discounted_cash": 18.04, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STAPLER SKIN ROTATING HEAD 35 WIDE PRW35", "code_information": [{"code": "PRW35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.24, "discounted_cash": 29.48, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STAPLR SKIN PROXIMTE PLUS MD WIDE 35 PMW35", "code_information": [{"code": "PMW35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STPLR PWR ECHELON FLEX STANDARD 45MM PSEE45A", "code_information": [{"code": "PSEE45A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2084.05, "discounted_cash": 729.42, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUPPORTER ATHLETIC ADLT LG 39 INCH- 44 INCH", "code_information": [{"code": "202636S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.7, "discounted_cash": 12.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SURGIWAND II 5MM CAUT L-HOOK TBE GFS 178093", "code_information": [{"code": "178093", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 469.0, "discounted_cash": 164.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTRE ENDO STITCH PLYSRB VIOLT 2-O 4 170053", "code_information": [{"code": "170053", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE 0 8-18 CTD VIC UND BR CT- J840D", "code_information": [{"code": "J840D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.07, "discounted_cash": 17.52, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE 3-0 BLACK BRAIDED 12-18 A184H", "code_information": [{"code": "A184H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE 4/0 27 CHROMIC GUT RB-1 U203H", "code_information": [{"code": "U203H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE 5/0 18 CHROMIC GUT BL S-1 1792G", "code_information": [{"code": "1792G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE ENDOSTITCH PLYSRB VIOLT O 48 170052", "code_information": [{"code": "170052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE PRMA-HAND 2/0 12-30 BKL BRAID A305H", "code_information": [{"code": "A305H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE PRMA-HAND 3/0 12-30 BLK BRAID A304H", "code_information": [{"code": "A304H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE VLOC 180 ESTITCH ABS 8 LOOP VLOCA008L", "code_information": [{"code": "VLOCA008L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 113.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-VLOC 180 ABSORBABLE 2-0 ESTCH 8 LP VLOCA208L", "code_information": [{"code": "VLOCA208L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 113.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MCHNL FRAGILITY RBC PRFLG", "code_information": [{"code": "123U", "type": "CPT"}], "standard_charges": [{"minimum": 21.93, "maximum": 514.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 514.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 514.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCOLN1 GENE", "code_information": [{"code": "81290", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 49.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 157.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 157.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 56.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY DX", "code_information": [{"code": "29900", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29901", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29902", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD CERTIFICATION HHA PATIENT", "code_information": [{"code": "G0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 238.4, "maximum": 374.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 238.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 374.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 374.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 374.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD INR TEST REVIE INTER MGMT", "code_information": [{"code": "G0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.89, "maximum": 37.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD RECERTIFICATION HHA PT", "code_information": [{"code": "G0179", "type": "HCPCS"}], "standard_charges": [{"minimum": 184.38, "maximum": 289.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 184.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 289.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 289.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 289.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD SERVICE REQUIRED FOR PMD", "code_information": [{"code": "G0372", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.73, "maximum": 62.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MDFC FLAP W/PRSRV VASC PEDCL", "code_information": [{"code": "15730", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEAS LUNG VOL THRU 2 YRS", "code_information": [{"code": "94013", "type": "CPT"}], "standard_charges": [{"minimum": 87.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE BLOOD OXYGEN LEVEL", "code_information": [{"code": "94760", "type": "CPT"}], "standard_charges": [{"minimum": 11.11, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE BLOOD OXYGEN LEVEL", "code_information": [{"code": "94761", "type": "CPT"}], "standard_charges": [{"minimum": 19.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE BLOOD OXYGEN LEVEL", "code_information": [{"code": "94762", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE KIDNEY PRESSURE", "code_information": [{"code": "50396", "type": "CPT"}], "standard_charges": [{"minimum": 788.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 788.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE URETER PRESSURE", "code_information": [{"code": "50686", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE VENOUS PRESSURE", "code_information": [{"code": "93770", "type": "CPT"}], "standard_charges": [{"minimum": 36.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEATOTOMY 53020", "code_information": [{"code": "53020", "type": "CPT"}, {"code": "1481297", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEATOTOMY-INFANT 53025", "code_information": [{"code": "53025", "type": "CPT"}, {"code": "1481298", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36595", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36596", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECHANICAL CHEST WALL OSCILL", "code_information": [{"code": "94669", "type": "CPT"}], "standard_charges": [{"minimum": 811.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 811.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECHANICAL TRACTION THERAPY", "code_information": [{"code": "97012", "type": "CPT"}], "standard_charges": [{"minimum": 66.77, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECKELS DIVERT EXAM", "code_information": [{"code": "78290", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1351.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2124.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2124.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2124.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 635.86, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 676.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 FULL GENE ANALYSIS", "code_information": [{"code": "234U", "type": "CPT"}], "standard_charges": [{"minimum": 760.13, "maximum": 2116.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1346.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2116.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2116.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2116.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 760.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 760.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE DUP/DELET VARIANT", "code_information": [{"code": "81304", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 187.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE FULL SEQ", "code_information": [{"code": "81302", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 659.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1346.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2116.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2116.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2116.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 760.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 760.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE KNOWN VARIANT", "code_information": [{"code": "81303", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 481.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 481.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 481.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 172.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 172.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED DOC RSN NO ACE ARN ARNI", "code_information": [{"code": "G2093", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED DOC RSN NO LOW EX", "code_information": [{"code": "G2179", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED NUTRITION INDIV SUBSEQ", "code_information": [{"code": "97803", "type": "CPT"}], "standard_charges": [{"minimum": 130.32, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 204.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 204.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 204.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED PHYSIC DOS EVAL RAD EXPS", "code_information": [{"code": "76145", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3918.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6159.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6159.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6159.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED REAS NO PERF FOOT EXAM", "code_information": [{"code": "G9502", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED REAS NOT INCL HISTO TYPE", "code_information": [{"code": "G9419", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED REAS PT, PN, NOT DOC", "code_information": [{"code": "G8722", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED REAS RPT NO HISTO TYPE", "code_information": [{"code": "G9423", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED RSN FOR NO DOC SPIRO", "code_information": [{"code": "M1215", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED RSN NO ACE-I/ARB RX", "code_information": [{"code": "M1201", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED RSN NO IMP/CON MMR/MSI", "code_information": [{"code": "M1194", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED RSN NO PRESC BRONCHDIL", "code_information": [{"code": "G9696", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED RSN NO RPT BLADDER INJ", "code_information": [{"code": "G9626", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED RSN NO RPT BOWEL INJ", "code_information": [{"code": "G9629", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED RSN SYS ANTIMI NT RX", "code_information": [{"code": "G9960", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED SERV 10PM-8AM 24 HR FAC", "code_information": [{"code": "99053", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED SERV EVE/WKEND/HOLIDAY", "code_information": [{"code": "99051", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED SERVICE OUT OF OFFICE", "code_information": [{"code": "99056", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDI-LOOP VESSEL LOOP MAXI BLUE 2/PK DYNJVL01", "code_information": [{"code": "DYNJVL01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDIAL CANTHOPEXY 21280", "code_information": [{"code": "21280", "type": "CPT"}, {"code": "44595829", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2631.5, "maximum": 9357.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/LMPH NOD BX", "code_information": [{"code": "39402", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/MEDSTNL BX", "code_information": [{"code": "39401", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [{"code": "551", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9899.47, "maximum": 16994.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9899.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14158.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15574.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16994.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [{"code": "552", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5738.7, "maximum": 9851.93, "estimated_discounted_cash": 12619.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5738.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8207.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9028.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9851.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME LEVEL 1", "code_information": [{"code": "G9148", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME LEVEL II", "code_information": [{"code": "G9149", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME LEVEL III", "code_information": [{"code": "G9150", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL NUTRITION GROUP", "code_information": [{"code": "97804", "type": "CPT"}], "standard_charges": [{"minimum": 71.53, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 112.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL NUTRITION INDIV IN", "code_information": [{"code": "97802", "type": "CPT"}], "standard_charges": [{"minimum": 152.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 152.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 239.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 239.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 239.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL REASON FOR NO BETA", "code_information": [{"code": "G9190", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL SERVICES AFTER HRS", "code_information": [{"code": "99050", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL TESTIMONY", "code_information": [{"code": "99075", "type": "CPT"}], "standard_charges": [{"minimum": 603.95, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 603.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 949.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 949.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 949.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDIUM 10 DEGREE HAMMERTOE IMPLANT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HT-00005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 1076.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDLINE IV ADMINISTRATION SETS WITH SMARTSITE NEEDLE-FREE VALVES DYNDTN0555", "code_information": [{"code": "DYNDTN0555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.44, "discounted_cash": 9.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDLINE SMALL BORE IV EXTENSION SET DYNDTN0001", "code_information": [{"code": "DYNDTN0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDPOR SPHERE WITH ENUCLEATION 20MM 6317", "code_information": [{"code": "6317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 393.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDPOR SPHERE WITH ENUCLEATION IMPLANT INSERTER 20MM DIAMETER 80012", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "80012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1450.0, "discounted_cash": 507.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDRSN >1 SINUS CT W 90D DX", "code_information": [{"code": "G9353", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDRSN NO PT CATEGORY", "code_information": [{"code": "G9292", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDTRONIC METRIX 18MM X 5CM RETRACTOR", "code_information": [{"code": "9569815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 494.96, "discounted_cash": 173.24, "setting": "both", "billing_class": "facility"}]}, {"description": "MEG EVOKED EACH ADDL", "code_information": [{"code": "95967", "type": "CPT"}], "standard_charges": [{"minimum": 848.7, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 848.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1333.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1333.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1333.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEG EVOKED SINGLE", "code_information": [{"code": "95966", "type": "CPT"}], "standard_charges": [{"minimum": 971.08, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 971.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1525.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1525.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1525.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEG SPONTANEOUS", "code_information": [{"code": "95965", "type": "CPT"}], "standard_charges": [{"minimum": 1918.31, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1918.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3014.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3014.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3014.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEGADYNE 6.5 INCH MODIFIED EXTENDED BLADE", "code_information": [{"code": "MEG0014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MEMBRANE AMNIOTIC 9MM AMBIODICSC 2", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AD-5090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 414.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MEMBRANE AMNIOTIC ALLOGRAFT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AC20048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7200.0, "discounted_cash": 2520.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MEMBRANEBLUE 0.15% (TRYPAN BLUE) OPHTHALMIC SOLUTION 0.5 ML", "code_information": [{"code": "MED0755", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 353.0, "discounted_cash": 123.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MEMBREANE SCRAPER 25G STIFF TANO DIAMOND DUSTED", "code_information": [{"code": "20.04.25S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MENACWY-TT MENB-FHBP VACC IM", "code_information": [{"code": "90623", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENACWY-TT VACCINE IM", "code_information": [{"code": "90619", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENACWYD/MENACWYCRM VACC IM", "code_information": [{"code": "90734", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENB-4C VACC 2 DOSE IM", "code_information": [{"code": "90620", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENB-FHBP VACC 2/3 DOSE IM", "code_information": [{"code": "90621", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENISCAL CINCH II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MENISCAL REPAIR TRUESPAN 12 DEGREE PLGA SYSTEM 228161", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228161", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1250.0, "discounted_cash": 437.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MENISCAL REPAIR TRUESPAN 24 DEGREE PLGA SYSTEM 228162", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228162", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1250.0, "discounted_cash": 437.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MENISCAL REPAIR TRUESPAN PEEK 0DEGREE", "code_information": [{"code": "222150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1448.0, "discounted_cash": 506.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MENISCAL REPAIR TRUESPAN PEEK 24DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1448.0, "discounted_cash": 506.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MENISCAL TRNSPL KNEE W/SCPE", "code_information": [{"code": "29868", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "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": 5596.97, "maximum": 9608.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5596.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8004.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8805.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9608.6, "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": 3593.84, "maximum": 6169.72, "estimated_discounted_cash": 22944.01, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3593.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5139.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5653.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6169.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEPERIDINE 25MG/ML INJ", "code_information": [{"code": "MED0400", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPILEX BORDER FLEX FOAM DRESSING 4X4 595300", "code_information": [{"code": "595300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.01, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPILEX BORDER SACRUM DRESSING WITH SAFETAC 8.7\"X9.8\" 282455", "code_information": [{"code": "282455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.36, "discounted_cash": 15.53, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPIVACAINE 1%/CARBOCAINE 30ML", "code_information": [{"code": "MED0137", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPIVACAINE 1.5%/CARBOCAINE 30ML", "code_information": [{"code": "MED0138", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH 1.7MM DELTA ORBITAL FLOOR FX", "code_information": [{"code": "70-05145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5253.0, "discounted_cash": 1838.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH 10CM X 15CM MONOFIL POLY W/ ABS POLY ACID GRIP ABS COLL FILM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "LPG1510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH 5.5 X 3.5 PARIETEX PROGRIP LEFT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "TEM1409GL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 702.0, "discounted_cash": 245.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH 5.5 X 3.5 PARIETEX PROGRIP RIGHT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "TEM1409GR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 702.0, "discounted_cash": 245.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH ABDOMINAL WALL 30 CM X 30 CM PARTIALLY ABSORBL LIGHTWEIGHT ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UML1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 716.0, "discounted_cash": 250.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH BAG ENVELOPE TYRX NEURO ABSORABLE NMRM6133", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "NMRM6133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1790.0, "discounted_cash": 626.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH BIOLOGIC STRATTICE LAPAROSCOPIC 10 X 16", "code_information": [{"code": "Q4130", "type": "HCPCS"}, {"code": "1016005", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 7978.0, "discounted_cash": 2792.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH COMPOSITE 12CM ROUND OPTIMIZED PARIETEX", "code_information": [{"code": "PCO12X", "type": "CDM"}], "standard_charges": [{"gross_charge": 977.0, "discounted_cash": 341.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH DESARA BLUE SLING FOR FEMALE STRESS URINARY INCONTINENCE CAL-DS01B", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "CAL-DS01B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1728.0, "discounted_cash": 604.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH ENVELOPE TYREX ABSORBABLE ANITIBACTERIAL MEDIUM 2.5 X 2.7IN", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "NMRM6122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1718.0, "discounted_cash": 601.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA 10IN X 14IN FLAT SHEET STRL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "112660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA 12CM X 8CM OVAL DOUBLE LAYER PATCH", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "10201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1106.0, "discounted_cash": 387.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA 3IN X 6IN PARTIALLY ABSORBABLY REPAIR ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UMR3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA 5.3IN X 3.1IN LFT MED LIGHT WT LG PORE BARD 3DMAX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "117310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA 6IN X 6IN PARTIALLY ABSORBABLY REPAIR ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UMM3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA 9IN X 7IN VENTRAL ELLIPTICAL LIGHTWEIGHT STRL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5954790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2572.0, "discounted_cash": 900.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA PROLENE 4CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "phse6", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 790.0, "discounted_cash": 276.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA SYMBOTEX 25 X 15 MONOFILAMENT ABSORB COLLAGEN/ MARKING", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "SYM2515E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2463.0, "discounted_cash": 862.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PERFIX PLUG SMALL 0112950", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "112950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH POC 9 CM CIRC OPTIMIZED COMPOSITE PARIETEX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PCO9X", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 684.0, "discounted_cash": 239.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PROCEED 6X6 SQUARE NO RETURN PCDM1", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PCDM1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1332.0, "discounted_cash": 466.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PROCEED VENTRAL PATCH MD CIR 2.5 PVPM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PVPM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1231.0, "discounted_cash": 430.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PROCEED VENTRAL PATCH SM CIR 1.7 PVPS", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PVPS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1029.0, "discounted_cash": 360.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PROLENE 6IN X 6IN HERNIA REPAIR KNITTED STRL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PMH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PROLENE KEYHOLE 1 X 4", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PMSK", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 199.0, "discounted_cash": 69.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH REPAIR 6IN X 6IN HERNIA FLAT SHEET GROIN", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "112720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 41.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH RESTRATA 3.8CMX50.CM RMESH-1.5X2", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "RMESH-1.5X2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2936.0, "discounted_cash": 1027.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH RIGHT 15CM X 10CM ANATOMICAL MONOFILAMENT POLY ABSRB POLY ACID", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "LPG1510AR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1124.0, "discounted_cash": 393.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SLING SYSTEM SUPRIS RETROPUBIC", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "93-4450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1597.0, "discounted_cash": 558.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 1.7IN SM CIRC W/ STRP VENTRALEX ST", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5950007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 788.0, "discounted_cash": 275.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 10CM X 15CM SLF FIXATING BILATERAL ANATOMICAL LAP PROGRIP", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "LPG1510AK2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 944.0, "discounted_cash": 330.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 10IN X 13IN OVAL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PCDT1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5805.0, "discounted_cash": 2031.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 10IN X 8IN ELLIPTICAL HERNIA REPAIR VENTRALIGHT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5954810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3045.0, "discounted_cash": 1065.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 12IN X 12IN 30CM X 30CM NONABSORBABLE PROLENE STRL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PML", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 426.0, "discounted_cash": 149.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 12IN X 8IN TISSUE SEPARATING BIORESORBABLE HERNIA REPAIR PROCEED STRL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PCDJ1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4099.0, "discounted_cash": 1434.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 15CM X 10CM OPTIMIZED COMPOSITE PARIETEX", "code_information": [{"code": "PCO1510X", "type": "CDM"}], "standard_charges": [{"gross_charge": 938.0, "discounted_cash": 328.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 2.16IN X 4.92IN LG UNDYED EXTENDED OVERLAY DIAMOND KNITTED POLYPROPOLE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3DPL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 811.0, "discounted_cash": 283.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 2.5IN MED CIRC W/ STRP VENTRALEX ST", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5950008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 945.6, "discounted_cash": 330.96, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 3.2IN LG CIRC W/ STRP VENTRALEX ST", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5950009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1260.8, "discounted_cash": 441.28, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 3DMAX 5.3X3.1IN RT ABD HRN LTWT LG PORE KNIT MFL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "117320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 3IN X 6INC TISSUE SEPARATING FOR HERNIA REPAIR PROCEED", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PCDR1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 819.0, "discounted_cash": 286.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 4.5IN HERNIA CIRC PATCH TISSUE REGENERATION HYDROGEL VENTRIO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5950020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 4.5IN HERNIA REPAIR TISSUE REGENERATION CIRC VENTRALIGHT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5954450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1393.0, "discounted_cash": 487.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 4IN X 6IN TISSUE SEPARATING BIOABSORBABLE COMPONENT FLEXIBLE OVAL NONA", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PCDN1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1308.0, "discounted_cash": 457.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 5.5IN X 4.3IN MED OVAL HERNIA REPAIR", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5950040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1706.0, "discounted_cash": 597.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 5IN X 3IN LFT MED HERNIA REPAIR NONABSORBABLE PATCH BARD 3DMAX STRL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "115310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2050.0, "discounted_cash": 717.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 5IN X 3IN LFT MED HERNIA REPAIR NONABSORBABLE PATCH BARD 3DMAX STRL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "115310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 341.2, "discounted_cash": 119.42, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 6.2IN X 4.1IN LFT LG LIGHT WT LG PORE BARD 3DMAX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "117311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 426.0, "discounted_cash": 149.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 6.2IN X 4.1IN RIGHT LG HERNIA REPAIR LIGHTWEIGHT LG PORE BARD 3DMAX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "117321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 426.0, "discounted_cash": 149.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 6IN X 3IN FLAT SHEET HERNIA PATCH", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "112680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 6IN X 4IN ELLIPTICAL VENTRALIGHT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5954460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1071.0, "discounted_cash": 374.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 6IN X 8IN HERNIA REPAIR WOUND CARE COMPOSIX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "123680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 616.0, "discounted_cash": 215.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 6IN X 8IN OVAL TISSUE SEPARATING PROCEDE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PCDG1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2368.0, "discounted_cash": 828.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 7IN X 5.4IN LG HERNIA OVAL VENTRIO SEPRA TECH", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5950050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2215.0, "discounted_cash": 775.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 8CM X 12CM LFT ANATOMICAL PARIETEX PROGRIP", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "TEM1208GL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 682.0, "discounted_cash": 238.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 8CM X 12CM RIGHT PARIETEX PROGRIP", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "TEM1208GR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 682.0, "discounted_cash": 238.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 8IN X 10IN BIORESORBABLE HERNIA REPAIR LIGHTWEIGHT LAMINATE TISSUE SEP", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PCDH1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3830.0, "discounted_cash": 1340.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 8IN X 6.8IN ELLIPSE HERNIA VENTRALIGHT STRL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5954680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2035.0, "discounted_cash": 712.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG LG 4.3IN X 6.3IN LFT HERNIA REPAIR 3DMAX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "115311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG LG 4.3IN X 6.3IN RT HERNIA REPAIR PREFORMED KNITTED PP 3DMAX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "115321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 303.0, "discounted_cash": 106.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG MRLX 4X1.8IN GROIN HRN PTCH PSHP KNTD STRL PP", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "112700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG PARIETEX ROUND 9CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "SYM9", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 772.0, "discounted_cash": 270.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG PROLENE KEYHOLE 12IN X 12IN 30CM X 30CM NONABSORBABLE STRL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PMLK", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURGICAL 6IN OVAL WITH ECHO PS POSITIONING SYSTEM VENTRALIGHT ST", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5955600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1664.0, "discounted_cash": 582.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SUT 3IN X 6IN HERNIA NON ABSORBL FLAT SOFT UNDYED SHEETS CUTINTO ANY DESIRE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PMII", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 56.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SYMBOTEX 15 X 10 SYM1510", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "SYM1510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 962.0, "discounted_cash": 336.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SYMBOTEX COMPOSITE 12 CM SYM12", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "SYM12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1102.0, "discounted_cash": 385.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH TISSUE SEPARATING PHYSIOMESH OPEN 10 X 10CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "OPHY1010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 921.0, "discounted_cash": 322.35, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH TISSUE SEPARATING PHYSIOMESH OPEN 12X15 CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "OPHY1215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1435.0, "discounted_cash": 502.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH TISSUE SEPARATING PHYSIOMESH OPEN 15 X 25CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "OPHY1525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4317.0, "discounted_cash": 1510.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH TISSUE SEPARATING PHYSIOMESH OPEN 20 X 30CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "OPHY2030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4599.0, "discounted_cash": 1609.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH TISSUE SEPARATING PHYSIOMESH OPEN 25 X 37.5CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "OPHY2536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6054.0, "discounted_cash": 2118.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH ULTRAPRO 10CM X 15CM ADVANCED", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UPA31015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 359.0, "discounted_cash": 125.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH ULTRAPRO POLYPROYLENE NONABSORBABLE PLUG SM 3CM X 5CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UPPS2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH VENTRALIGHT 4.5IN CIRCLE ST PS ECHO PS POSITIONING SYSTEM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5955450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1195.0, "discounted_cash": 418.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH VENTRALIGHT 4IN X 6IN CIRCLE ST PS ECHO PS POSITIONING SYSTEM 5955460", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5955460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1095.0, "discounted_cash": 383.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH VICRYL KNITTED 6X6 VKMM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "VKMM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 858.0, "discounted_cash": 300.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MESHSYMBOTEX 17 X 10 CM ELLIPTICAL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "SYM1710E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1010.0, "discounted_cash": 353.5, "setting": "both", "billing_class": "facility"}]}, {"description": "META-NAIL TIBIAL 13MM X 32CM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71655332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6829.0, "discounted_cash": 2390.15, "setting": "both", "billing_class": "facility"}]}, {"description": "METABOLIC PANEL IONIZED CA", "code_information": [{"code": "80047", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METACARPAL REAMER", "code_information": [{"code": "120-01000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1147.0, "discounted_cash": 401.45, "setting": "both", "billing_class": "facility"}]}, {"description": "METATARSECTOMY 28140", "code_information": [{"code": "28140", "type": "CPT"}, {"code": "1481300", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METER GLUCOSE BLOOD STRIPS ACCU CHEK", "code_information": [{"code": "5144418160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "METHERGINE 0.2 MG/ML INECTION", "code_information": [{"code": "MED0234", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "METHYLENE BLUE 1% 10 MG/1 ML", "code_information": [{"code": "MED0140", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "METHYLENE BLUE 1% 100 MG/10 ML", "code_information": [{"code": "MED0141", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 159.25, "setting": "both", "billing_class": "facility"}]}, {"description": "METHYLENE BLUE 50 MG/10 ML INJ SOLN", "code_information": [{"code": "MED0794", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "METHYLENEDIOXYAMPHETAMINES", "code_information": [{"code": "80359", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLPHENIDATE", "code_information": [{"code": "80360", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLPREDNISOLONE (DEPO-MEDROL) 40MG 1ML", "code_information": [{"code": "MED0142", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "METHYLPREDNISOLONE (SOLU-MEDROL) 125MG/2ML VIAL", "code_information": [{"code": "MED0144", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "METYRAPONE PANEL", "code_information": [{"code": "80436", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 140.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 232.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 365.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 365.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 365.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 131.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 131.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MGMT GENE PRMTR MTHYLTN ALYS", "code_information": [{"code": "81287", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 155.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 317.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 499.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 499.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 499.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 179.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 179.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIBM BUT NO DX OF BREAST CA", "code_information": [{"code": "G8946", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICA BURR 2 X 12MM", "code_information": [{"code": "57SR0212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1019.51, "discounted_cash": 356.83, "setting": "both", "billing_class": "facility"}]}, {"description": "MICA BURR 2 X 20MM", "code_information": [{"code": "57SR0220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1019.51, "discounted_cash": 356.83, "setting": "both", "billing_class": "facility"}]}, {"description": "MICA CANN. DRILL BIT 3MM X 60MM", "code_information": [{"code": "57S00030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 642.91, "discounted_cash": 225.02, "setting": "both", "billing_class": "facility"}]}, {"description": "MICA SCREW 3MM X 42MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S03042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MICA WEDGE BURR 3.1 X 13MM", "code_information": [{"code": "57SW3113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1019.51, "discounted_cash": 356.83, "setting": "both", "billing_class": "facility"}]}, {"description": "MICRO-SPONGE VECTRA F DRUG DELIVERY 9210864", "code_information": [{"code": "9210864", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 398.75, "discounted_cash": 139.56, "setting": "both", "billing_class": "facility"}]}, {"description": "MICRO-STENT INJECT W TRABECULAR MICRO-BYPASS SYSTEM G2-W", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "G2-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3686.0, "discounted_cash": 1290.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPT MACROBROTH", "code_information": [{"code": "87188", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPT MYCOBACTERI", "code_information": [{"code": "87190", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE DIFFUSE", "code_information": [{"code": "87181", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE DISK", "code_information": [{"code": "87184", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE ENZYME", "code_information": [{"code": "87185", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE MIC", "code_information": [{"code": "87186", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE MLC", "code_information": [{"code": "87187", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 50.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 102.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 161.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 161.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 161.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 57.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 57.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROCUVETTE TST 10 MICROLITER HEMOGLOBIN FOR USE W/ HEMOCUE HB 201 HEMOGLOBIN A", "code_information": [{"code": "111716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MICRODISSECTION LASER", "code_information": [{"code": "88380", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 201.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 316.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 316.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 316.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 116.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 124.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 104.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 104.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICRODISSECTION MANUAL", "code_information": [{"code": "88381", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 331.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 521.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 521.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 521.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 267.6, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 284.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 252.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 252.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICRODOSE INJECTION KIT 3275", "code_information": [{"code": "3275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROFLUID ANALY TEARS", "code_information": [{"code": "83861", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 90.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 90.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 90.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 32.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROFORCEPS ECKARDT END-GRIPPING 23GA/0.6MM", "code_information": [{"code": "1286.WD06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 419.0, "discounted_cash": 146.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROLINE RE-NEW II ENDOCUT SCISSOR TIP 16.51MM : 5.0MM", "code_information": [{"code": "3142R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROPORE SURGICAL TAPE MMM15301Z", "code_information": [{"code": "MMM15301Z", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROSATELLITE INSTABILITY", "code_information": [{"code": "81301", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 446.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 888.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1397.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1397.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1397.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 501.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 501.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROSOMAL ANTIBODY EACH", "code_information": [{"code": "86376", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROSURGICAL TECHNIQUES REQUIRING USE OF OPERATING MICROSCOPE 69990", "code_information": [{"code": "69990", "type": "CPT"}, {"code": "1481302", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROVOLT T-WAVE ASSESS", "code_information": [{"code": "93025", "type": "CPT"}], "standard_charges": [{"minimum": 505.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 505.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 794.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 794.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 794.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROWAVE BRONCH, 3D, EBUS", "code_information": [{"code": "C9751", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROWAVE THERMOTHERAPY PROSTATE TRANSURETHRAL 53850", "code_information": [{"code": "53850", "type": "CPT"}, {"code": "1481303", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2554.0, "maximum": 9675.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIDAZOLAM 2MG/2ML INJECTION PF VIAL", "code_information": [{"code": "MED0238", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MIDDLE CEREBRAL ARTERY ECHO", "code_information": [{"code": "76821", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 131.84, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 140.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIDDLE EAR EXPLORATION THROUGH POSTAURICULAR OR EAR CANAL INCISION 69440", "code_information": [{"code": "69440", "type": "CPT"}, {"code": "1481304", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIDFOOT LAPILOCK SYSTEM MF-LL-7000", "code_information": [{"code": "MF-LL-7000", "type": "CDM"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MILL DISPOSABLE MED 5400-701-000", "code_information": [{"code": "5400-701-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 670.91, "discounted_cash": 234.82, "setting": "both", "billing_class": "facility"}]}, {"description": "MILOOP 303071-9009-00", "code_information": [{"code": "303071-9009-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MINERAL OIL 100% 10ML", "code_information": [{"code": "MED0145", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MINI SUTURE-TAK DISPOSABLE KIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1322DS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MINITAPE BLUE 39.5", "code_information": [{"code": "72205127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 367.0, "discounted_cash": 128.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": [{"code": "663", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9729.76, "maximum": 16703.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9729.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13915.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15307.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16703.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINOR BLADDER PROCEDURES WITH MCC", "code_information": [{"code": "662", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17867.6, "maximum": 30674.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17867.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25554.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28109.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 30674.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINOR BLADDER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "664", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7201.06, "maximum": 12362.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7201.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10299.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11328.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12362.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINOR BLUNT TRAUMA W/HEAD CT", "code_information": [{"code": "G9529", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "606", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9198.1, "maximum": 15790.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9198.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13155.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14470.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15790.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "607", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5037.94, "maximum": 8648.89, "estimated_discounted_cash": 27318.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5037.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7205.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7925.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8648.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [{"code": "345", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9603.84, "maximum": 16487.41, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9603.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13735.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15109.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16487.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [{"code": "344", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17144.33, "maximum": 29432.55, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17144.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24520.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26972.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29432.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "346", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7758.26, "maximum": 13319.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7758.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11095.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12205.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13319.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MIOCHOL-E INTRAOCULAR SOLUTION", "code_information": [{"code": "MED0146", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 178.0, "discounted_cash": 62.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MIOSTAT 0.01% 1.5 ML OPHTHALMIC SOLUTION", "code_information": [{"code": "MED0147", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MIRROR CLEAN", "code_information": [{"code": "MED0241", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 20.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC", "code_information": [{"code": "640", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7486.96, "maximum": 12853.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7486.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10707.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11778.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12853.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC", "code_information": [{"code": "641", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4587.8, "maximum": 7876.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4587.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6561.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7217.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7876.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MISOPROSTOL 100 MCG TABLETS 43386-160-06", "code_information": [{"code": "MED 43386-160-06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MISSING HB A1C LEVEL", "code_information": [{"code": "M1212", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIT STEN, VALVE OR TRANS AF", "code_information": [{"code": "G9746", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MITOCHONDRIAL ANTIBODY EACH", "code_information": [{"code": "86381", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MITOCHONDRIAL GENE", "code_information": [{"code": "81440", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 13329.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4155.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8476.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13329.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13329.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13329.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4786.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4786.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MITOMYCIN 0.2MG/ML OPHTHALMIC INJECTION", "code_information": [{"code": "MED0335", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MITOMYCIN 40MG/40ML IRRIGATION", "code_information": [{"code": "MED0528", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 482.0, "discounted_cash": 168.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MITOMYCIN 40MG/50ML IRRIGATION (MEDID)", "code_information": [{"code": "MED0595", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 589.0, "discounted_cash": 206.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MITOMYCIN 40MG/80ML IRRIGATION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9281", "type": "HCPCS"}, {"code": "MED0529", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 803.0, "discounted_cash": 281.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MITOMYCIN 40MG/80ML IRRIGATION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9281", "type": "HCPCS"}, {"code": "MED0529", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 803.0, "discounted_cash": 281.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MIX BONE 2.5MM CRUSH GENIN IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PHG-02C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3286.0, "discounted_cash": 1150.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MIX CRUSH 2.5MM BONE GRAFT", "code_information": [{"code": "HG-02C", "type": "CDM"}], "standard_charges": [{"gross_charge": 1687.0, "discounted_cash": 590.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MIX CRUSH 5CC BONE MATRIX TENSIX STRL IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PHG-05C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4274.0, "discounted_cash": 1495.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MIXER CEMENT AUTOPLEX M4 MIXER WITH VERTAPLEX HV 0707-000-000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "707-000-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1722.5, "discounted_cash": 602.88, "setting": "both", "billing_class": "facility"}]}, {"description": "MIXER SYSTEM BONE CEMENT MIXEVAC III SMALL SPATULA MIXER STERILE LATEX FREE", "code_information": [{"code": "206020000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.0, "discounted_cash": 47.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MIXING BOWL VACUUM 71271801", "code_information": [{"code": "71271801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MIXOR VAC SYS.W/SYRINGE 71270020", "code_information": [{"code": "71270020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 81.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MLH1 GENE", "code_information": [{"code": "81288", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 240.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 490.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 771.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 771.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 771.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 276.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 276.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE DUP/DELETE VARIANT", "code_information": [{"code": "81294", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 516.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 811.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 811.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 811.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 291.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 291.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE FULL SEQ", "code_information": [{"code": "81292", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 844.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1722.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 972.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 972.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE KNOWN VARIANTS", "code_information": [{"code": "81293", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 413.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 844.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1327.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1327.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1327.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 476.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 476.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MLH1 MRNA SEQ ALYS", "code_information": [{"code": "158U", "type": "CPT"}], "standard_charges": [{"minimum": 407.35, "maximum": 2708.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1722.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MLT FAM GRP BHV TRAIN 1ST 60", "code_information": [{"code": "96202", "type": "CPT"}], "standard_charges": [{"minimum": 101.74, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MLT FAM GRP BHV TRAIN EA ADD", "code_information": [{"code": "96203", "type": "CPT"}], "standard_charges": [{"minimum": 28.62, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MLX 9X38X28MM 12DEG 2093828", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "2093828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6980.0, "discounted_cash": 2443.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MMR VACCINE SC", "code_information": [{"code": "90707", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MMRV VACCINE SC", "code_information": [{"code": "90710", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ I-ARTIC RX DEV", "code_information": [{"code": "20704", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ IMED RX DEV", "code_information": [{"code": "20702", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNPJ OF TMJ W/ANESTH", "code_information": [{"code": "21073", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNT SUBS TX FOR CHANGE DX", "code_information": [{"code": "G0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 130.32, "maximum": 204.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 204.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 204.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 204.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNTAL/BEHAV/PSYCH HLTH SS", "code_information": [{"code": "G4013", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG 1ST 2 HRS", "code_information": [{"code": "495T", "type": "CPT"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG EA ADDL HR", "code_information": [{"code": "496T", "type": "CPT"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNTR PSYCHDLC MED 1STPHY/QHP", "code_information": [{"code": "820T", "type": "CPT"}], "standard_charges": [{"minimum": 699.29, "maximum": 1098.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 699.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1098.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1098.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1098.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNTR PSYCHDLC MED 2NDPHY/QHP", "code_information": [{"code": "821T", "type": "CPT"}], "standard_charges": [{"minimum": 346.49, "maximum": 544.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 346.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 544.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 544.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 544.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNTR PSYCHDLC MED CLN STAFF", "code_information": [{"code": "822T", "type": "CPT"}], "standard_charges": [{"minimum": 346.49, "maximum": 544.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 346.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 544.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 544.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 544.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBILIZATION OF COLON", "code_information": [{"code": "44139", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD OR SEVERE OSA", "code_information": [{"code": "G8846", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH PHYS/QHP 5/>YRS", "code_information": [{"code": "99156", "type": "CPT"}], "standard_charges": [{"minimum": 356.02, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 356.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 559.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 559.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 559.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH PHYS/QHP <5 YRS", "code_information": [{"code": "99155", "type": "CPT"}], "standard_charges": [{"minimum": 403.69, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 403.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 634.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 634.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 634.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTHER PHYS/QHP EA", "code_information": [{"code": "99157", "type": "CPT"}], "standard_charges": [{"minimum": 289.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 289.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 454.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 454.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 454.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHYS/QHP 5/>YRS", "code_information": [{"code": "99152", "type": "CPT"}], "standard_charges": [{"minimum": 55.61, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHYS/QHP <5 YRS", "code_information": [{"code": "99151", "type": "CPT"}], "standard_charges": [{"minimum": 114.44, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHYS/QHP EA", "code_information": [{"code": "99153", "type": "CPT"}], "standard_charges": [{"minimum": 47.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SEDAT ENDO SERVICE >5YRS", "code_information": [{"code": "G0500", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.45, "maximum": 39.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MODIFICATION OF CONTACT LENS", "code_information": [{"code": "92325", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB CBA EACH", "code_information": [{"code": "86362", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86363", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE H/N/HF/G", "code_information": [{"code": "17311", "type": "CPT"}], "standard_charges": [{"minimum": 869.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE T/A/L", "code_information": [{"code": "17313", "type": "CPT"}], "standard_charges": [{"minimum": 869.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE", "code_information": [{"code": "17312", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE T/A/L", "code_information": [{"code": "17314", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS SURG ADDL BLOCK", "code_information": [{"code": "17315", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLEC FLUOR IMG SUS NEV 1ST", "code_information": [{"code": "700T", "type": "CPT"}], "standard_charges": [{"minimum": 1106.05, "maximum": 1738.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1106.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1738.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1738.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1738.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLEC FLUOR IMG SUS NEV EA", "code_information": [{"code": "701T", "type": "CPT"}], "standard_charges": [{"minimum": 4.37, "maximum": 6.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATHOLOGY INTERPR", "code_information": [{"code": "G0452", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 75.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 8.02, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 8.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MON ANESTH CARE", "code_information": [{"code": "G9654", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONITORING KIT PRESS W/TRANS 84\" (5 42585-05", "code_information": [{"code": "42585-05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MONOCYTE DSTRBJ WDTH WHL BLD", "code_information": [{"code": "427U", "type": "CPT"}], "standard_charges": [{"minimum": 18.16, "maximum": 28.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONONUCLEAR CELL ANTIGEN", "code_information": [{"code": "86356", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 107.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 107.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 107.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONOPTY DISPOSABLE CORE BIOPSY INSTRUMENT 18G X 20CM 121820", "code_information": [{"code": "121820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1313.0, "discounted_cash": 459.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MONSEL'S SOLUTION 30ML SOLUTION", "code_information": [{"code": "MED0148", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MONSEL'S SOLUTION 8ML", "code_information": [{"code": "MED0524", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 1", "code_information": [{"code": "81400", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 79.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 163.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 256.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 256.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 256.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 92.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 92.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 2", "code_information": [{"code": "81401", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 171.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 3", "code_information": [{"code": "81402", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 187.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 383.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 602.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 602.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 602.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 216.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 216.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 4", "code_information": [{"code": "81403", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 231.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 472.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 5", "code_information": [{"code": "81404", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 343.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 6", "code_information": [{"code": "81405", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 376.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 768.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 7", "code_information": [{"code": "81406", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 353.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 721.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 8", "code_information": [{"code": "81407", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1057.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2157.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3393.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3393.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3393.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1218.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1218.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 9", "code_information": [{"code": "81408", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2500.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8020.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8020.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8020.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPS PATELLA LEFT OC MOPS15", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MOPS15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18270.0, "discounted_cash": 6394.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MORCELLATOR TISSUE HND PIECE MORCELLEX", "code_information": [{"code": "C1782", "type": "HCPCS"}, {"code": "MX0100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1640.0, "discounted_cash": 574.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MORPHINE 4MG/ML 1ML", "code_information": [{"code": "MED0339", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MORPHINE PCA 50MG/50ML", "code_information": [{"code": "MED0229", "type": "CDM"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MORPHINE PF/DURAMORPH 10MG/10ML", "code_information": [{"code": "MED0149", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MORPHINE/DURAMORPH 5MG/10ML", "code_information": [{"code": "MED0150", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MOST RCT BP </= 140/90", "code_information": [{"code": "G9788", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOST RCT BP >/= 140/90", "code_information": [{"code": "G9790", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOST RCT TOB STAT FREE", "code_information": [{"code": "G9791", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOST RCT TOB STAT NOT FREE", "code_information": [{"code": "G9792", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOST RECENT ASSESS VOL MGMT", "code_information": [{"code": "G8955", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOTION ANALYSIS VIDEO/3D", "code_information": [{"code": "96000", "type": "CPT"}], "standard_charges": [{"minimum": 432.31, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 432.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 679.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 679.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 679.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOTION FLUOROSCOPY/SWALLOW", "code_information": [{"code": "92611", "type": "CPT"}], "standard_charges": [{"minimum": 405.28, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 405.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 636.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 636.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 636.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOTION TEST W/FT PRESS MEAS", "code_information": [{"code": "96001", "type": "CPT"}], "standard_charges": [{"minimum": 580.09, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 580.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 911.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 911.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 911.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOTOCLIP FUSION SYSTEM 12X12X12MM SUPER ELASTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1412-1212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3904.0, "discounted_cash": 1366.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MOTOR &/ SENS NRVE CNDJ TEST", "code_information": [{"code": "95905", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOTR COG VR GAIT TRAIN EA 15", "code_information": [{"code": "791T", "type": "CPT"}], "standard_charges": [{"minimum": 136.67, "maximum": 214.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 136.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOUTH PROCEDURES WITH CC/MCC", "code_information": [{"code": "137", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9183.51, "maximum": 15765.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9183.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13134.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14447.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15765.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOUTH PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "138", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5210.09, "maximum": 8944.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5210.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7451.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8196.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8944.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOUTHPIECE NBLZR 10 ML 7FT TUBING STANDARD CONNECTOR SM VOLUME TEE ADAPTER AIRLI", "code_information": [{"code": "2435", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MOUTHPIECE PATIENT 59FR WITHOUT FOAM W/ STRP ADLT", "code_information": [{"code": "H336N60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MOXEZA OPHTHALMIC 0.5% 3ML", "code_information": [{"code": "MED0598", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 136.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MOXIFLOXACIN 0.5% OPHTHALMIC DROPS 3 ML", "code_information": [{"code": "MED0299", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 401.0, "discounted_cash": 140.35, "setting": "both", "billing_class": "facility"}]}, {"description": "MPACT FLAT LINER HC 36/F 01.32.3648HCT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1.32.3648HCT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1300.0, "discounted_cash": 455.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MPACT TWO HOLE CUP 56MM 01.32.156DH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1.32.156DH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MPJ IMPLANT ARSENAL RIGHT 300-82-002 300-82-002", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "300-82-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5974.0, "discounted_cash": 2090.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MPL GENE COMMON VARIANTS", "code_information": [{"code": "81338", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 383.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 602.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 602.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 602.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 216.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 216.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MPL GENE SEQ ALYS EXON 10", "code_information": [{"code": "81339", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 472.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MPM USED", "code_information": [{"code": "G2148", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MPSV4 VACCINE SUBQ", "code_information": [{"code": "90733", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR ANG LWR EXT W OR W/O DYE", "code_information": [{"code": "73725", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1346.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2116.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2116.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2116.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 619.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 659.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR ANGIO SPINE W/O&W/DYE", "code_information": [{"code": "72159", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1396.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2196.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2196.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2196.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 631.04, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 671.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR ANGIOGRAPHY NECK W/DYE", "code_information": [{"code": "70548", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 433.29, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 460.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR ELASTOGRAPHY", "code_information": [{"code": "76391", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 363.36, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 386.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR SPECTROSCOPY", "code_information": [{"code": "76390", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1626.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2557.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2557.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2557.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety determination by a physician or other qualified health care professional responsible for the safety of the MR procedure, including review of implant MR conditions for indicated MR examination, analysis of risk vs clinical benefit of performing M", "code_information": [{"code": "76016", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 384.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 604.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 604.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 604.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 109.3, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 116.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources (eg, surgical reports, imaging reports, medical device databases, device vendors, review o", "code_information": [{"code": "76014", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 107.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 168.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 168.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 168.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources (eg, surgical reports, imaging reports, medical device databases, device vendors, review o", "code_information": [{"code": "76015", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 235.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 370.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 370.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 370.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety implant electronics preparation under supervision of physician or other qualified health care professional, including MR-specific programming of pulse generator and/or transmitter to verify device integrity, protection of device internal circuit", "code_information": [{"code": "76018", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 401.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 630.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 630.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 630.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 192.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 205.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety implant positioning and/or immobilization under supervision of physician or other qualified health care professional, including application of physical protections to secure implanted medical device from MR-induced translational or vibrational f", "code_information": [{"code": "76019", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 259.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 408.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 408.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 408.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 295.03, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 313.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety medical physics examination customization, planning and performance monitoring by medical physicist or MR safety expert, with review and analysis by physician or other qualified health care professional to prioritize and select views and imaging", "code_information": [{"code": "76017", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1056.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1660.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1660.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1660.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 459.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 490.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR-STAPH DNA AMP PROBE", "code_information": [{"code": "87641", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Abdomen w/ + w/o Contrast 74185", "code_information": [{"code": "74185", "type": "CPT"}, {"code": "675636", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4647.0, "discounted_cash": 1626.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1907.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1907.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2352.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1725.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1352.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2126.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2126.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2126.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 621.39, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 660.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Abdomen w/ Contrast 74185", "code_information": [{"code": "74185", "type": "CPT"}, {"code": "675635", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4647.0, "discounted_cash": 1626.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1907.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1907.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2352.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1725.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1352.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2126.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2126.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2126.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 621.39, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 660.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Abdomen w/o Contrast 74185", "code_information": [{"code": "74185", "type": "CPT"}, {"code": "675662", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4647.0, "discounted_cash": 1626.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1907.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1907.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2352.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1725.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1352.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2126.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2126.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2126.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 621.39, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 660.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Chest w/ + w/o Contrast 71555", "code_information": [{"code": "71555", "type": "CPT"}, {"code": "675637", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4647.0, "discounted_cash": 1626.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1907.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1907.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2352.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1725.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1337.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2102.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2102.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2102.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 611.74, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 650.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Elbow w/ + w/o Contrast Bl 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572743", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 8109.0, "discounted_cash": 2838.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3328.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3328.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4105.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3011.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Elbow w/ + w/o Contrast Left 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572745", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4054.0, "discounted_cash": 1418.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2052.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1505.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Elbow w/ + w/o Contrast Right 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572747", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4054.0, "discounted_cash": 1418.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2052.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1505.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Forearm w/ + w/o Contrast Bl 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572755", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 8109.0, "discounted_cash": 2838.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3328.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3328.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4105.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3011.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Forearm w/ + w/o Contrast Left 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572757", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4054.0, "discounted_cash": 1418.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2052.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1505.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Forearm w/ + w/o Contrast Rt 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572759", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4054.0, "discounted_cash": 1418.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2052.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1505.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Hand w/ + w/o Contrast Bl 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572761", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 8109.0, "discounted_cash": 2838.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3328.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3328.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4105.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3011.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Hand w/ + w/o Contrast Left 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572763", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4054.0, "discounted_cash": 1418.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2052.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1505.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Hand w/ + w/o Contrast Right 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572765", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4054.0, "discounted_cash": 1418.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2052.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1505.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Head w/ + w/o Contrast 70546", "code_information": [{"code": "70546", "type": "CPT"}, {"code": "630719", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5079.0, "discounted_cash": 1777.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2084.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2084.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2571.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1886.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 639.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 680.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Head w/ Contrast 70545", "code_information": [{"code": "70545", "type": "CPT"}, {"code": "630721", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4647.0, "discounted_cash": 1626.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1907.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1907.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2352.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1725.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 422.04, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 448.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Head w/o Contrast 70544", "code_information": [{"code": "70544", "type": "CPT"}, {"code": "630723", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1032.0, "discounted_cash": 361.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 383.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 392.29, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 417.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Humerus w/ + w/o Contrast Bl 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572773", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 8109.0, "discounted_cash": 2838.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3328.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3328.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4105.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3011.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Neck w/ + w/o Contrast 70549", "code_information": [{"code": "70549", "type": "CPT"}, {"code": "630737", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5079.0, "discounted_cash": 1777.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2084.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2084.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2571.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1886.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 642.3, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 683.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Neck w/o Contrast 70547", "code_information": [{"code": "70547", "type": "CPT"}, {"code": "630743", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1021.0, "discounted_cash": 357.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 419.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 419.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 516.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 379.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 393.08, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 418.28, "methodology": "fee schedule"}], "billing_class": "facility"}, {"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1032.0, "discounted_cash": 361.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 383.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 393.08, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 418.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Pelvis w/ + w/o contrast 72198", "code_information": [{"code": "72198", "type": "CPT"}, {"code": "1748452", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1348.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2119.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2119.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2119.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 624.6, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 664.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Shoulder w/ + w/o Contrast Bl 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572785", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 8109.0, "discounted_cash": 2838.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3328.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3328.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4105.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3011.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA Shoulder w/ + w/o Contrast Lt 73225", "code_information": [{"code": "73225", "type": "CPT"}, {"code": "1572787", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4054.0, "discounted_cash": 1418.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1664.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2052.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1505.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1344.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2114.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 605.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 643.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, ABD", "code_information": [{"code": "C8900", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, CHEST", "code_information": [{"code": "C8909", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, LWR EXT", "code_information": [{"code": "C8912", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, PELVIS", "code_information": [{"code": "C8918", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, ABD", "code_information": [{"code": "C8901", "type": "HCPCS"}], "standard_charges": [{"minimum": 1018.38, "maximum": 1600.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, CHEST", "code_information": [{"code": "C8910", "type": "HCPCS"}], "standard_charges": [{"minimum": 1018.38, "maximum": 1600.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, LWR EXT", "code_information": [{"code": "C8913", "type": "HCPCS"}], "standard_charges": [{"minimum": 1018.38, "maximum": 1600.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, PELVIS", "code_information": [{"code": "C8919", "type": "HCPCS"}], "standard_charges": [{"minimum": 1018.38, "maximum": 1600.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, ABD", "code_information": [{"code": "C8902", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, CHEST", "code_information": [{"code": "C8911", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, LWR EXT", "code_information": [{"code": "C8914", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, PELVIS", "code_information": [{"code": "C8920", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA, W/DYE, SPINAL CANAL", "code_information": [{"code": "C8931", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA, W/DYE, UPPER EXTREMITY", "code_information": [{"code": "C8934", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA, W/O DYE, SPINAL CANAL", "code_information": [{"code": "C8932", "type": "HCPCS"}], "standard_charges": [{"minimum": 1018.38, "maximum": 1600.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA, W/O DYE, UPPER EXTR", "code_information": [{"code": "C8935", "type": "HCPCS"}], "standard_charges": [{"minimum": 1018.38, "maximum": 1600.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA, W/O&W/DYE, SPINAL CANAL", "code_information": [{"code": "C8933", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA, W/O&W/DYE, UPPER EXTR", "code_information": [{"code": "C8936", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRCP", "code_information": [{"code": "S8037", "type": "HCPCS"}], "standard_charges": [{"minimum": 635.57, "maximum": 999.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 635.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 999.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 999.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 999.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRGFUS STRTCTC LES ABLTJ", "code_information": [{"code": "398T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRGFUS STRTCTC LES ABLTJ", "code_information": [{"code": "406U", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 11512.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI ABDOMEN W/DYE", "code_information": [{"code": "74182", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 543.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 577.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Abdomen w/ + w/o Contrast 74183", "code_information": [{"code": "74183", "type": "CPT"}, {"code": "625604", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 576.39, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 612.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Abdomen w/o Contrast 74181", "code_information": [{"code": "74181", "type": "CPT"}, {"code": "625612", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 313.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 333.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Ankle w/ + w/o Contrast Bl 73723", "code_information": [{"code": "73723", "type": "CPT"}, {"code": "625698", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 14296.0, "discounted_cash": 5003.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7238.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5309.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 692.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 736.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Ankle w/ + w/o Contrast Left 73723", "code_information": [{"code": "73723", "type": "CPT"}, {"code": "625700", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 692.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 736.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Ankle w/ + w/o Contrast Right 73723", "code_information": [{"code": "73723", "type": "CPT"}, {"code": "625702", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 692.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 736.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Ankle w/ Contrast Left 73722", "code_information": [{"code": "73722", "type": "CPT"}, {"code": "625706", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 3463.0, "discounted_cash": 1212.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1421.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1421.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1753.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1286.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 579.6, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 616.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Ankle w/ Contrast Right 73722", "code_information": [{"code": "73722", "type": "CPT"}, {"code": "625708", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6386.0, "discounted_cash": 2235.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2621.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2621.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3233.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2371.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 579.6, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 616.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Ankle w/o Contrast Bilateral 73721", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "625710", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 11093.0, "discounted_cash": 3882.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4553.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4553.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5616.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4119.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Ankle w/o Contrast Left 73721", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "625712", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Ankle w/o Contrast Right 73721", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "625714", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN STEM W/DYE", "code_information": [{"code": "70552", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 460.62, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 489.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W/DYE", "code_information": [{"code": "70558", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 881.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W/O & W/DYE", "code_information": [{"code": "70559", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 881.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W/O DYE", "code_information": [{"code": "70557", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2173.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3416.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3416.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3416.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C- BILATERAL", "code_information": [{"code": "77047", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 353.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 376.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C- UNILATERAL", "code_information": [{"code": "77046", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 355.31, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 377.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C-+ W/CAD BI", "code_information": [{"code": "77049", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1280.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2012.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2012.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2012.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 574.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C-+ W/CAD UNI", "code_information": [{"code": "77048", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1286.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2022.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2022.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2022.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.02, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 618.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus w/+w/o Left 72156", "code_information": [{"code": "72156", "type": "CPT"}, {"code": "41579580", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 521.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 554.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus w/+w/o Left 72156", "code_information": [{"code": "72156", "type": "CPT"}, {"code": "42634886", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 521.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 554.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus w/+w/o Right 72156", "code_information": [{"code": "72156", "type": "CPT"}, {"code": "41579579", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 521.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 554.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus w/+w/o Right 72156", "code_information": [{"code": "72156", "type": "CPT"}, {"code": "42634889", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 521.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 554.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus w/Contrast Lt 72142", "code_information": [{"code": "72142", "type": "CPT"}, {"code": "41579582", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1951.0, "discounted_cash": 682.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 987.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 724.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 469.46, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 499.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus w/Contrast Lt 72142", "code_information": [{"code": "72142", "type": "CPT"}, {"code": "42634898", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1951.0, "discounted_cash": 682.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 987.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 724.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 469.46, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 499.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus w/Contrast Rt 72142", "code_information": [{"code": "72142", "type": "CPT"}, {"code": "41579581", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1951.0, "discounted_cash": 682.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 987.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 724.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 469.46, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 499.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus w/Contrast Rt 72142", "code_information": [{"code": "72142", "type": "CPT"}, {"code": "42634892", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1951.0, "discounted_cash": 682.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 987.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 724.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 469.46, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 499.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus wo/Contrast Lt 72141", "code_information": [{"code": "72141", "type": "CPT"}, {"code": "41579585", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 298.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus wo/Contrast Lt 72141", "code_information": [{"code": "72141", "type": "CPT"}, {"code": "42634883", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 298.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus wo/Contrast Rt 72141", "code_information": [{"code": "72141", "type": "CPT"}, {"code": "41579583", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 298.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brachial Plexus wo/Contrast Rt 72141", "code_information": [{"code": "72141", "type": "CPT"}, {"code": "42634895", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 298.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brain w/ + w/o Contrast 70553", "code_information": [{"code": "70553", "type": "CPT"}, {"code": "627680", "type": "CDM"}, {"code": "611", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 520.11, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 553.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Brain w/o Contrast 70551", "code_information": [{"code": "70551", "type": "CPT"}, {"code": "627684", "type": "CDM"}, {"code": "611", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2379.0, "discounted_cash": 832.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 976.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 976.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1204.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 883.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 313.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 333.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI CHEST W/DYE", "code_information": [{"code": "71551", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 717.07, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 762.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI CHEST W/O & W/DYE", "code_information": [{"code": "71552", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 889.91, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 945.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Chest w/o Contrast 71550", "code_information": [{"code": "71550", "type": "CPT"}, {"code": "629712", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 653.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 694.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Clavicle w +w/o Contrast Bl 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "12693424", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Clavicle w +w/o Contrast Rt 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "12693422", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Clavicle w/o Contrast Left 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "12693417", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Clavicle w/o Contrast Right 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "12693415", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Elbow w/ + w/o Contrast Bl 73223", "code_information": [{"code": "73223", "type": "CPT"}, {"code": "630825", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 14296.0, "discounted_cash": 5003.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7238.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5309.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 695.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 739.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Elbow w/ + w/o Contrast Left 73223", "code_information": [{"code": "73223", "type": "CPT"}, {"code": "630828", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 695.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 739.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Elbow w/ + w/o Contrast Right 73223", "code_information": [{"code": "73223", "type": "CPT"}, {"code": "630831", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 695.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 739.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Elbow w/ Contrast Bilateral 73222", "code_information": [{"code": "73222", "type": "CPT"}, {"code": "630835", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 13283.0, "discounted_cash": 4649.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5452.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5452.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6725.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4933.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 575.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Elbow w/ Contrast Left 73222", "code_information": [{"code": "73222", "type": "CPT"}, {"code": "630839", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6639.0, "discounted_cash": 2323.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3361.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2465.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 575.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Elbow w/ Contrast Right 73222", "code_information": [{"code": "73222", "type": "CPT"}, {"code": "630841", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6639.0, "discounted_cash": 2323.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3361.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2465.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 575.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Elbow w/o Contrast Bilateral 73221", "code_information": [{"code": "73221", "type": "CPT"}, {"code": "630843", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 11093.0, "discounted_cash": 3882.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4553.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4553.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5616.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4119.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 367.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Elbow w/o Contrast Left 73221", "code_information": [{"code": "73221", "type": "CPT"}, {"code": "630845", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 367.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Elbow w/o Contrast Right 73221", "code_information": [{"code": "73221", "type": "CPT"}, {"code": "630849", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 367.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI FETAL EA ADDL GESTATION", "code_information": [{"code": "74713", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 622.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 977.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 977.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 977.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 274.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 292.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI FETAL SNGL/1ST GESTATION", "code_information": [{"code": "74712", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1006.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1582.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1582.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1582.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 656.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 698.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Face Neck Orbit w/ + w/o Cont 70543", "code_information": [{"code": "70543", "type": "CPT"}, {"code": "630853", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 584.41, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 621.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Face Neck Orbit w/o Contrast 70540", "code_information": [{"code": "70540", "type": "CPT"}, {"code": "630859", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2571.0, "discounted_cash": 899.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1055.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1055.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1301.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 954.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 400.34, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 425.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/ + w/o Contrast Bilat 73720", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "630861", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 13633.0, "discounted_cash": 4771.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6902.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5063.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 615.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/ + w/o Contrast Left 73720", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "630863", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 615.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/ + w/o Contrast Right 73720", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "630865", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 615.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/o Contrast Bilat 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "630873", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 10549.0, "discounted_cash": 3692.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5340.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3917.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 391.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 416.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/o Contrast Left 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "630875", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 391.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 416.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/o Contrast Right 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "630877", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 391.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 416.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Foot w/ + w/o Contrast Bl 73720", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "630879", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 13633.0, "discounted_cash": 4771.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6902.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5063.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 615.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Foot w/ + w/o Contrast Left 73720", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "630881", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 615.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Foot w/ + w/o Contrast Right 73720", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "630883", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 615.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Foot w/o Contrast Bilateral 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "630891", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 10549.0, "discounted_cash": 3692.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5340.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3917.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 391.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 416.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Foot w/o Contrast Left 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "630897", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 391.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 416.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Foot w/o Contrast Right 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "630901", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 391.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 416.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Forearm w/ + w/o Contrast Bl 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "630905", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 13633.0, "discounted_cash": 4771.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6902.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5063.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Forearm w/ + w/o Contrast Left 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "630909", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Forearm w/ + w/o Contrast Rt 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "630913", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Forearm w/o Contrast Bilateral 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "630931", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 10549.0, "discounted_cash": 3692.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5340.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3917.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Forearm w/o Contrast Left 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "630937", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Forearm w/o Contrast Right 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "630941", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI GDN PARNCHYMA TISS ABLTJ", "code_information": [{"code": "77022", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 968.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1522.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1522.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1522.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI GUIDANCE NDL PLMT RS&I", "code_information": [{"code": "77021", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1789.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2812.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2812.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2812.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 833.63, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 885.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hand w/ + w/o Contrast Bl 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "630951", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 13633.0, "discounted_cash": 4771.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6902.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5063.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hand w/ + w/o Contrast Left 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "630953", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hand w/ + w/o Contrast Right 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "630955", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hand w/o Contrast Bilateral 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "630970", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 10549.0, "discounted_cash": 3692.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5340.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3917.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hand w/o Contrast Left 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "630973", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hand w/o Contrast Right 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "630975", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hip w/ + w/o Contrast Bl 73723", "code_information": [{"code": "73723", "type": "CPT"}, {"code": "630979", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 14296.0, "discounted_cash": 5003.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7238.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5309.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 692.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 736.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hip w/ + w/o Contrast Left 73723", "code_information": [{"code": "73723", "type": "CPT"}, {"code": "630981", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 692.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 736.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hip w/ + w/o Contrast Right 73723", "code_information": [{"code": "73723", "type": "CPT"}, {"code": "630985", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 692.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 736.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hip w/ Contrast Left 73722", "code_information": [{"code": "73722", "type": "CPT"}, {"code": "630994", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 3463.0, "discounted_cash": 1212.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1421.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1421.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1753.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 579.6, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 616.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hip w/ Contrast Right 73722", "code_information": [{"code": "73722", "type": "CPT"}, {"code": "630999", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 3463.0, "discounted_cash": 1212.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1421.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1421.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1753.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1286.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 579.6, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 616.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hip w/o Contrast Bilateral 73721", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "631002", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 11093.0, "discounted_cash": 3882.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4553.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4553.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5616.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4119.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hip w/o Contrast Left 73721", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "631007", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Hip w/o Contrast Right 73721", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "631011", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Humerus w/ + w/o Contrast Bl 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "631015", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 13633.0, "discounted_cash": 4771.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6902.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5063.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Humerus w/ + w/o Contrast Left 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "631021", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Humerus w/ + w/o Contrast Rt 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "631027", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Humerus w/o Contrast Bilateral 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "631062", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 10549.0, "discounted_cash": 3692.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5340.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3917.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}, {"minimum": 0.51, "maximum": 8450.0, "gross_charge": 10551.0, "discounted_cash": 3692.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4331.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4331.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5341.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3918.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Humerus w/o Contrast Left 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "631069", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Humerus w/o Contrast Right 73218", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "631073", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Knee w/ + w/o Contrast Bl 73723", "code_information": [{"code": "73723", "type": "CPT"}, {"code": "631079", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 14296.0, "discounted_cash": 5003.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7238.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5309.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 692.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 736.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Knee w/ + w/o Contrast Left 73723", "code_information": [{"code": "73723", "type": "CPT"}, {"code": "631083", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 692.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 736.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Knee w/ + w/o Contrast Right 73723", "code_information": [{"code": "73723", "type": "CPT"}, {"code": "631088", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 692.95, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 736.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Knee w/ Contrast Right 73722", "code_information": [{"code": "73722", "type": "CPT"}, {"code": "631101", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 3463.0, "discounted_cash": 1212.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1421.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1421.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1753.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1286.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 579.6, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 616.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Knee w/o Contrast Bilateral 73721", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "631108", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 11093.0, "discounted_cash": 3882.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4553.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4553.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5616.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4119.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Knee w/o Contrast Left 73721", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "631113", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Knee w/o Contrast Right", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "631121", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI LOWER EXTREMITY W/DYE", "code_information": [{"code": "73719", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 459.01, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 488.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI ORBIT/FACE/NECK W/DYE", "code_information": [{"code": "70542", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 470.27, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 500.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Pelvis w/ + w/o Contrast 72197", "code_information": [{"code": "72197", "type": "CPT"}, {"code": "631199", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 573.18, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 609.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Pelvis w/ Contrast 72196", "code_information": [{"code": "72196", "type": "CPT"}, {"code": "631203", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2271.0, "discounted_cash": 794.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 932.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 932.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1149.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 843.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 461.43, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 490.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Pelvis w/o Contrast 72195", "code_information": [{"code": "72195", "type": "CPT"}, {"code": "631208", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 392.29, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 417.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Sacrum/Coccyx w + w/o Contrast 72197", "code_information": [{"code": "72197", "type": "CPT"}, {"code": "42887939", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 573.18, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 609.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Sacrum/Coccyx w + w/o Contrast 72197", "code_information": [{"code": "72197", "type": "CPT"}, {"code": "42887940", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 573.18, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 609.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Sacrum/Coccyx w/o Contrast 72195", "code_information": [{"code": "72195", "type": "CPT"}, {"code": "42887931", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 392.29, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 417.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Sacrum/Coccyx w/o Contrast 72195", "code_information": [{"code": "72195", "type": "CPT"}, {"code": "42887932", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 392.29, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 417.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Scapula w +w/o Contrast Right 73220", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "12693432", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Shoulder w/ + w/o Contrast Bl 73223", "code_information": [{"code": "73223", "type": "CPT"}, {"code": "631215", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 14296.0, "discounted_cash": 5003.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7238.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5309.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 695.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 739.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Shoulder w/ + w/o Contrast Lt 73223", "code_information": [{"code": "73223", "type": "CPT"}, {"code": "631217", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 695.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 739.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Shoulder w/ + w/o Contrast Rt 73223", "code_information": [{"code": "73223", "type": "CPT"}, {"code": "631219", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 695.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 739.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Shoulder w/ Contrast Bilateral 73222", "code_information": [{"code": "73222", "type": "CPT"}, {"code": "631221", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 13283.0, "discounted_cash": 4649.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5452.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5452.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6725.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4933.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 575.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Shoulder w/ Contrast Left 73222", "code_information": [{"code": "73222", "type": "CPT"}, {"code": "631227", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6639.0, "discounted_cash": 2323.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3361.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2465.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 575.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Shoulder w/ Contrast Right 73222", "code_information": [{"code": "73222", "type": "CPT"}, {"code": "631233", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6639.0, "discounted_cash": 2323.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3361.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2465.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 575.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Shoulder w/o Contrast Bl 73221", "code_information": [{"code": "73221", "type": "CPT"}, {"code": "631239", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 11093.0, "discounted_cash": 3882.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4553.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4553.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5616.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4119.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 367.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Shoulder w/o Contrast Left 73221", "code_information": [{"code": "73221", "type": "CPT"}, {"code": "631245", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 367.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Shoulder w/o Contrast Right 73221", "code_information": [{"code": "73221", "type": "CPT"}, {"code": "631251", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 367.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Signature Knee w/o contrast L 73721", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "42604170", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Signature Knee w/o contrast L 73721", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "42604172", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 366.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Spine Cervical w/ + w/o Cont 72156", "code_information": [{"code": "72156", "type": "CPT"}, {"code": "629594", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 521.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 554.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Spine Cervical w/ Contrast 72142", "code_information": [{"code": "72142", "type": "CPT"}, {"code": "629596", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1951.0, "discounted_cash": 682.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 800.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 987.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 724.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 469.46, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 499.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Spine Cervical w/o Contrast 72141", "code_information": [{"code": "72141", "type": "CPT"}, {"code": "629598", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 298.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Spine Lumbar w/ + w/o Contrast 72158", "code_information": [{"code": "72158", "type": "CPT"}, {"code": "631277", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 520.11, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 553.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Spine Lumbar w/ Contrast 72149", "code_information": [{"code": "72149", "type": "CPT"}, {"code": "631283", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 673.0, "discounted_cash": 235.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 276.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 276.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 340.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 249.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 458.2, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 487.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Spine Lumbar w/o Contrast 72148", "code_information": [{"code": "72148", "type": "CPT"}, {"code": "631287", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 299.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 318.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Spine Thoracic w/ + w/o Cont 72157", "code_information": [{"code": "72157", "type": "CPT"}, {"code": "631293", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 523.32, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 556.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Spine Thoracic w/ Contrast 72147", "code_information": [{"code": "72147", "type": "CPT"}, {"code": "631289", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6327.0, "discounted_cash": 2214.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2597.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2597.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3203.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2349.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 464.64, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 494.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Spine Thoracic w/o Contrast 72146", "code_information": [{"code": "72146", "type": "CPT"}, {"code": "631295", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5685.0, "discounted_cash": 1989.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2333.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2333.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2878.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2111.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 299.03, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 318.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Tibia/Fibula w/ + w/o Cont Bl 73720", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "631299", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 13633.0, "discounted_cash": 4771.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5596.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6902.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5063.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 615.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Tibia/Fibula w/ + w/o Cont Lt 73720", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "631301", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 615.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Tibia/Fibula w/ + w/o Cont Rt 73720", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "631305", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 615.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Tibia/Fibula w/o Contrast Bl 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "631329", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 10549.0, "discounted_cash": 3692.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4330.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5340.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3917.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 391.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 416.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Tibia/Fibula w/o Contrast Left 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "631335", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 391.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 416.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Tibia/Fibula w/o Contrast Rt 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "631341", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 391.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 416.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI UE Non Joint w/ + w/o Contrast Left", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "631355", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6816.0, "discounted_cash": 2385.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2797.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3450.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2531.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 801.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI UE Non Joint w/o Contrast Left", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "631400", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5275.0, "discounted_cash": 1846.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2670.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1959.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 582.81, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI W/CONT, BREAST,  BI", "code_information": [{"code": "C8906", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI W/CONT, BREAST,  UNI", "code_information": [{"code": "C8903", "type": "HCPCS"}], "standard_charges": [{"minimum": 796.3, "maximum": 1251.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI W/O FOL W/CONT, BREAST,", "code_information": [{"code": "C8908", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI W/O FOL W/CONT, BRST, UN", "code_information": [{"code": "C8905", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Wrist w/ + w/o Contrast Bl 73223", "code_information": [{"code": "73223", "type": "CPT"}, {"code": "631418", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 14296.0, "discounted_cash": 5003.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5868.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7238.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5309.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 695.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 739.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Wrist w/ + w/o Contrast Left 73223", "code_information": [{"code": "73223", "type": "CPT"}, {"code": "631423", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 695.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 739.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Wrist w/ + w/o Contrast Right 73223", "code_information": [{"code": "73223", "type": "CPT"}, {"code": "631429", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 7145.0, "discounted_cash": 2500.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2933.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3617.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2653.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 695.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 739.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Wrist w/ Contrast Bilateral 73222", "code_information": [{"code": "73222", "type": "CPT"}, {"code": "631441", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 13283.0, "discounted_cash": 4649.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5452.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5452.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6725.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4933.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 575.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Wrist w/ Contrast Left 73222", "code_information": [{"code": "73222", "type": "CPT"}, {"code": "631449", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6639.0, "discounted_cash": 2323.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3361.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2465.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 575.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Wrist w/ Contrast Right 73222", "code_information": [{"code": "73222", "type": "CPT"}, {"code": "631454", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 6639.0, "discounted_cash": 2323.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2725.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3361.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2465.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 575.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Wrist w/o Contrast Left 73221", "code_information": [{"code": "73221", "type": "CPT"}, {"code": "631465", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 367.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Wrist w/o Contrast Right 73221", "code_information": [{"code": "73221", "type": "CPT"}, {"code": "631482", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 5550.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2278.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2809.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2061.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 344.85, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 367.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRS 90 DAYS POST STK", "code_information": [{"code": "G0045", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRS DISC PAIN ACQUISJ DATA", "code_information": [{"code": "609T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 2645.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1682.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRS DISC PAIN ALG ALYS DATA", "code_information": [{"code": "611T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 2645.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1682.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRS DISC PAIN TRANSMIS DATA", "code_information": [{"code": "610T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 2645.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1682.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRS DISCOGENIC PAIN I&R", "code_information": [{"code": "612T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 2645.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1682.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2645.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRSA SCREEN", "code_information": [{"code": "87081", "type": "CPT"}, {"code": "1233830", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRV Head w/o Contrast 70544", "code_information": [{"code": "70544", "type": "CPT"}, {"code": "42625550", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1032.0, "discounted_cash": 361.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 383.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 392.29, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 417.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH2 GENE DUP/DELETE VARIANT", "code_information": [{"code": "81297", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 266.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 543.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 855.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 855.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 855.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 307.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 307.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH2 GENE FULL SEQ", "code_information": [{"code": "81295", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 477.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 973.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1530.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1530.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1530.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 549.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 549.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH2 GENE KNOWN VARIANTS", "code_information": [{"code": "81296", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 422.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 861.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1354.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1354.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1354.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 486.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 486.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH2 MRNA SEQ ALYS", "code_information": [{"code": "159U", "type": "CPT"}], "standard_charges": [{"minimum": 407.35, "maximum": 1530.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 973.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1530.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1530.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1530.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE DUP/DELETE VARIANT", "code_information": [{"code": "81300", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 606.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 954.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 954.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 954.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 342.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 342.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE FULL SEQ", "code_information": [{"code": "81298", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 802.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1636.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2573.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2573.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2573.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 924.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 924.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE KNOWN VARIANTS", "code_information": [{"code": "81299", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 385.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 785.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1235.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1235.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1235.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 443.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 443.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 MRNA SEQ ALYS", "code_information": [{"code": "160U", "type": "CPT"}], "standard_charges": [{"minimum": 407.35, "maximum": 2573.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1636.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2573.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2573.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2573.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MT BONE GRAFT MICROVASC", "code_information": [{"code": "20957", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTHFR GENE", "code_information": [{"code": "81291", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 81.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 166.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 262.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 262.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 262.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 94.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 94.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM ADDL 15 MIN", "code_information": [{"code": "99607", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM EST 15 MIN", "code_information": [{"code": "99606", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM NP 15 MIN", "code_information": [{"code": "99605", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUCOPOLYSACCHARIDES", "code_information": [{"code": "83864", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 35.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 72.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 114.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 114.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 114.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 41.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 41.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUCORMYCOSIS ANTIBODY", "code_information": [{"code": "86732", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULT FAM ADAPT BHV TX GDN", "code_information": [{"code": "97157", "type": "CPT"}], "standard_charges": [{"minimum": 120.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULTIFOCAL ERG W/I&R", "code_information": [{"code": "92274", "type": "CPT"}], "standard_charges": [{"minimum": 257.46, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 257.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 404.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 404.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 404.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULTIHANCE 10 ML GADOBENATE DIMEGLUMINE 529 MG/ML IV SOL 10 ML", "code_information": [{"code": "MED0854", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MULTIHANCE 5 ML GADOBENATE DIMEGLUMINE 529 MG/ML IV SOL 5 ML", "code_information": [{"code": "MED0242", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MULTIPLE FAMILY GROUP PSYTX", "code_information": [{"code": "90849", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [{"code": "59", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6857.37, "maximum": 11772.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6857.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9807.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10788.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11772.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [{"code": "58", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10571.04, "maximum": 18147.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10571.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15118.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16630.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18147.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC", "code_information": [{"code": "60", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5582.37, "maximum": 9583.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5582.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7983.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8782.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9583.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SLEEP LATENCY TEST", "code_information": [{"code": "95805", "type": "CPT"}], "standard_charges": [{"minimum": 1619.53, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1619.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2544.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2544.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2544.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUMPS ANTIBODY", "code_information": [{"code": "86735", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUPIROCIN 2% 22GM OINTMENT/ BACTROBAN", "code_information": [{"code": "MED0152", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MUPIROCIN NASAL 2% 1 GRAM OINTMENT/BACTROBAN", "code_information": [{"code": "MED0153", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MURAMIDASE", "code_information": [{"code": "85549", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MURILUBE 2ML", "code_information": [{"code": "MED0151", "type": "CDM"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MUSC TEST DONE W/N TEST COMP", "code_information": [{"code": "95886", "type": "CPT"}], "standard_charges": [{"minimum": 216.13, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 216.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 339.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 339.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 339.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSC TST DONE W/N TST NONEXT", "code_information": [{"code": "95887", "type": "CPT"}], "standard_charges": [{"minimum": 198.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 198.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 312.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 312.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 312.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSC TST DONE W/NERV TST LIM", "code_information": [{"code": "95885", "type": "CPT"}], "standard_charges": [{"minimum": 189.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 189.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE OR TENDON TRANSFER-UPPER ARM OR ELBOW-SINGLE 24301", "code_information": [{"code": "24301", "type": "CPT"}, {"code": "1482272", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 2 LIMBS", "code_information": [{"code": "95861", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 3 LIMBS", "code_information": [{"code": "95863", "type": "CPT"}], "standard_charges": [{"minimum": 524.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 524.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 824.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 824.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 824.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 4 LIMBS", "code_information": [{"code": "95864", "type": "CPT"}], "standard_charges": [{"minimum": 638.92, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 638.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1004.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1004.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1004.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST CRAN NERVE BILAT", "code_information": [{"code": "95868", "type": "CPT"}], "standard_charges": [{"minimum": 336.92, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 336.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 529.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 529.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 529.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST HEMIDIAPHRAGM", "code_information": [{"code": "95866", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST NONPARASPINAL", "code_information": [{"code": "95870", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST ONE FIBER", "code_information": [{"code": "95872", "type": "CPT"}], "standard_charges": [{"minimum": 195.5, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 195.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 307.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 307.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 307.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST ONE LIMB", "code_information": [{"code": "95860", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST THOR PARASPINAL", "code_information": [{"code": "95869", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFER-ANY TYPE-SHOULDER OR UPPER ARM-MULTIPLE 23397", "code_information": [{"code": "23397", "type": "CPT"}, {"code": "1482072", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFER-ANY TYPE-SHOULDER OR UPPER ARM; SINGLE 23395", "code_information": [{"code": "23395", "type": "CPT"}, {"code": "1482282", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE-MYOCUTANEOUS OR FASCIOCUTANEOUS FLAP-UPPER EXTREMITY 15736", "code_information": [{"code": "15736", "type": "CPT"}, {"code": "1482327", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE-MYOCUTANEOUS-OR FASCIOCUTANEOUS FLAP-HEAD/NECK 15733", "code_information": [{"code": "15733", "type": "CPT"}, {"code": "44898307", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE-MYOCUTANEOUS-OR FASCIOCUTANEOUS FLAP-TRUNK 15734", "code_information": [{"code": "15734", "type": "CPT"}, {"code": "1482288", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SPECIFIC KINASE ANTB", "code_information": [{"code": "86366", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MV AB BONE CEMENT 40GRAMS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71271590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MV BONE CEMENT 40GRAMS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71271580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MYCOBACTERIA CULTURE", "code_information": [{"code": "87116", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA AMP PROBE", "code_information": [{"code": "87551", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 60.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 123.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 193.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 193.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 193.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 69.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 69.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA DIR PROBE", "code_information": [{"code": "87550", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA QUANT", "code_information": [{"code": "87552", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIC IDENTIFICATION", "code_information": [{"code": "87118", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPLASMA", "code_information": [{"code": "87109", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 61.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 61.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 61.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPLASMA ANTIBODY", "code_information": [{"code": "86738", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYD88 GENE P.LEU265PRO VRNT", "code_information": [{"code": "81305", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 447.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 703.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 252.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 252.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGPHY 2/> SPINE REGIONS", "code_information": [{"code": "72270", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 208.22, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 221.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY L-S SPINE", "code_information": [{"code": "72265", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 164.8, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 175.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62302", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62303", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62304", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62305", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY NECK SPINE", "code_information": [{"code": "72240", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 163.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 174.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY THORACIC SPINE", "code_information": [{"code": "72255", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1190.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2975.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4677.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 152.72, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 162.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [{"code": "827", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15211.15, "maximum": 26113.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15211.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21755.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23930.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26113.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [{"code": "826", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30685.69, "maximum": 52679.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30685.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43887.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48275.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52679.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "828", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10182.94, "maximum": 17481.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10182.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14563.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16020.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17481.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC", "code_information": [{"code": "829", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19516.7, "maximum": 33505.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19516.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27913.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30704.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33505.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "830", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9015.01, "maximum": 15476.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9015.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12893.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14182.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15476.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCARDIAL IMAGING MCG", "code_information": [{"code": "541T", "type": "CPT"}], "standard_charges": [{"minimum": 2141.54, "maximum": 3365.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCARDIAL IMAGING MCG I&R", "code_information": [{"code": "542T", "type": "CPT"}], "standard_charges": [{"minimum": 16348.75, "maximum": 25690.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16348.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25690.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25690.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25690.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD CONTRAST PRFUJ ECHO", "code_information": [{"code": "439T", "type": "CPT"}], "standard_charges": [{"minimum": 427.55, "maximum": 671.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 427.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 671.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 671.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 671.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1 STD W/CT", "code_information": [{"code": "78429", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 373.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 586.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 586.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 586.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1STD RST/STRS", "code_information": [{"code": "78491", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 9450.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2405.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6011.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER", "code_information": [{"code": "78432", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 439.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 690.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 690.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 690.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER CT", "code_information": [{"code": "78433", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET MLT RST&STRS", "code_information": [{"code": "78492", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 9450.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2405.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6011.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST&STRS CT", "code_information": [{"code": "78431", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 412.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 648.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 648.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 648.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST/STRS W/CT", "code_information": [{"code": "78430", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 354.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 557.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 557.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 557.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET SINGLE STUDY", "code_information": [{"code": "78459", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5372.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8445.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8445.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8445.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD STRAIN IMG SPCKL TRCK", "code_information": [{"code": "93356", "type": "CPT"}], "standard_charges": [{"minimum": 53.53, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 84.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 84.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 84.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOMINAL < 250 G 58140", "code_information": [{"code": "58140", "type": "CPT"}, {"code": "1481305", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOMINAL > 250 G 58146", "code_information": [{"code": "58146", "type": "CPT"}, {"code": "1481306", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY VAGINAL 250 G 58145", "code_information": [{"code": "58145", "type": "CPT"}, {"code": "1481307", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOSURE TISSUE POLYP DEVISE", "code_information": [{"code": "30-401LITE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MYOSURE TISSUE REMOVAL DEVICE", "code_information": [{"code": "10-401FC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3830.0, "discounted_cash": 1340.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MYRINGOPLASTY 69620", "code_information": [{"code": "69620", "type": "CPT"}, {"code": "1481308", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION 69420", "code_information": [{"code": "69420", "type": "CPT"}, {"code": "1481309", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYRINGOTOMY LASER-ASSIST", "code_information": [{"code": "S2225", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 4382.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYRINGOTOMY W/ASPIRATION & OR EUSTACHIAN TUBE INFLATION REQ.GEN.ANESTHESIA 69421", "code_information": [{"code": "69421", "type": "CPT"}, {"code": "1481310", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Brain/Brain Stem", "code_information": [{"code": "611", "type": "RC"}], "standard_charges": [{"minimum": 1168.0, "maximum": 2282.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1168.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2282.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1951.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) General", "code_information": [{"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 1168.0, "maximum": 2282.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1168.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2282.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1951.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Head And Neck", "code_information": [{"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 1168.0, "maximum": 2282.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1168.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2282.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1951.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Lower Extremities", "code_information": [{"code": "616", "type": "RC"}], "standard_charges": [{"minimum": 1168.0, "maximum": 2282.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1168.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2282.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1951.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Other Mra", "code_information": [{"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 1168.0, "maximum": 2282.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1168.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2282.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1951.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Other Mrt", "code_information": [{"code": "619", "type": "RC"}], "standard_charges": [{"minimum": 1168.0, "maximum": 2282.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1168.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2282.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1951.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Spinal Cord/Spine", "code_information": [{"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 1168.0, "maximum": 2282.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1168.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2282.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1951.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology, Other Magnetic Resonance Imaging (MRI)", "code_information": [{"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 1168.0, "maximum": 2282.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1168.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2282.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1951.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation of target, intracranial, including stereotactic navigation and frame placement, when performed", "code_information": [{"code": "61715", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 85671.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54495.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 85671.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 85671.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 85671.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Magnetic resonance image guided low intensity focused ultrasound (MRgFUS), stereotactic blood-brain barrier disruption using microbubble resonators to increase the concentration of blood-based biomarkers of target, intracranial, including stereotactic nav", "code_information": [{"code": "947T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 85878.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54627.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 85878.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 85878.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 85878.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Management of a new patient with dementia, low complexity, for use in CMMI model", "code_information": [{"code": "G0522", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Management of a new patient with dementia, moderate to high complexity, for use in CMMI model", "code_information": [{"code": "G0523", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Management of established patient with dementia, low complexity, for use in CMMI model", "code_information": [{"code": "G0527", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Management of established patient with dementia, moderate to high complexity, for use in CMMI model", "code_information": [{"code": "G0528", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Management of established patient-caregiver dyad with dementia, high complexity, for use in CMMI model", "code_information": [{"code": "G0526", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Management of established patient-caregiver dyad with dementia, low complexity, for use in CMMI model", "code_information": [{"code": "G0524", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Management of established patient-caregiver dyad with dementia, moderate complexity, for use in CMMI model", "code_information": [{"code": "G0525", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Management of new patient-caregiver dyad with dementia, high complexity, for use in CMMI model", "code_information": [{"code": "G0521", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Management of new patient-caregiver dyad with dementia, low complexity, for use in CMMI model", "code_information": [{"code": "G0519", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Management of new patient-caregiver dyad with dementia, moderate complexity, for use in CMMI model", "code_information": [{"code": "G0520", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Measurement Of Diameters Of Pelvis In Female", "code_information": [{"code": "74710", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Measurement Of Exhaled Carbon Dioxide Gas", "code_information": [{"code": "94770", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Measurement Of Lung Stretching Capacity", "code_information": [{"code": "94750", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Medical Device Culture", "code_information": [{"code": "87088", "type": "CPT"}, {"code": "633898", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Medical Rehabilitation Day Program General", "code_information": [{"code": "940", "type": "RC"}], "standard_charges": [{"minimum": 170.0, "maximum": 200.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 200.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 170.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Medical Rehabilitation Day Program Other", "code_information": [{"code": "949", "type": "RC"}], "standard_charges": [{"minimum": 170.0, "maximum": 200.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 200.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 170.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Medical genetics and genetic counseling services, each 30 minutes of total time provided by the genetic counselor on the date of the encounter", "code_information": [{"code": "96041", "type": "CPT"}], "standard_charges": [{"minimum": 231.66, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 231.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 364.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 364.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 364.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Medication assisted treatment, buprenorphine (injectable) administered on a weekly basis; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of t", "code_information": [{"code": "G0533", "type": "HCPCS"}], "standard_charges": [{"minimum": 2818.52, "maximum": 4429.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2818.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4429.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4429.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4429.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Melatonin levels test, sleep study, 7 or 9 sample melatonin profile (cortisol optional), enzyme-linked immunosorbent assay (ELISA), saliva, screening/preliminary", "code_information": [{"code": "462U", "type": "CPT"}], "standard_charges": [{"minimum": 2.55, "maximum": 4.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Memory Goal Status G-9169 -> CI At least 1% but less than 20% impaired", "code_information": [{"code": "G9169", "type": "HCPCS"}, {"code": "16164870", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "Memory Goal Status G-9169 -> CJ At least 20% but less than 40% impaired", "code_information": [{"code": "G9169", "type": "HCPCS"}, {"code": "16164869", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "Memory Goal Status G-9169 -> CK At least 40% but less than 60% impaired", "code_information": [{"code": "G9169", "type": "HCPCS"}, {"code": "16164868", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "Memory Goal Status G-9169 -> CL At least 60% but less than 80% impaired", "code_information": [{"code": "G9169", "type": "HCPCS"}, {"code": "16164867", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "Memory Goal Status G-9169 -> CM At least 80% but less than 100% impaired", "code_information": [{"code": "G9169", "type": "HCPCS"}, {"code": "16164866", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "Memory Goal Status G-9169 -> CN 100% impaired", "code_information": [{"code": "G9169", "type": "HCPCS"}, {"code": "16164865", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "Meningococcal pentavalent vaccine, Men B-4C recombinant proteins and outer membrane vesicle and conjugated Men A, C, W, Y-diphtheria toxoid carrier, for intramuscular use", "code_information": [{"code": "90624", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Missing and murdered indigenous persons (MMIP) mental health and clinical care", "code_information": [{"code": "H0052", "type": "HCPCS"}], "standard_charges": [{"minimum": 481.22, "maximum": 756.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 481.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 756.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 756.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 756.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Morphometric analysis, in situ hybridization 88377", "code_information": [{"code": "88377", "type": "CPT"}, {"code": "42974379", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 63.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 507.16, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 538.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Morphometric analysis, tumor immunohistochemistry 88360", "code_information": [{"code": "88360", "type": "CPT"}, {"code": "22455580", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 63.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 123.15, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 130.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Most recent glycemic status assessment (HBA1c or GMI) level < 7.0%", "code_information": [{"code": "M1371", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Most recent glycemic status assessment (HBA1c or GMI) level >= 7.0% and < 8.0%", "code_information": [{"code": "M1372", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Most recent glycemic status assessment (HBA1c or GMI) level >= 8.0% and <= 9.0%", "code_information": [{"code": "M1373", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Motor Speech Current Status G-8999 -> CM At least 80% but less than 100% impaired", "code_information": [{"code": "G8999", "type": "HCPCS"}, {"code": "16164873", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "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": 109.24, "maximum": 171.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ COMMON DIGIT", "code_information": [{"code": "64632", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N-INVAS ARTL PLAQ ALYS", "code_information": [{"code": "710T", "type": "CPT"}], "standard_charges": [{"minimum": 604.59, "maximum": 950.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 604.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N-INVAS EST C FFR SW ALY CTA", "code_information": [{"code": "75580", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4353.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 2001.72, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 2126.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N-NVS ARTL PLAQ ALYS DAT PRP", "code_information": [{"code": "711T", "type": "CPT"}], "standard_charges": [{"minimum": 604.59, "maximum": 950.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 604.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N-NVS ARTL PLAQ ALYS QUAN", "code_information": [{"code": "712T", "type": "CPT"}], "standard_charges": [{"minimum": 361.01, "maximum": 567.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 361.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 567.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 567.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 567.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N-NVS ARTL PLAQ ALYS RVW I&R", "code_information": [{"code": "713T", "type": "CPT"}], "standard_charges": [{"minimum": 604.59, "maximum": 950.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 604.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N. GONORRHOEAE ASSAY W/OPTIC", "code_information": [{"code": "87850", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 62.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 98.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 98.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 98.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 35.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 35.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA AMP PROB", "code_information": [{"code": "87591", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA DIR PROB", "code_information": [{"code": "87590", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 107.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 107.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 107.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA QUANT", "code_information": [{"code": "87592", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 171.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 61.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NACL 0.9% PF FOR INJECTION 50ML VIAL", "code_information": [{"code": "MED0154", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "NACL 3000ML BAG", "code_information": [{"code": "MED0269", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL 1MM X 175MM STERILE P31-102-1750-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P31-102-1750-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15399.0, "discounted_cash": 5389.65, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL 2.25MM FLEXIBLE TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "194-2250S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 607.0, "discounted_cash": 212.45, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL 3.5MM X 180MMSYSTEM FLEX THREAD FIBULA 8424-3-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8424-3-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5750.0, "discounted_cash": 2012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL 3.6 X 50MM INATE METACARPAL EXINN923650", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINN923650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3968.0, "discounted_cash": 1388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL 4.5X70MM SYS OF2084520S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF2084520S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4290.0, "discounted_cash": 1501.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL 7.2MM X 70MM HINDFOOT TREADED PEG P31-772-070F", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P31-772-070F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2128.0, "discounted_cash": 744.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL ALIF 5.5MM X 30MM KF0000030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KF0000030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2430.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL ANKLE ARTHRODESIS RIGHT 11MM X 150MM 1819-1115S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1819-1115S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5553.0, "discounted_cash": 1943.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL ARTHRODESIS 10MM X 180MM PHOENIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-440118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5834.0, "discounted_cash": 2041.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL BONE 1 1/2IN HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6541-4-515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 117.36, "discounted_cash": 41.08, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL BONE 3.0MM TITANIUM ELASTIC NAIL TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "475.93", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 730.0, "discounted_cash": 255.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL BONE TIBIAL 8.5MM X 30CM TRIGEN META-NAIL TITANIUM ROUND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71655030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6108.0, "discounted_cash": 2137.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL CLAVICLE 4 X 120MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CRX-WG2-40120-SC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 5768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL CLAVICLE SIZING PROBE 9.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL CRx-WG 4.2MM X 120MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CRx-WG2-40120-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6695.0, "discounted_cash": 2343.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL CRx-WG SONOMA 4.2MM X 100MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CRX-WG2-40100-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8343.0, "discounted_cash": 2920.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL ELASTIC 2.5MM X 440MM PINK TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "475.925", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 712.0, "discounted_cash": 249.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL FEMORAL 12MM X 420MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1828-1242S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 606.0, "discounted_cash": 212.1, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL FIBULA 3.0MM X 130MM RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8973R-30-130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6493.16, "discounted_cash": 2272.61, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL FIBULA 3.0MMX180MM AR-8973R-30-180", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-8973R-30-180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6493.16, "discounted_cash": 2272.61, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL FIBULA 3.5MM X 130MM TITANIUM 8424-1-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8424-1-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4995.0, "discounted_cash": 1748.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL FIBULA LEFT 3.0 X 130MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8973L-30-130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6493.16, "discounted_cash": 2272.61, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL FIXATION 5.5MM X 70MM OF2905520S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF2905520S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4290.0, "discounted_cash": 1501.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL FIXATION OSSIO TRIMMABLE OF2012450S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF2012450S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL FIXATION TRIMM 2.4X30MM OF2012430S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF2012430S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL FLEXIBLE 2.0MM SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "197-2000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL FXTN 1.5MM X 20MM BONE BIONX SMARTNAIL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "531520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL HINDFOOT COMPRESSION END CAP SHORT P31-111-0000-03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P31-111-0000-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 656.0, "discounted_cash": 229.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL HUMERAL 9MM TO 7.5MM X 22CM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71770922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5408.0, "discounted_cash": 1892.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL HUMERAL PROXIMAL 8 X 150MM RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1832-1045S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6658.0, "discounted_cash": 2330.3, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL HUMERAL TRIGEN 10/8.5MM X 26MM BENT LONG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71771026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5408.0, "discounted_cash": 1892.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL MINI 7MM X 80MM 2600-00-7080", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2600-00-7080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10352.0, "discounted_cash": 3623.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL OSSIO FIBER CANNULATED TRIMMABLE 3.0 X 50MM OF2053050S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF2053050S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3170.0, "discounted_cash": 1109.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL SURG 10MM X 200MM ANKLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1819-1020S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4806.0, "discounted_cash": 1682.1, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL TIBIAL 11 X 390MM 2341-1139S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2341-1139S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4061.0, "discounted_cash": 1421.35, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL TIBIAL TRIGEN 10MM X 31CM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71655131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3655.0, "discounted_cash": 1279.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL TIBL 10MM X 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7165-5132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8113.0, "discounted_cash": 2839.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL TIBL 10MM X 37MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71655137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7416.0, "discounted_cash": 2595.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL TIBL 13MM X 34MM META NAIL TRIGEN IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71655334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8374.0, "discounted_cash": 2930.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL TRIGEN 13MM X 38CM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71653438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6633.0, "discounted_cash": 2321.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL TRIGEN META 11.5MM X 36CM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71655236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6108.0, "discounted_cash": 2137.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NAIL VALOR 10MM X 200MM SMALL LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "415101020L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6184.0, "discounted_cash": 2164.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NANOBITER STRAIGHT TIP STR SHFT DISPOSABLE AR-10911D-1", "code_information": [{"code": "AR-10911D-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 772.73, "discounted_cash": 270.46, "setting": "both", "billing_class": "facility"}]}, {"description": "NANOGRASPER TIP 70MM DISPOSBALE AR-10903D-1", "code_information": [{"code": "AR-10903D-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 772.73, "discounted_cash": 270.46, "setting": "both", "billing_class": "facility"}]}, {"description": "NANOPASS CRESCENT CAT02298", "code_information": [{"code": "CAT02298", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 653.67, "discounted_cash": 228.78, "setting": "both", "billing_class": "facility"}]}, {"description": "NARCOSYNTHESIS", "code_information": [{"code": "90865", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL ENDOSCOP PO DEBRID", "code_information": [{"code": "S2342", "type": "HCPCS"}], "standard_charges": [{"minimum": 2297.0, "maximum": 2297.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL ENDOSCOPY W/MAXILLARY ANTROSTOMY W/REM.OF TISSUE MAXILLARY SINUS 31267", "code_information": [{"code": "31267", "type": "CPT"}, {"code": "1481311", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL FUNCTION STUDIES", "code_information": [{"code": "92512", "type": "CPT"}], "standard_charges": [{"minimum": 127.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 127.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 199.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 199.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 199.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL POSISEP X BAM 0.6 X 2.0 9210974", "code_information": [{"code": "9210974", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 462.55, "discounted_cash": 161.89, "setting": "both", "billing_class": "facility"}]}, {"description": "NASAL SALINE 0.65% SPRAY 45 ML", "code_information": [{"code": "MED0155", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NASAL SMEAR FOR EOSINOPHILS", "code_information": [{"code": "89190", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL SPLINT POSISEP X", "code_information": [{"code": "9210584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 430.65, "discounted_cash": 150.73, "setting": "both", "billing_class": "facility"}]}, {"description": "NASAL SPLINT SAMLL 1-LEFT1-RIGHT SILICONE SEPTAL 890915", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "890915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "NASAL/ENDOSCOPY DIAGNOSTIC UNILATERAL/BILATERAL (SEPARATE PROCEDURE) 31231", "code_information": [{"code": "31231", "type": "CPT"}, {"code": "1582419", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/OROGASTRIC W/TUBE PLMT", "code_information": [{"code": "43752", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY DIAGNOSTIC WITH MAXILLARY SINUSOSCOPY 31233", "code_information": [{"code": "31233", "type": "CPT"}, {"code": "14526143", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31291", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURGICAL W/CONCHA BULLOSA RESECTION 31240", "code_information": [{"code": "31240", "type": "CPT"}, {"code": "1582418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURGICAL W/DILATION FRONTAL SINUS OSTINUM 31296", "code_information": [{"code": "31296", "type": "CPT"}, {"code": "1635701", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1663.5, "maximum": 8450.0, "gross_charge": 3437.0, "discounted_cash": 1202.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1663.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURGICAL W/DILATION SPHENOID SINUS OSTIUM 31297", "code_information": [{"code": "31297", "type": "CPT"}, {"code": "1635702", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURGICAL W/REPAIR OF CEREBROSPINAL FLUID LEAK ETHMOID REGION 31290", "code_information": [{"code": "31290", "type": "CPT"}, {"code": "24956605", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 6085.0, "discounted_cash": 2129.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2945.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2008.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURGICAL W/SPHENOIDOTOMY 31287", "code_information": [{"code": "31287", "type": "CPT"}, {"code": "1635700", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/BIOPSY/POLYPECTOMY OR DEBRIDEMENT 31237", "code_information": [{"code": "31237", "type": "CPT"}, {"code": "1582415", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/BIOPSY/POLYPECTOMY W/CONTROL OF NASAL HEMORRHAGE 31238", "code_information": [{"code": "31238", "type": "CPT"}, {"code": "1481312", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/DACROCYSTORHINOSTOMY 31239", "code_information": [{"code": "31239", "type": "CPT"}, {"code": "3680305", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/DILATION OF FRONTAL SINUS BALLOON 31296", "code_information": [{"code": "31296", "type": "CPT"}, {"code": "1592972", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1289.86, "maximum": 8450.0, "gross_charge": 2665.0, "discounted_cash": 932.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1289.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/DILATION OF FRONTAL/SPHENOID SINUS OSTIA 31298", "code_information": [{"code": "31298", "type": "CPT"}, {"code": "44896135", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/DILATION OF MAXILLARY SINUS BALLOON 31295", "code_information": [{"code": "31295", "type": "CPT"}, {"code": "1592973", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1663.5, "maximum": 8450.0, "gross_charge": 3437.0, "discounted_cash": 1202.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1663.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY W/FRONTAL SINUS EXPLORATION W/REMOVAL OF TISSUE 31253", "code_information": [{"code": "31253", "type": "CPT"}, {"code": "44893651", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY W/SPHENOIDOTOMY 31257", "code_information": [{"code": "31257", "type": "CPT"}, {"code": "44896134", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY W/SPHENOIDOTOMY W/REMOVAL OF TISSUE 31259", "code_information": [{"code": "31259", "type": "CPT"}, {"code": "44893652", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/FRONTAL SINUS EXPLORATION 31276", "code_information": [{"code": "31276", "type": "CPT"}, {"code": "1481313", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY 31256", "code_information": [{"code": "31256", "type": "CPT"}, {"code": "1481314", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY W/SPHENOIDECTOMY AND REMOVAL OF TISSUE 31288", "code_information": [{"code": "31288", "type": "CPT"}, {"code": "1481315", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS; SURGICAL W/DEST. POSTERIOR NASAL NERVE 31242", "code_information": [{"code": "31242", "type": "CPT"}, {"code": "46301531", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5830.44, "discounted_cash": 2040.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2821.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS; SURGICAL W/DEST. W/CRYOABLATION POSTERIOR NASAL NERVE 31243", "code_information": [{"code": "31243", "type": "CPT"}, {"code": "46395503", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5702.0, "discounted_cash": 1995.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2759.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS; SURGICAL W/LIGATION OF SPHENOPALATINE ARTERY 31241", "code_information": [{"code": "31241", "type": "CPT"}, {"code": "45295340", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1817.9, "maximum": 8450.0, "gross_charge": 3756.0, "discounted_cash": 1314.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1817.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASOPHARYNGOSCOPY W/DILATION OF EUSTACHIAN TUBE BILATERAL 69706", "code_information": [{"code": "69706", "type": "CPT"}, {"code": "45838043", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 5229.0, "discounted_cash": 1830.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASOPHARYNGOSCOPY W/DILATION OF EUSTACHIAN TUBE UNILATERAL 69705", "code_information": [{"code": "69705", "type": "CPT"}, {"code": "45838041", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 899.75, "maximum": 9357.0, "gross_charge": 1859.0, "discounted_cash": 650.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 899.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASOPHARYNGOSCOPY W/ENDOSCOPE 92511", "code_information": [{"code": "92511", "type": "CPT"}, {"code": "1587132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 171.64, "maximum": 8450.0, "gross_charge": 520.0, "discounted_cash": 182.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NATURAL IRIS CONFORMER # 4 MED", "code_information": [{"code": "89129", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 723.0, "discounted_cash": 253.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NATURAL IRIS CONFORMER # 6 MED", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "89131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "NATURAL IRIS CONFORMER COLOR #6 SMALL", "code_information": [{"code": "89125", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 723.0, "discounted_cash": 253.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NATURAL-IRIS CONFORMER COLOR #2 SMALL", "code_information": [{"code": "89121", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 723.0, "discounted_cash": 253.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NAV SRV PEER SUP 60 MIN PR M", "code_information": [{"code": "G0140", "type": "HCPCS"}], "standard_charges": [{"minimum": 374.54, "maximum": 588.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 374.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAV SRV PEER SUP ADD 30 PR M", "code_information": [{"code": "G0146", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.41, "maximum": 244.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 155.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAVIGATION SPHERES 800-100-004", "code_information": [{"code": "800-100-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.5, "discounted_cash": 19.43, "setting": "both", "billing_class": "facility"}]}, {"description": "NAVIGATIONAL BRONCHOSCOPY", "code_information": [{"code": "31627", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NB RESUSCITATION", "code_information": [{"code": "99465", "type": "CPT"}], "standard_charges": [{"minimum": 656.38, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 656.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1031.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1031.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1031.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC O/T PAD 1", "code_information": [{"code": "640T", "type": "CPT"}], "standard_charges": [{"minimum": 43.83, "maximum": 68.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC O/T PAD EA", "code_information": [{"code": "859T", "type": "CPT"}], "standard_charges": [{"minimum": 43.83, "maximum": 68.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC SCR PAD", "code_information": [{"code": "860T", "type": "CPT"}], "standard_charges": [{"minimum": 43.83, "maximum": 68.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC R-T FLUOR WND IMG 1ST", "code_information": [{"code": "598T", "type": "CPT"}], "standard_charges": [{"minimum": 1106.05, "maximum": 1738.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1106.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1738.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1738.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1738.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC R-T FLUOR WND IMG EA", "code_information": [{"code": "599T", "type": "CPT"}], "standard_charges": [{"minimum": 4.37, "maximum": 6.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 1 OR 2 MUSC", "code_information": [{"code": "20560", "type": "CPT"}], "standard_charges": [{"minimum": 74.71, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 3+ MUSC", "code_information": [{"code": "20561", "type": "CPT"}], "standard_charges": [{"minimum": 112.85, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 112.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 177.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 177.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 177.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDL OCULOELECTROMYOGRAPHY 1+", "code_information": [{"code": "92265", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDL STIMULATION 21G X 4\"", "code_information": [{"code": "STIM2104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.66, "discounted_cash": 17.03, "setting": "both", "billing_class": "facility"}]}, {"description": "NDLE 18GX3.5 PINK HUB STRL SNGL USE 405184", "code_information": [{"code": "405184", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.31, "discounted_cash": 3.96, "setting": "both", "billing_class": "facility"}]}, {"description": "NDOVAG CRYG RF REMDL TISS", "code_information": [{"code": "672T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDSC HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "33509", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEAR IFR 2IMG MIBMN GLND I&R", "code_information": [{"code": "507T", "type": "CPT"}], "standard_charges": [{"minimum": 240.39, "maximum": 377.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 240.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 377.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 377.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 377.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEBULIZER KIT DISP HANDHELD W/MASK HCS4485", "code_information": [{"code": "HCS4485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NEBULIZER PT 6CC 90DEG SM VOLUME EASY SEAL THREADED CAP HND HELD ORIN LINE W/ 7F", "code_information": [{"code": "1883", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 1/2 CIRCLE CATGUT TAPER SZ4", "code_information": [{"code": "1824-4DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 10G BEVEL 0306-101-000", "code_information": [{"code": "306-101-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 79.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 11GA CURVED", "code_information": [{"code": "306-011-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1164.0, "discounted_cash": 407.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 15G 24MM-48MM ADJ LENGTH DISP DIN1515X", "code_information": [{"code": "DIN1515X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.24, "discounted_cash": 16.53, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 16G N6/D4", "code_information": [{"code": "N6/D4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 18G BLUNT FILL 11811022", "code_information": [{"code": "11811022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 18GX1.5 ECLIPSE USE LUER-LOK 305712", "code_information": [{"code": "305712", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 20GX3.5YELLOWHUBSTRL SNGLUSE 405182", "code_information": [{"code": "405182", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.31, "discounted_cash": 3.96, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 20GX6 INSULATED EXT SET 30 DEG 4894278", "code_information": [{"code": "4894278", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 20GX6 YELLOW LONG STRL SNGL USE 405211", "code_information": [{"code": "405211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.4, "discounted_cash": 7.84, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 22G X 3.5' SHARP BEVEL QUINCKE PAIN8117", "code_information": [{"code": "PAIN8117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 22GX5 BLACK LONG STRL SINGLE USE 405148", "code_information": [{"code": "405148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.45, "discounted_cash": 9.61, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 22GX7 BLACK LONG STRL SINGLE 405149", "code_information": [{"code": "405149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.45, "discounted_cash": 9.61, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 25GX2 BLUE HUB NEONATAL STERILE 405078", "code_information": [{"code": "405078", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 25GX4.69BLUELONG STRLSNGLUSE 405234", "code_information": [{"code": "405234", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 25GX5 PENCILPT LONGBLUE STRL 405140", "code_information": [{"code": "405140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 25GX5\"SPINALSTRL PENCAN 25/CS 333875", "code_information": [{"code": "333875", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 8G X 11CM OPEN TIP DELIVERY RAN-811-OT", "code_information": [{"code": "RAN-811-OT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 583.19, "discounted_cash": 204.12, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS 10GA IVAS", "code_information": [{"code": "306-530-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.77, "discounted_cash": 54.52, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS HARVEST NO PORTS 11GA X 15 CM", "code_information": [{"code": "RAN-1115N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 634.0, "discounted_cash": 221.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS INSUFFLATION 14G VERSA S100000", "code_information": [{"code": "S100000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS INSUFFLATION 14G VERSASTEP VS150000", "code_information": [{"code": "VS150000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 56.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE AIX12310", "code_information": [{"code": "AIX12310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5277.9, "discounted_cash": 1847.27, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ANESTHESIA 25GA X 3.5IN BLUE SPINAL STRL DISP", "code_information": [{"code": "405180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.66, "discounted_cash": 3.38, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ASPIRATION 11 G BONE MARROW ASPIRATION NDL", "code_information": [{"code": "710.151.99S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ASPIRATION 8GX15CM BONE MARROW BEVELED", "code_information": [{"code": "2090-9052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ATKINSON RETROBULBAR 25G X 1.5IN", "code_information": [{"code": "581637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BEVEL TIP 8G ASSEMBLY", "code_information": [{"code": "1001-90183", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 337.0, "discounted_cash": 117.95, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BEVELED JAMSHIDI", "code_information": [{"code": "RAN-815NRT-BEV", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 616.01, "discounted_cash": 215.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 14GA X 4.5IN TRU-CUT STRANDARD HANDLE CUTTINGEDGE THINWALL SOFT TI", "code_information": [{"code": "2N2702X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 18GA X 6 SOFT TISSUE TRU CUT", "code_information": [{"code": "2N2713X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 18GA X 6IN TRU CUT", "code_information": [{"code": "2713", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY CHEST LINING", "code_information": [{"code": "32400", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LIVER ADD-ON", "code_information": [{"code": "47001", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LYMPH NODES", "code_information": [{"code": "38505", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1439.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BONE MARROW ASPIRATION NEEDLE BEVELED FENESTRATED NEEDLE, BULLET TIP STYLET 8.0GX15.0CM", "code_information": [{"code": "2090-9053", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 756.0, "discounted_cash": 264.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BOVIE ELECTRODE 2.84IN X 0.093IN", "code_information": [{"code": "1552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE CLIP STIMULATING SAFE AIX12025", "code_information": [{"code": "AIX12025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3843.45, "discounted_cash": 1345.21, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE COATED SHARP 2.5 P0118A", "code_information": [{"code": "P0118A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.41, "discounted_cash": 10.64, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE COUDE 18G RX2", "code_information": [{"code": "107-1418", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE CURVED COUPE 6\"", "code_information": [{"code": "107-1614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE DISSECT 40MM MICRO STRAIGHT BOVIE TUNGSTEN COLORADOINSTR", "code_information": [{"code": "N104A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ECLIPSE 23X1 RB 100/BX 305826", "code_information": [{"code": "305826", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ECLIPSE 25X1-1/2 RB 305838", "code_information": [{"code": "305838", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ELECTRODE 15MM F/NIMS GREEN 5140-533-625", "code_information": [{"code": "5140-533-625", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 32.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ELECTRODE 2.5IN EXTENDED E Z CLEAN MEGAFINE", "code_information": [{"code": "118A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 22.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ELECTRODE 2.84IN .093IN BOVIE TIP", "code_information": [{"code": "E1552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPI 14GA 6IN FOR ACCESSORY KIT W/ STYLET", "code_information": [{"code": "3550-28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPI 14GA CURVED COUDE NEUROMODULATION", "code_information": [{"code": "SC-4210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPI 14GA X 101.6MM RADIOPAQUE FOR SPINAL CORD STIMULATION PROCEDURE RX CO", "code_information": [{"code": "105-1314", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.11, "discounted_cash": 58.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPI 16GA X 3.5IN OPEN DULL BEVEL RADIOPAQUE W/ ATTACHABLE WING R.K.", "code_information": [{"code": "100-1416", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.19, "discounted_cash": 29.82, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPI 16GA X 3.5IN RADIOPAQUE ROUNDED REAR HEEL W/ ATTACHABLE WING RX COUDE", "code_information": [{"code": "105-1416", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.16, "discounted_cash": 30.51, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPI 18GA 3.5IN TUOHY THIN WALL WITHOUT WINGS PERISAFE LF STRL DISP", "code_information": [{"code": "405018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.12, "discounted_cash": 7.74, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPI 18GA X 3.5IN TUOHY REMOVABLE WING REG WALL PLASTIC HUB STRL DISP", "code_information": [{"code": "183A07", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPI 18GA X 5IN TUOHY PERISAFE", "code_information": [{"code": "405190", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPIDURAL 20G X 3.5\" TUOHY NO WNGS 405028", "code_information": [{"code": "405028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.12, "discounted_cash": 7.74, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ESURG PLASMABUTTON 12D 30D HFRQ CBL RESCT STRL DISP", "code_information": [{"code": "WA22657C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 314.0, "discounted_cash": 109.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EXT 41G SUBRETINAL INJECTION 1270.EXT", "code_information": [{"code": "1270.EXT", "type": "CDM"}], "standard_charges": [{"gross_charge": 432.0, "discounted_cash": 151.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FERGUSON ROUND BODY 1/2 CIRCLE", "code_information": [{"code": "1842-12DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 73.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FISTULA SZ 7 SUT ANCHOR REVERSE CUTTING HALF CIRC DISP", "code_information": [{"code": "1832-7DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FLEXIBLE RP 360DEG SUT PASSER DISP", "code_information": [{"code": "3910-900-091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 406.19, "discounted_cash": 142.17, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FOREIGN BODY 4 3/4IN 25GA X 6IN CURVED SS", "code_information": [{"code": "18370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE HD SCOPRION WITH MEGALOADER AR-13999HDN", "code_information": [{"code": "AR-13999HDN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.26, "discounted_cash": 198.89, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE HYPO SAFETY 22 X 1 1/2 8881850215", "code_information": [{"code": "8881850215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INJ 14.6IN 21GA CONCAVE SIDE OPENING UROLOGY NDL IS DESIGNED TO REDUCE PRO", "code_information": [{"code": "M0068903040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 53.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INJ 14.6IN21GA CONCAVE SIDE OPEN 9012M0", "code_information": [{"code": "9012M0", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.85, "discounted_cash": 74.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INJ 2.8MM 25GA UPPER GASTROINTESTINALINJECTOR FORCE COMPLETE CHANNEL", "code_information": [{"code": "NM-400U-0525", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INJ SUREFIRE FOR USEIN ARTHROSCOPIC AND MINI OPEN PROCEDURES SCORPIONINSTR", "code_information": [{"code": "AR-13991N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INJECTION COLON", "code_information": [{"code": "129-0172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INJECTION HUMPBACK MULTIFIRE SCORPIONINSTR DISP", "code_information": [{"code": "AR-13995N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INJECTION SHOULDER SCORPION STRLINSTR", "code_information": [{"code": "AR-13990N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INJETAK PRECISION CYSTOCOPIC 23G 4.8F 70CM 96009", "code_information": [{"code": "96009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSERTION 5IN NEUROMODULATION", "code_information": [{"code": "SC-4205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSERTION 6.5IN LNG SPINAL CORD STIMULATOR SYS", "code_information": [{"code": "SC-4206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSUFFLATION 13GA 120MM LAP DISP", "code_information": [{"code": "C2201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSUFFLATION 13GA 150MM LAP DISP", "code_information": [{"code": "C2202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSUFFLATION 14GA X 150MM PNEUMOPERITONEUM ENDOPATH SS", "code_information": [{"code": "PN150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 292.78, "discounted_cash": 102.47, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSUFFLATION 14GX12CM ENDOPATH PN120", "code_information": [{"code": "PN120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.77, "discounted_cash": 27.92, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSUFFLTN 14GX12CM ULTRA VERESS UV120", "code_information": [{"code": "UV120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSULATED 20GA X 6IN EXTENSION STIM SET", "code_information": [{"code": "333680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSULATED 21GA X 4IN STIMUPLEX W/ EXTENSION SET SURG NDL FOR STIMUPLEX NER", "code_information": [{"code": "333686", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSULATED 22GA X 1 3/8IN F/STIMUPLEX", "code_information": [{"code": "333693", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSULATED 22GA X 1IN 30DEG BEVEL FOR STIMPULEX NERVE STIMULATOR W/ EXTENSI", "code_information": [{"code": "4894539", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSULATED 22GA X 2IN 30DEG BEVEL PERIPHERAL NERVE BLOCK NDL SNGL SHOT FOR", "code_information": [{"code": "4894502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.93, "discounted_cash": 17.13, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INTRODUCER 16GA 3.5IN STRAIGHT WAVEPOINT", "code_information": [{"code": "WS-17-3.5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INTRODUCER 5IN 10GA BEVELED CONFIDENCE", "code_information": [{"code": "2839-02-510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 214.0, "discounted_cash": 74.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INTRODUCER 6IN 11GA BEVELED CONFIDENCE", "code_information": [{"code": "2839-02-611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 337.0, "discounted_cash": 117.95, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INTRODUCER ON-Q 8.0IN T PEEL LF SS STR DISP", "code_information": [{"code": "ACC03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INTRODUCTION 11GA 5IN FOUR FACET DIAMOND TIP VERTEBROPLASTY STRL", "code_information": [{"code": "306-110-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.0, "discounted_cash": 50.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INTRODUCTION 11GA 5IN TIP MATCH GROUND DIAMOND TIP", "code_information": [{"code": "306-110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 229.0, "discounted_cash": 80.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INTRODUCTION 11GA MATCH GOUND BEVEL TIP", "code_information": [{"code": "306-111-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INTRODUCTION 13GA 5IN FOUR FACET DIAMOND TIP MATCH GROUND STRL DISP", "code_information": [{"code": "306130000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.0, "discounted_cash": 50.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE JAMSHIDI 8GA X 15CM BEVELED TIP RAN-B15NRT-BEV", "code_information": [{"code": "RAN-B15NRT-BEV", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 734.0, "discounted_cash": 256.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE JAMSHIDI BONE MARROW ASPIRATION 11GA 150MM", "code_information": [{"code": "6000-105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.0, "discounted_cash": 387.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE JAMSHIDIBMA 8GA X 150MM", "code_information": [{"code": "RAN-815N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 634.0, "discounted_cash": 221.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE KEITH 2.5IN STRAIGHT", "code_information": [{"code": "1827-212DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE KWIC 8G X 6IN", "code_information": [{"code": "6002-070-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1097.52, "discounted_cash": 384.13, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE MAYO CATGUT 1 2 CIR 2 PK TAPER PT 1824-5DC", "code_information": [{"code": "1824-5DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.5, "discounted_cash": 13.13, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE MAYO CATGUT 1 2 CIR TROCAR PT SZ4 1826-4DC", "code_information": [{"code": "1826-4DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE MED 25GA X 8IN", "code_information": [{"code": "187365", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE METAL STYLET 18G X 6INCH TUOHY EPIDURAL PAIN8006", "code_information": [{"code": "PAIN8006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.62, "discounted_cash": 17.72, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE MICRO 3MM X 3CM COLORADO STRAIGHT REPROCESS BOVIEINSTR", "code_information": [{"code": "N103AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE MICROSURGICAL 3CM POINT TUNGSTEN STRL", "code_information": [{"code": "E1651", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE NANO 125MM AR-3210-0043", "code_information": [{"code": "AR-3210-0043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.75, "discounted_cash": 402.41, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE NANO SCOPE 2.0, 125MM AR-3210-0070", "code_information": [{"code": "AR-3210-0070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2135.25, "discounted_cash": 747.34, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE NERVE BLOCK 22GA X 2ININSULATED 30 DEGREE SHRT BEVEL SNGL SHOT W/ ATTACHE", "code_information": [{"code": "333690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE NERVE BLOCK 2IN X 22GA 30 DEGREE SHRT BEVEL SNGL SHOT ATTACHED STIMUPLEX-", "code_information": [{"code": "STIMA2250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE OPHTH ATKINSON 23GA 1.5IN RETROBULBAR SHORTEN SINGLE BEVEL", "code_information": [{"code": "8065421020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE OPHTHALMIC 23GA BKFLSH XTD SHIRAGA BRUSH", "code_information": [{"code": "1281.SD06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 155.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ORO-TRACHEAL INJECTION STRL", "code_information": [{"code": "1650050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PASSER SUT EXPRESSEW II", "code_information": [{"code": "214005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PERIPHERAL NERVE 21GA X 4IN NDL NERVE STIMULATION 30 DEGREE BEVEL ATTACHE", "code_information": [{"code": "4894260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.61, "discounted_cash": 18.41, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PERIURETHRAL", "code_information": [{"code": "652100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PHACO FRAGMENTATION 23G/0.6MM TITANIUM WRENCH", "code_information": [{"code": "3005.F106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PMI TUNGSTEN 4CM MICRO STRAIGHT", "code_information": [{"code": "P1651", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PNEUMOPERITONEUM 14G 120MM 172015", "code_information": [{"code": "172015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PORTAL ACCESS 20GA X 3/4IN POWER PAC HUBER GRIPPER", "code_information": [{"code": "21-3367-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE QUINCKE SPINAL NEEDLE 25G X 5IN", "code_information": [{"code": "PAIN8025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.43, "discounted_cash": 5.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE RETROBULAR 25GA 1.5IN ATKINSON ANES OPHTHALMIC STRLINSTR DISP", "code_information": [{"code": "8065420920", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ROUS SUB TENON/PARABULBAR 25G X 16MM CURVED BEVEL DOWN EXTRA SHARP AX14594", "code_information": [{"code": "AX14594", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SAFETY 20GA X .75IN GRIPPER PLUS", "code_information": [{"code": "21-2767-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SAFETY PRO-EDGE 18G X 1IN", "code_information": [{"code": "401810", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SCLEROTHERAPY 25 G X 4MMINTERJECT", "code_information": [{"code": "M0051836", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SOFT TIP 25G", "code_information": [{"code": "8065149525", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 22GA X 3 1/2 405181", "code_information": [{"code": "405181", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.31, "discounted_cash": 3.96, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 22GA X 3.5IN CHIBA METAL STYLET STRL DISP", "code_information": [{"code": "18369", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 22GA X 3.5IN CLR HUBINSTR", "code_information": [{"code": "333320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.48, "discounted_cash": 2.27, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 22GA X 6IN CHIBA", "code_information": [{"code": "183A73", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 22GA X 7\" 333357", "code_information": [{"code": "333357", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.6, "discounted_cash": 6.86, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 25G X 6IN QUINCHE POINT 18399", "code_information": [{"code": "18399", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.29, "discounted_cash": 17.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 25G X 6IN QUINCHE POINT 183A99", "code_information": [{"code": "183A99", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.56, "discounted_cash": 21.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 25GX6 CHIBA PLASTIC HUB 183A70", "code_information": [{"code": "183A70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL QUINCKE 25G X 2.5 PAIN8016", "code_information": [{"code": "PAIN8016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.82, "discounted_cash": 3.79, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL SPINOCAN QUINKE 18G X 3 1/2\" 333350", "code_information": [{"code": "333350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.8, "discounted_cash": 2.73, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINE ENTRADA", "code_information": [{"code": "SC-4220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPNL 22GA 2.5IN FITTED STYLET REG WALL QUINCKE LF STRL DISP", "code_information": [{"code": "405074", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SURG 150MM", "code_information": [{"code": "172016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SURG 2 1/2IN KEITH ABDOMINAL STRAIGHT TRIANGULAR POINT", "code_information": [{"code": "1827-2 1/2 D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SURG 20GA X 3.5IN TUOHY NDL WINGED EPI W/ CLR HUB PERIFIX LF", "code_information": [{"code": "332168", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SURIGICAL 18GA X 3.5IN TUOHY NDL EPI W/ CLR HUB AND WING PERIFIX", "code_information": [{"code": "332166", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SUT 1/2 CIRC TROCAR MAYO", "code_information": [{"code": "1826-4D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SUT MULTIFIRE REPROCESS SCORPION DISP", "code_information": [{"code": "AR13995NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SUT REPROCESS SCORPION SUREFIREINSTR", "code_information": [{"code": "AR13991NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 214.0, "discounted_cash": 74.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TAPERES CURVED 26MM 1/2 CIRCLE XLOOP", "code_information": [{"code": "AR-7281", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.83, "discounted_cash": 24.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TROFLEX 11GA X 27.5MM CRVD VERTEBRAL COMPRESSION FRACTURE PROC", "code_information": [{"code": "306-011-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1107.0, "discounted_cash": 387.45, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TUOHY EPIDURAL 18G X 7 7-2150-18", "code_information": [{"code": "7-2150-18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.59, "discounted_cash": 26.81, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLES MENISCAL FIBERWIRE 2-0 SMALL", "code_information": [{"code": "AR-7223SM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 156.1, "discounted_cash": 54.64, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLES QUINCKE SPINAL PAIN8021", "code_information": [{"code": "PAIN8021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLES SAFETYGLIDE STERILE HYPODERMIC 18G X 1.5\" 305918", "code_information": [{"code": "305918", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLES: BLUNT TIP NEEDLE WITHOUT FILTER 18G X 1.5\" SYR110022", "code_information": [{"code": "SYR110022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEG PRESS VENTILATION CNP", "code_information": [{"code": "94662", "type": "CPT"}], "standard_charges": [{"minimum": 2048.58, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2048.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3219.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3219.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3219.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THER DME>50 SQCM", "code_information": [{"code": "97606", "type": "CPT"}], "standard_charges": [{"minimum": 1409.04, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1409.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2214.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THER NDME>50SQCM", "code_information": [{"code": "97608", "type": "CPT"}], "standard_charges": [{"minimum": 116.03, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 116.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 182.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THR NDME<=50SQCM", "code_information": [{"code": "97607", "type": "CPT"}], "standard_charges": [{"minimum": 103.33, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 103.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEGATIVE PRESSURE WOUND THERAPY ; PER SESSION LESS THAN OR EQUAL TO 50 SQ. CM 97605", "code_information": [{"code": "97605", "type": "CPT"}, {"code": "11054962", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 770.56, "maximum": 8450.0, "gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEISSERIA MENINGITIDIS", "code_information": [{"code": "86741", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEO/POLY/BACI PACKET 1GM", "code_information": [{"code": "MED0160", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/POLY/DEX (MAXITROL) OPHTHALMIC OINTMENT 3.5GM", "code_information": [{"code": "MED0157", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/POLY/HYDROCORT 1% 10ML OTIC SOLUTION/ CORTISPORIN", "code_information": [{"code": "MED0158", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/POLYMYXIN/BACITRACIN (NEOSPORIN) OINT 15GM", "code_information": [{"code": "MED0159", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEOMYCIN/POLYMIXIN B SULFATE IRRIGATION 1 ML", "code_information": [{"code": "MED0231", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEOMYCIN/POLYMYXIN/DEXAMTHASONE JELLY", "code_information": [{"code": "MED0161", "type": "CDM"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "NEONATE CRIT CARE INITIAL", "code_information": [{"code": "99468", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4132.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6493.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6493.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6493.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 1786.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1786.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2807.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2807.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2807.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 988.0, "maximum": 988.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "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": 988.0, "maximum": 988.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NEOXFLO OR CLARIXFLO 1 MG", "code_information": [{"code": "Q4155", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD ALG RSK DBTC KDN DS", "code_information": [{"code": "385U", "type": "CPT"}], "standard_charges": [{"minimum": 562.68, "maximum": 3809.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2422.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD MULT ECLIA TUM NEC", "code_information": [{"code": "105U", "type": "CPT"}], "standard_charges": [{"minimum": 1368.0, "maximum": 3809.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2422.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1368.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD NUC MRS MEAS GFR", "code_information": [{"code": "259U", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 137.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 137.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 75.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 75.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD RSK HI STG KDN DS", "code_information": [{"code": "384U", "type": "CPT"}], "standard_charges": [{"minimum": 1080.0, "maximum": 3809.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2422.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH RNA PRETRNSPL PERPH BLD", "code_information": [{"code": "319U", "type": "CPT"}], "standard_charges": [{"minimum": 3816.0, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3816.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3816.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH RNA PSTTRNSPL PERPH BLD", "code_information": [{"code": "320U", "type": "CPT"}], "standard_charges": [{"minimum": 3816.0, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3816.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3816.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPHRECTOMY PARTIAL LAPAROSCOPIC 50543", "code_information": [{"code": "50543", "type": "CPT"}, {"code": "1481316", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPHROLOGY SS", "code_information": [{"code": "G4014", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPHROTOMY W/EXPLORATION", "code_information": [{"code": "50045", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPHROURETERECTOMY LAPAROSCOPIC 50548", "code_information": [{"code": "50548", "type": "CPT"}, {"code": "1481327", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPHROURETERECTOMY W/PARTIAL URETERECTOMY LAPAROSCOPIC 50546", "code_information": [{"code": "50546", "type": "CPT"}, {"code": "1481328", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPRECTOMY LAPRASCOPIC-RADICAL 50545", "code_information": [{"code": "50545", "type": "CPT"}, {"code": "1481333", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE CONNECTOR 5MM X 15MM AXOGUARD NERVE COAPTATION AID", "code_information": [{"code": "C9361", "type": "HCPCS"}, {"code": "AGX515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3667.0, "discounted_cash": 1283.45, "setting": "both", "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK <4 CM", "code_information": [{"code": "64885", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK >4 CM", "code_information": [{"code": "64886", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT MULTIPLE STRANDS 64902", "code_information": [{"code": "64902", "type": "CPT"}, {"code": "1481336", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT MULTIPLE STRANDS ARM OR LEG;MORE THAN 4 CM IN LENGTH 64898", "code_information": [{"code": "64898", "type": "CPT"}, {"code": "1481337", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT MULTIPLE STRANDS ARM OR LEG;UP TO 4 CM IN LENGTH 64897", "code_information": [{"code": "64897", "type": "CPT"}, {"code": "1481338", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT MULTIPLE STRANDS HAND OR FOOT;MORE THAN 4 CM IN LENGTH 64896", "code_information": [{"code": "64896", "type": "CPT"}, {"code": "1481339", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT MULTIPLE STRANDS HAND OR FOOT;UP TO 4 CM IN LENGTH 64895", "code_information": [{"code": "64895", "type": "CPT"}, {"code": "1481340", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT SINGLE STRAND 64901", "code_information": [{"code": "64901", "type": "CPT"}, {"code": "1481341", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT SINGLE STRAND ARM OR LEG;MORE THAN 4 CM IN LENGTH 64893", "code_information": [{"code": "64893", "type": "CPT"}, {"code": "1481342", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT SINGLE STRAND ARM OR LEG;UP TO 4 CM IN LENGTH 64892", "code_information": [{"code": "64892", "type": "CPT"}, {"code": "1481343", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT SINGLE STRAND HAND OR FOOT;MORE THAN 4 CM IN LENGTH 64891", "code_information": [{"code": "64891", "type": "CPT"}, {"code": "1481344", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT SINGLE STRAND HAND OR FOOT;UP TO 4 CM IN LENGTH 64890", "code_information": [{"code": "64890", "type": "CPT"}, {"code": "1481345", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GUIDE 1.5MM X 3CM NEURAGEN", "code_information": [{"code": "C9352", "type": "HCPCS"}, {"code": "PGN130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3307.0, "discounted_cash": 1157.45, "setting": "both", "billing_class": "facility"}]}, {"description": "NERVE PALSY FASCIAL GRAFT", "code_information": [{"code": "15840", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MICROSURG GRAFT", "code_information": [{"code": "15842", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MUSCLE GRAFT", "code_information": [{"code": "15841", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64905", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64907", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PROTECTOR AXOGVARD 7X40", "code_information": [{"code": "C9361", "type": "HCPCS"}, {"code": "AG0740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4996.0, "discounted_cash": 1748.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NERVE REPAIR W/NERVE ALLOGRAFT; EACH NERVE/ FIRST STRAND 64912", "code_information": [{"code": "64912", "type": "CPT"}, {"code": "44934126", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE REPAIR WITH SYNTHETIC CONDUIT OR VEIN ALLOGRAFT 64910", "code_information": [{"code": "64910", "type": "CPT"}, {"code": "1481346", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE SURGERY", "code_information": [{"code": "64859", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE TEASING PREPARATIONS", "code_information": [{"code": "88362", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 191.73, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 204.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITH MCC", "code_information": [{"code": "54", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8323.37, "maximum": 14289.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8323.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11904.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13094.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14289.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITHOUT MCC", "code_information": [{"code": "55", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6354.3, "maximum": 10908.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6354.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9088.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9996.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10908.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NET ROTH 2.5MM X 230 CM 3 CM X 6 CM NET STANDARD RETRIEVER DISP", "code_information": [{"code": "711052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 292.0, "discounted_cash": 102.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL A-SYNCLN PRTN", "code_information": [{"code": "393U", "type": "CPT"}], "standard_charges": [{"minimum": 779.03, "maximum": 2169.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1379.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 779.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 779.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL _-SYNCLN PRTN", "code_information": [{"code": "394U", "type": "CPT"}], "standard_charges": [{"minimum": 61.43, "maximum": 286.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 286.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 286.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURAXL LBR ANES VAG DLVR", "code_information": [{"code": "1967", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY FOOT 28055", "code_information": [{"code": "28055", "type": "CPT"}, {"code": "2401708", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1509.59, "maximum": 8450.0, "gross_charge": 3119.0, "discounted_cash": 1091.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1509.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY HAMSTRING", "code_information": [{"code": "27325", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY POPLITEAL", "code_information": [{"code": "27326", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURFLMNT LT CHN DIG IA QUAN", "code_information": [{"code": "361U", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALYS B-AMYL 1-42&1-40", "code_information": [{"code": "358U", "type": "CPT"}], "standard_charges": [{"minimum": 375.12, "maximum": 2169.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1379.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 375.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 375.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER CELL AGGREGJ", "code_information": [{"code": "206U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 3190.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3190.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3190.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER MRNA 24 GEN", "code_information": [{"code": "289U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 1094.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER QUAN IMAGING", "code_information": [{"code": "207U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 736.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 736.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 736.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 14 ACYL CARN", "code_information": [{"code": "322U", "type": "CPT"}], "standard_charges": [{"minimum": 278.03, "maximum": 1080.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 16 C METBLT", "code_information": [{"code": "263U", "type": "CPT"}], "standard_charges": [{"minimum": 278.03, "maximum": 1080.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD RNA NEXT GEN SEQ", "code_information": [{"code": "170U", "type": "CPT"}], "standard_charges": [{"minimum": 278.03, "maximum": 2808.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO AUTISM 32 AMINES ALG", "code_information": [{"code": "63U", "type": "CPT"}], "standard_charges": [{"minimum": 278.03, "maximum": 1080.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO CERE FOLATE DEFNCY SRM", "code_information": [{"code": "410U", "type": "CPT"}], "standard_charges": [{"minimum": 53.07, "maximum": 1670.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1670.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1670.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO CERE FOLATE DEFNCY SRM", "code_information": [{"code": "412U", "type": "CPT"}], "standard_charges": [{"minimum": 61.43, "maximum": 96.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO CSF PRION PRTN QUAL", "code_information": [{"code": "35U", "type": "CPT"}], "standard_charges": [{"minimum": 779.03, "maximum": 2169.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1379.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 779.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 779.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 12 COM", "code_information": [{"code": "216U", "type": "CPT"}], "standard_charges": [{"minimum": 768.44, "maximum": 2213.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 768.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2213.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2213.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 51 GENE", "code_information": [{"code": "217U", "type": "CPT"}], "standard_charges": [{"minimum": 768.44, "maximum": 3165.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 768.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3165.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3165.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO MUSC DYS DMD SEQ ALYS", "code_information": [{"code": "218U", "type": "CPT"}], "standard_charges": [{"minimum": 768.44, "maximum": 3281.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 768.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3281.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3281.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROELTRD STIM POST TIBIAL", "code_information": [{"code": "64566", "type": "CPT"}], "standard_charges": [{"minimum": 598.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROENDOSCOPIC VENTRICULOCISTERNOSTOMY THIRD VENTRICLE 62201", "code_information": [{"code": "62201", "type": "CPT"}, {"code": "1481348", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROENDOSCOPY ADD-ON", "code_information": [{"code": "62160", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROLOGICAL EYE DISORDERS", "code_information": [{"code": "123", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4664.44, "maximum": 8007.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4664.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6671.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7338.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8007.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROLOGY SS", "code_information": [{"code": "G4015", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROMUSCULAR JUNCTION TEST", "code_information": [{"code": "95937", "type": "CPT"}], "standard_charges": [{"minimum": 238.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 238.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 374.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 374.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 374.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROMUSCULAR REEDUCATION", "code_information": [{"code": "97112", "type": "CPT"}], "standard_charges": [{"minimum": 157.35, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 157.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY AND/OR TRANSPOSITION;CRANIAL NERVE 64716", "code_information": [{"code": "64716", "type": "CPT"}, {"code": "1481355", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY AND/OR TRANSPOSITION;MEDIAN NERVE AT CARPAL TUNNEL 64721", "code_information": [{"code": "64721", "type": "CPT"}, {"code": "1481356", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY AND/OR TRANSPOSITION;ULNAR NERVE AT ELBOW 64718", "code_information": [{"code": "64718", "type": "CPT"}, {"code": "1481357", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY AND/OR TRANSPOSITION;ULNAR NERVE AT WRIST 64719", "code_information": [{"code": "64719", "type": "CPT"}, {"code": "1481358", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY BRACHIAL PLEXUS 64713", "code_information": [{"code": "64713", "type": "CPT"}, {"code": "1481359", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY DIGITAL 1 OR BOTH SAME DIGIT 64702", "code_information": [{"code": "64702", "type": "CPT"}, {"code": "1481363", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1037.69, "maximum": 8450.0, "gross_charge": 2144.0, "discounted_cash": 750.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1037.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY MAJOR PERIPHERAL NERVE ARM OR LEG OPEN 64708", "code_information": [{"code": "64708", "type": "CPT"}, {"code": "1481360", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY NERVE OF HAND OR FOOT 64704", "code_information": [{"code": "64704", "type": "CPT"}, {"code": "1481364", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY SCIATIC NERVE 64712", "code_information": [{"code": "64712", "type": "CPT"}, {"code": "1481361", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURORRAPHY W/VEIN AUTOGRAFT", "code_information": [{"code": "64911", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR AXONICS 1101", "code_information": [{"code": "L8679", "type": "HCPCS"}, {"code": "1101 Stimulator", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20408.0, "discounted_cash": 7142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR F15 4101", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "4101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22069.0, "discounted_cash": 7724.15, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR IMPLANTABLE NON RECHAREABLE BATTERY FOR SPINAL CORD STIMULATION", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "37702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30508.0, "discounted_cash": 10677.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR INTERSTIM X 97800", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "97800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22219.0, "discounted_cash": 7776.65, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR LEAD 16 LEAD 60 CM LAMITRODE TRIPOLE", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10331.0, "discounted_cash": 3615.85, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR RESTORE SENSOR 54MM X 54MM X 9MM RECHARGEABLE BATTERY 9 YEAR DEV", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "37714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44883.0, "discounted_cash": 15709.05, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR WIRELESS EXTERNAL", "code_information": [{"code": "97725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUROSURGICAL SS", "code_information": [{"code": "G4016", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROVASCULAR PEDICLE FLAP 15750", "code_information": [{"code": "15750", "type": "CPT"}, {"code": "1481365", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRAL HUMERAL HAED 50MM X 18MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-50-218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2492.0, "discounted_cash": 872.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUTRAL HUMERAL HEAD 46MM X 18MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-46-218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2491.0, "discounted_cash": 871.85, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUTRALIZATION TEST VIRAL", "code_information": [{"code": "86382", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 SCR", "code_information": [{"code": "86408", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 107.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 60.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 60.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 TITER", "code_information": [{"code": "86409", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 268.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 422.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 422.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 422.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRON BEAM TX COMPLEX", "code_information": [{"code": "77423", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 914.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 288.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 453.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 453.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 453.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEVRO SMART REMOTE PTSR3100", "code_information": [{"code": "PTSR3100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1642.5, "discounted_cash": 574.88, "setting": "both", "billing_class": "facility"}]}, {"description": "NEW HDACHE PED PT DIS", "code_information": [{"code": "G2194", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEWBORN METABOLIC SCREENING", "code_information": [{"code": "S3620", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEXA FGT SIZE #20", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "FGT-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3570.0, "discounted_cash": 1249.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEXGEN COMPLETE KNEE PATELLA SZ 35", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5972-65-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1619.0, "discounted_cash": 566.65, "setting": "both", "billing_class": "facility"}]}, {"description": "NEXUS BONESCALPEL 20MM MIS BLUNT BLADE SHEATH & TUBESET 110-31-2120", "code_information": [{"code": "110-31-2120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1954.0, "discounted_cash": 683.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEXXT MATRIXX SYSTEM TLIF OBLIQUE 30D X 10W X 10H 54M-30-10-SP", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "54M-30-10-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 1540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NF DSCHRG MGMT 30 MIN+", "code_information": [{"code": "99316", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NF DSCHRG MGMT 30 MIN/LESS", "code_information": [{"code": "99315", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGENT DETECTION GI", "code_information": [{"code": "87505", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 197.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 327.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 514.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 514.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 514.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 184.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 184.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS CMV", "code_information": [{"code": "87910", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 397.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 656.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 370.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 370.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HEP B", "code_information": [{"code": "87912", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 397.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 656.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 370.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 370.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HEP C", "code_information": [{"code": "87902", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 397.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 656.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 370.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 370.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HIV1", "code_information": [{"code": "87906", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 198.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 328.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 516.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 516.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 516.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 185.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 185.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HIV1 REV", "code_information": [{"code": "87901", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 397.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 656.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 370.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 370.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS SARSCOV2", "code_information": [{"code": "87913", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 656.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1032.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 370.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 370.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT HIV GNRJ SEQ ALYS", "code_information": [{"code": "219U", "type": "CPT"}], "standard_charges": [{"minimum": 768.44, "maximum": 1208.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 768.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT STI MULT AMP PRB TQ", "code_information": [{"code": "402U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 205.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT STI MULT AMP PRB TQ", "code_information": [{"code": "736T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "202U", "type": "CPT"}], "standard_charges": [{"minimum": 600.17, "maximum": 1671.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1062.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "223U", "type": "CPT"}], "standard_charges": [{"minimum": 600.17, "maximum": 1671.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1062.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM NEG", "code_information": [{"code": "142U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 225.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 225.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 225.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM POS", "code_information": [{"code": "141U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 225.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 225.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 225.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG ORG ID 6+", "code_information": [{"code": "86U", "type": "CPT"}], "standard_charges": [{"minimum": 52.17, "maximum": 288.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT QUAN ANTMCRB SC", "code_information": [{"code": "311U", "type": "CPT"}], "standard_charges": [{"minimum": 11.64, "maximum": 34.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT/VIRAL TRAIL IP10", "code_information": [{"code": "351U", "type": "CPT"}], "standard_charges": [{"minimum": 255.0, "maximum": 401.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 375.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 375.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV RNA VAG FLU ALG", "code_information": [{"code": "81513", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 363.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS AMP PRB", "code_information": [{"code": "352U", "type": "CPT"}], "standard_charges": [{"minimum": 205.39, "maximum": 205.39, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS DNA ALG", "code_information": [{"code": "81514", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 670.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 378.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 378.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS CHRNC HCV 6 ASSAYS", "code_information": [{"code": "81596", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 184.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 289.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 289.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 289.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 103.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 103.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA UNTRGT NGNRJ SEQ", "code_information": [{"code": "152U", "type": "CPT"}], "standard_charges": [{"minimum": 52.17, "maximum": 3061.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3061.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3061.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA&RNA 21 SARSCOV2", "code_information": [{"code": "225U", "type": "CPT"}], "standard_charges": [{"minimum": 600.17, "maximum": 1671.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1062.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS FUNGI DNA 15 TRGT", "code_information": [{"code": "140U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 225.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 225.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 225.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS GU PTHGN ARG DETCJ", "code_information": [{"code": "372U", "type": "CPT"}], "standard_charges": [{"minimum": 363.71, "maximum": 600.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 363.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS STRN TYP WHL GEN SEQ", "code_information": [{"code": "10U", "type": "CPT"}], "standard_charges": [{"minimum": 615.25, "maximum": 1713.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 615.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 615.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS VIR RESP RNA 3 TRGT", "code_information": [{"code": "240U", "type": "CPT"}], "standard_charges": [{"minimum": 205.39, "maximum": 205.39, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS VIR RESP RNA 4 TRGT", "code_information": [{"code": "241U", "type": "CPT"}], "standard_charges": [{"minimum": 205.39, "maximum": 205.39, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFROS NFROT W/DRG", "code_information": [{"code": "50040", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NI REHAB MED CHIRO", "code_information": [{"code": "M1143", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC", "code_information": [{"code": "33782", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC W/OSTIA IMPLT", "code_information": [{"code": "33783", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIPPLE EXPLORATION 19110", "code_information": [{"code": "19110", "type": "CPT"}, {"code": "1481366", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NITROBLUE TETRAZOLIUM DYE", "code_information": [{"code": "86384", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PARACRV NRV", "code_information": [{"code": "64435", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD VAGUS NRV", "code_information": [{"code": "64408", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AUTOL WBC CONCENTRATE", "code_information": [{"code": "481T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH NSLC P-ART ANGRP", "code_information": [{"code": "93568", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SLCTV LV/LA ANG", "code_information": [{"code": "93565", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SLCTV RV/RA ANG", "code_information": [{"code": "93566", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SPRVLV AORTGRPHY", "code_information": [{"code": "93567", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P ANGRPH MAPCA", "code_information": [{"code": "93575", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P-ART ANGRP BI", "code_information": [{"code": "93573", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT PULM VN ANGRPH", "code_information": [{"code": "93574", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CATH SLCTV OPAC", "code_information": [{"code": "93564", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CTH SLCTV C ANG", "code_information": [{"code": "93563", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CNTRST KNE ARTHG/CT/MRI", "code_information": [{"code": "27369", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CTH SLCT P-ART ANGRP UNI", "code_information": [{"code": "93569", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT 1 VEIN", "code_information": [{"code": "36465", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT MLT VN", "code_information": [{"code": "36466", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "213T", "type": "CPT"}], "standard_charges": [{"minimum": 1508.0, "maximum": 2827.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "214T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "215T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "216T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "217T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "218T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PST CHMBR EYE MEDICATION", "code_information": [{"code": "699T", "type": "CPT"}], "standard_charges": [{"minimum": 3951.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50430", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50431", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PX ONLY MAM DUCTO/GLCTO", "code_information": [{"code": "19030", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT 1 INCMPTNT VEIN", "code_information": [{"code": "36470", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT MLT INCMPTNT VN", "code_information": [{"code": "36471", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT SPIDER VEINS", "code_information": [{"code": "36468", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX STM CL PRDCT ANL SFT TIS", "code_information": [{"code": "748T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NK CELLS TOTAL COUNT", "code_information": [{"code": "86357", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 58.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 96.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NL COMP CGEN KDN ABNORMALITY", "code_information": [{"code": "50070", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NL REMOVAL CALCULUS", "code_information": [{"code": "50060", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NL RMVL LG STAGHORN CALCULUS", "code_information": [{"code": "50075", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NL SEC SURG OPERJ CALCULUS", "code_information": [{"code": "50065", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO 1DOSE MENI VAC BTWN 11&13", "code_information": [{"code": "G9415", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4021.0, "discounted_cash": 1407.35, "setting": "both", "billing_class": "facility"}]}, {"description": "NO ADMIT REQ SURG REV", "code_information": [{"code": "G9413", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO ADMIT W/IN 180D REQ REMOV", "code_information": [{"code": "G9411", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO AHI OR RDI INITIAL DX", "code_information": [{"code": "G8844", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO ANTIBIO W IN 10D OF SYMPT", "code_information": [{"code": "G9287", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO ASA/ANTIPLAT THER USE RNG", "code_information": [{"code": "G8599", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO ASPIRIN MED RSN", "code_information": [{"code": "G2128", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO ASSESS BONE LOSS", "code_information": [{"code": "G8863", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO BP MEASURE DOC", "code_information": [{"code": "G8756", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO BP OUTPT", "code_information": [{"code": "G2129", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO BRST CNCR DX MIN INVASIVE", "code_information": [{"code": "G8877", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO CARD TAMP E/IN 30D", "code_information": [{"code": "G9409", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO CAREGIVER", "code_information": [{"code": "G2184", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO CHAD OR CHAD SCR 0 OR 1", "code_information": [{"code": "G9931", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO COMBO PROHPYL THRP FOR PT", "code_information": [{"code": "G9958", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO DOC >1 DOSE REDUC TECH", "code_information": [{"code": "G9638", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO DOC CHLAM SCR TS W/FOLLOW", "code_information": [{"code": "G9821", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO DOC COMM RISK CALC", "code_information": [{"code": "G9317", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO DOC COUNT OF CT IN 12MO", "code_information": [{"code": "G9322", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO DOC CUR FUNCT ASSESS", "code_information": [{"code": "G8541", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO DOC ELDER MAL SCRN", "code_information": [{"code": "G8536", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO DOC OF DSM-IV", "code_information": [{"code": "G9213", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO DOC ORDER ANTI-PLAT RNG", "code_information": [{"code": "G9611", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO DOC SHARE DEC PRIOR PROC", "code_information": [{"code": "G9297", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO DOC TYPE NSM LUNG CA", "code_information": [{"code": "G9290", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO DOCUMNTD HBV RESULTS RCD", "code_information": [{"code": "G9915", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO EARLY IND/DELIVERY", "code_information": [{"code": "G9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO ELIG REF FOR OTO EVAL", "code_information": [{"code": "G8857", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO ELIG TPA INIT W/IN 4.5 HR", "code_information": [{"code": "G8601", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO EVAL RISK VTE CARD PRIOR", "code_information": [{"code": "G9299", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO F/U REC IMAGE STUDY", "code_information": [{"code": "G9548", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO FILT REMOV W/IN 3MOS PLCM", "code_information": [{"code": "G9544", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO FOLLOW UP PULM NOD NORSN", "code_information": [{"code": "G9347", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO FUNCT STAT PERF, RSN NOS", "code_information": [{"code": "G9918", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO HBV STATUS ASSESD AND INT", "code_information": [{"code": "G9913", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO HIST TYPE DOC ON REPORT", "code_information": [{"code": "G9284", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO HX SPIRO PRS SPIRO>=70%", "code_information": [{"code": "M1213", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO IMPR VIS ACUIT W/IN 90D", "code_information": [{"code": "G9517", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO IMPRO MED TIME PAIN MED", "code_information": [{"code": "G9427", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO IMPROVE VISUAL FUNCT", "code_information": [{"code": "G0915", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO INTERV REQ FOR LEAK", "code_information": [{"code": "G9305", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO LOW PECARN PED HEAD TRAUM", "code_information": [{"code": "G9597", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO MED VISIT IN 24MO", "code_information": [{"code": "G9246", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO MPM", "code_information": [{"code": "G2150", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO MPM MED RSN", "code_information": [{"code": "G2149", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO MRS 90 DAYS POST STK", "code_information": [{"code": "G0046", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO NECK FS PROM INCAP", "code_information": [{"code": "M1149", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO NECK FS PROM NO RSN", "code_information": [{"code": "G2210", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO OFF ASSIS EOL", "code_information": [{"code": "G9382", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO PAP PRESCRIBED", "code_information": [{"code": "G8850", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO PCV RECD", "code_information": [{"code": "M1179", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO PHARM THER OSTEO RX", "code_information": [{"code": "G8635", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO PNEUM VAX ADMIN 19+", "code_information": [{"code": "M1304", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO PNEUMOCOCCAL ADMIN", "code_information": [{"code": "G8867", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO POSTOP REN FAIL", "code_information": [{"code": "G8576", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO PROL INTUB REQ", "code_information": [{"code": "G8570", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO PT CATEGORY ON REPORT", "code_information": [{"code": "G9293", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO PT TBCO CESS INTERV RNG", "code_information": [{"code": "G9908", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO PT TBCO CESS INTERV RNG", "code_information": [{"code": "M1289", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO PT TBCO SCRN RNG", "code_information": [{"code": "G9905", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO PT TBCO SCRN RNG", "code_information": [{"code": "M1312", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO REAS, NO RET OR W/IN 90D", "code_information": [{"code": "G9515", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO REC CORTICO>60D 1RX 600MG", "code_information": [{"code": "G9470", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO RECD CORTICO>=10MG/D >60D", "code_information": [{"code": "G9468", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO REOP REQ BLD GRFT OTH", "code_information": [{"code": "G8578", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO RET FOR SURG W IN 30D", "code_information": [{"code": "G9307", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO RSK FAC OR 1 MOD RISK TE", "code_information": [{"code": "G8970", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO RSN ACE ARB ARNI", "code_information": [{"code": "G2096", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO RSN ACE-I/ARB RX", "code_information": [{"code": "M1203", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO RSN NO BRIEF COUNS", "code_information": [{"code": "G2202", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO RX ACE/ARB THERAPY", "code_information": [{"code": "G8937", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO SATISFY WITH CARE", "code_information": [{"code": "G0918", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO SCRN PROV RSN NOS", "code_information": [{"code": "G9925", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO SENT LYMPH NODE BIOPSY", "code_information": [{"code": "G8882", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO SIGNS MELANOMA", "code_information": [{"code": "G8749", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO SLEEP APNEA ASSESS", "code_information": [{"code": "G8841", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO SMOK B/4 ANES DAY OF SURG", "code_information": [{"code": "G9644", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO SPIRO DOC NO RES DOC", "code_information": [{"code": "M1216", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO SRCH FOR CT IN 12MO NORSN", "code_information": [{"code": "G9342", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO STATIN/NO ORDER STATIN", "code_information": [{"code": "G9665", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO SURG SITE INFECTION", "code_information": [{"code": "G9311", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO TA TV ULTRASND", "code_information": [{"code": "G8807", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO TOB SCR/CESS INT", "code_information": [{"code": "G0029", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO TOB SCR/CESS INT", "code_information": [{"code": "M1313", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO TPA INIT W/IN 4.5 HR", "code_information": [{"code": "G8602", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO TRTMT CHEMO AND HER2", "code_information": [{"code": "G2208", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO UNHEAL ETOH USER", "code_information": [{"code": "G9622", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO UNPLND HOSP READM IN 30D", "code_information": [{"code": "G9309", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO WARF OR FDA DRUG PRESC", "code_information": [{"code": "G9928", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO WELL-CHLD VIST RECV BY PT", "code_information": [{"code": "G9965", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOCARDIA ANTIBODY", "code_information": [{"code": "86744", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NODE NEG PRE/POST SYST THER", "code_information": [{"code": "G9911", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON CUTANEOUS LOC", "code_information": [{"code": "G9295", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON STRL VISIONAIRE LT CUT BLK KIT LGNP", "code_information": [{"code": "V0200022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3835.0, "discounted_cash": 1342.25, "setting": "both", "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": 12850.34, "maximum": 22060.84, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12850.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18378.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20216.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22060.84, "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": 22874.51, "maximum": 39269.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22874.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32715.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35987.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39269.86, "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": 8527.76, "maximum": 14640.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8527.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12196.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13416.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14640.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-BLIND INTERATRIAL SHUNT", "code_information": [{"code": "C9760", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 85878.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54627.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 85878.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 85878.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 85878.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-COV PROC, CLINICAL TRIAL", "code_information": [{"code": "G0294", "type": "HCPCS"}], "standard_charges": [{"minimum": 147.43, "maximum": 231.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-COV SURG PROC,CLIN TRIAL", "code_information": [{"code": "G0293", "type": "HCPCS"}], "standard_charges": [{"minimum": 147.43, "maximum": 231.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE BURNS", "code_information": [{"code": "935", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "988", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10380.03, "maximum": 17819.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10380.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14845.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16330.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17819.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [{"code": "987", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19927.3, "maximum": 34210.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19927.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28500.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31350.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34210.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "989", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6834.86, "maximum": 11733.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6834.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9775.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10752.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11733.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-IMAGING HEART FUNCTION", "code_information": [{"code": "78414", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 99.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 155.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 155.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 155.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-LOCKING SCREW 3.5X20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P73ST020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITH CC/MCC", "code_information": [{"code": "600", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6064.14, "maximum": 10410.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6064.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8673.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9540.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10410.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "601", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4177.8, "maximum": 7172.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4177.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5975.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6572.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7172.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-OPHTHALMIC FVA", "code_information": [{"code": "C9733", "type": "HCPCS"}], "standard_charges": [{"minimum": 1668.68, "maximum": 2623.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-ROUTINE BL DRAW 3/> YRS", "code_information": [{"code": "36410", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-SPEECH DEVICE SERVICE", "code_information": [{"code": "92606", "type": "CPT"}], "standard_charges": [{"minimum": 321.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC", "code_information": [{"code": "71", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6154.78, "maximum": 10566.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6154.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8802.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9682.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10566.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC", "code_information": [{"code": "70", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10217.01, "maximum": 17540.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10217.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14612.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16073.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17540.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "72", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4694.25, "maximum": 8058.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4694.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6713.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7385.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8058.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC", "code_information": [{"code": "67", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8673.14, "maximum": 14889.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8673.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12404.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13644.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14889.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC", "code_information": [{"code": "68", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5407.18, "maximum": 9282.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5407.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7733.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8506.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9282.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONTRAUMATIC STUPOR AND COMA WITH MCC", "code_information": [{"code": "80", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12746.32, "maximum": 21882.26, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12746.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18229.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20052.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21882.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONTRAUMATIC STUPOR AND COMA WITHOUT MCC", "code_information": [{"code": "81", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4703.38, "maximum": 8074.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4703.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6726.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7399.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8074.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NOONAN SPECTRUM DISORDERS", "code_information": [{"code": "81442", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8595.84, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2679.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5466.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8595.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8595.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8595.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3086.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3086.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORMAL NEWBORN", "code_information": [{"code": "795", "type": "MS-DRG"}], "standard_charges": [{"minimum": 988.0, "maximum": 1991.48, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1160.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1659.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1825.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1991.48, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 1599.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NORSN FOR GC CHL SYP TEST", "code_information": [{"code": "G9230", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORSN NO FOOT EXAM", "code_information": [{"code": "G9225", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORSN NOT FIRST LINE AMOX", "code_information": [{"code": "G9314", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOS EACH ORGANISM AG IA", "code_information": [{"code": "87449", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOS QUANT SENSORY TEST", "code_information": [{"code": "110T", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 755.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOSE ALLERGY TEST", "code_information": [{"code": "95065", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOT >1 SINUS CT W 90D DX", "code_information": [{"code": "G9352", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOT DISCH HOME BY DAY #2", "code_information": [{"code": "G8838", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOT ELG PRE EX IBD/UC/CROHN", "code_information": [{"code": "M1182", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOT NSM LUNG CA", "code_information": [{"code": "G9291", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOT PRES ANTIBIOTIC", "code_information": [{"code": "G8712", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOT REF FOR OTO EVAL", "code_information": [{"code": "G8858", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOT SCRN ETOH NO RSN", "code_information": [{"code": "G2199", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOVOSTITCH PRO MENISCAL REPAIR SYSTEM SIZE 2-0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CTX-A003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.0, "discounted_cash": 465.85, "setting": "both", "billing_class": "facility"}]}, {"description": "NOZZLE SMALL HDPE CEMENT 600-55-601", "code_information": [{"code": "600-55-601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NPM1 GENE", "code_information": [{"code": "81310", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 308.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 628.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 988.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 988.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 988.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 354.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 354.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NPM1 GENE ANALYSIS QUAN", "code_information": [{"code": "49U", "type": "CPT"}], "standard_charges": [{"minimum": 242.61, "maximum": 586.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 586.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 586.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRAS GENE VARIANTS EXON 2&3", "code_information": [{"code": "81311", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 369.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 754.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1186.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1186.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1186.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 425.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 425.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRPSYC GEN SEQ VRNT ALY 13", "code_information": [{"code": "419U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1923.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRPSYC TST EVAL PHYS/QHP 1ST", "code_information": [{"code": "96132", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRPSYC TST EVAL PHYS/QHP EA", "code_information": [{"code": "96133", "type": "CPT"}], "standard_charges": [{"minimum": 370.31, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 370.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 581.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 581.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 581.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 11-12 STUDIES", "code_information": [{"code": "95912", "type": "CPT"}], "standard_charges": [{"minimum": 457.71, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 457.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 719.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 719.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 719.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 13/> STUDIES", "code_information": [{"code": "95913", "type": "CPT"}], "standard_charges": [{"minimum": 506.97, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 506.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 796.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 796.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 796.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 7-8 STUDIES", "code_information": [{"code": "95910", "type": "CPT"}], "standard_charges": [{"minimum": 387.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 387.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 609.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 609.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 609.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 9-10 STUDIES", "code_information": [{"code": "95911", "type": "CPT"}], "standard_charges": [{"minimum": 443.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 443.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 696.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 696.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 696.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TST 3-4 STUDIES", "code_information": [{"code": "95908", "type": "CPT"}], "standard_charges": [{"minimum": 252.69, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 252.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 397.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 397.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 397.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TST 5-6 STUDIES", "code_information": [{"code": "95909", "type": "CPT"}], "standard_charges": [{"minimum": 301.95, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 301.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 474.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 474.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 474.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV RPR W/NRV ALGRFT EA ADDL", "code_information": [{"code": "64913", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NS VIS ADPT GUIDE JII KIT", "code_information": [{"code": "V0200112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2707.0, "discounted_cash": 947.45, "setting": "both", "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC DX SPHN SINUSC", "code_information": [{"code": "31235", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED&INF DCMPRN", "code_information": [{"code": "31293", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED/INF DCMPRN", "code_information": [{"code": "31292", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG ON DCMPRN", "code_information": [{"code": "31294", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRAOP HIPEC PX EA ADD 30MIN", "code_information": [{"code": "96548", "type": "CPT"}], "standard_charges": [{"minimum": 125.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 125.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRAPX C FFR W/3D FUNCJL MAP", "code_information": [{"code": "523T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK TRANSLOCATION ANALYSIS", "code_information": [{"code": "81194", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1321.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2078.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2078.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2078.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 746.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 746.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK1 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81191", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 528.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK2 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81192", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 528.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK3 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81193", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 528.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 11-20", "code_information": [{"code": "99447", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 21-30", "code_information": [{"code": "99448", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 31/>", "code_information": [{"code": "99449", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 5-10", "code_information": [{"code": "99446", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 5/>", "code_information": [{"code": "99451", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR RFRL", "code_information": [{"code": "99452", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTSTY MODUL RAD TX DLVR CPLX", "code_information": [{"code": "77386", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 914.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4504.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7081.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7081.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7081.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTSTY MODUL RAD TX DLVR SMPL", "code_information": [{"code": "77385", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 914.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2252.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3540.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3540.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3540.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUBHVL XM PHY/QHP EA ADDL HR", "code_information": [{"code": "96121", "type": "CPT"}], "standard_charges": [{"minimum": 351.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 351.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 551.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 551.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 551.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUBHVL XM PHYS/QHP 1ST HR", "code_information": [{"code": "96116", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR ANTIGEN ANTIBODY", "code_information": [{"code": "86235", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 71.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 71.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR EXAM OF TEAR FLOW", "code_information": [{"code": "78660", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 710.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1116.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1116.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1116.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 266.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 283.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR MATRIX PROTEIN 22", "code_information": [{"code": "86386", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 87.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 87.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 87.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRA-ARTERIAL", "code_information": [{"code": "79445", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 417.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 513.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 807.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 807.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 807.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRA-ARTICULAR", "code_information": [{"code": "79440", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 417.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 269.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 269.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 269.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 95.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 102.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRACAV ADMIN", "code_information": [{"code": "79200", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 417.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 231.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 363.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 363.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 363.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 127.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 135.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX IV ADMIN", "code_information": [{"code": "79101", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 417.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 220.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 346.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 346.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 346.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 129.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 138.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX ORAL ADMIN", "code_information": [{"code": "79005", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 417.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 222.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 349.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 349.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 349.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 124.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 132.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEUS SZ 1 SIMPLICITI SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWG401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NUCLEUS SZ 2 SIMPLICITI SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWG402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NUCLEUS SZ 3 SIMPLICITI SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWG403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NUCLR RX INTERSTIT COLLOID", "code_information": [{"code": "79300", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 417.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 300.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 472.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUDT15 GENE COMMON VARIANTS", "code_information": [{"code": "81306", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 742.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1168.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1168.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1168.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 419.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 419.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUDT15&TPMT GENE COM VRNT", "code_information": [{"code": "169U", "type": "CPT"}], "standard_charges": [{"minimum": 671.28, "maximum": 1869.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1188.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1869.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1869.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1869.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 671.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 671.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUERSTIM DBS ACTIVA PC", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "37601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37059.0, "discounted_cash": 12970.65, "setting": "both", "billing_class": "facility"}]}, {"description": "NURSING FAC CARE SUPERVISION", "code_information": [{"code": "99379", "type": "CPT"}], "standard_charges": [{"minimum": 254.28, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 254.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NURSING FAC CARE SUPERVISION", "code_information": [{"code": "99380", "type": "CPT"}], "standard_charges": [{"minimum": 397.34, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 397.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUSHIELD ORTHOPAEDICS 4X4CM NO-1440", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NO-1440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3832.0, "discounted_cash": 1341.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NUT 10MM DSF-610-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-610-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NUT 10MM EXT LIMB ALIGN SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6000-036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NUT 20MM NUT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-6000-037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "NUT FOR HH CONNECTOR OS-2803", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS-2803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "NUT ORTHOFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "50-1008M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NUTRITION/DIETICIAN SS", "code_information": [{"code": "G4017", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NVR CNDJ TST 1-2 STUDIES", "code_information": [{"code": "95907", "type": "CPT"}], "standard_charges": [{"minimum": 189.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 189.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Needle Biopsy Of Lung Or Chest Tissue, Accessed Through The Skin", "code_information": [{"code": "32405", "type": "CPT"}], "standard_charges": [{"minimum": 1996.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Needle EMG cranial nerve unilal 95867", "code_information": [{"code": "95867", "type": "CPT"}, {"code": "2616137", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 284.49, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 284.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 447.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 447.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 447.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Needle electromyography; larynx 95865", "code_information": [{"code": "95865", "type": "CPT"}, {"code": "17618236", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Negative pressure wound therapy (eg, vacuum assisted drainage collection) 97605", "code_information": [{"code": "97605", "type": "CPT"}, {"code": "1857286", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 770.56, "maximum": 8450.0, "gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Nephrology (renal transplant), quantification of CXCL10 chemokines, flow cytometry, urine, reported as pg/mL creatinine baseline and monitoring over time", "code_information": [{"code": "526U", "type": "CPT"}], "standard_charges": [{"minimum": 8262.0, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Nephrology (renal transplant), urine, nuclear magnetic resonance (NMR) spectroscopy measurement of 84 urinary metabolites, combined with patient data, quantification of BK virus (human polyomavirus 1) using real-time PCR and serum creatinine, algorithm re", "code_information": [{"code": "542U", "type": "CPT"}], "standard_charges": [{"minimum": 8262.0, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Nephrology (transplant monitoring), 48 variants by digital PCR, using cell-free DNA from plasma, donor-derived cell-free DNA, percentage reported as risk for rejection", "code_information": [{"code": "544U", "type": "CPT"}], "standard_charges": [{"minimum": 8262.0, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Neurofilament light chain (NfL)", "code_information": [{"code": "83884", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Neurofilament light chain (NfL), chemiluminescent enzyme immunoassay, plasma, quantitative", "code_information": [{"code": "547U", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Neurofilament light chain (NfL), ultra-sensitive immunoassay, serum or cerebrospinal fluid", "code_information": [{"code": "443U", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Neurology (Alzheimer disease), beta amyloid (A\u03b240, A\u03b242, A\u03b242/40 ratio) and tau-protein (ptau217, np-tau217, ptau217/np-tau217 ratio), blood, immunoprecipitation with quantitation by liquid chromatography with tandem mass spectrometry (LC-MS/MS), algorith", "code_information": [{"code": "503U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 549.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Neurology (dementia), beta amyloid (A\u03b240, A\u03b242, A\u03b242/40 ratio), tau-protein phosphorylated at residue (eg, pTau217), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP), by ultra-high sensitivity molecule array detection, plasma, a", "code_information": [{"code": "568U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 549.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Neurology (traumatic brain injury), analysis of glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), immunoassay, whole blood or plasma, individual components reported with the overall result of elevated or non-ele", "code_information": [{"code": "570U", "type": "CPT"}], "standard_charges": [{"minimum": 291.21, "maximum": 457.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 291.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 457.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 457.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 457.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 1 Hour", "code_information": [{"code": "99327", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 20 Minutes", "code_information": [{"code": "99324", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 30 Minutes", "code_information": [{"code": "99325", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 45 Minutes", "code_information": [{"code": "99326", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 75 Minutes", "code_information": [{"code": "99328", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Home Visit, Typically 45 Minutes", "code_information": [{"code": "99343", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Office Or Other Outpatient Visit, Typically 10 Minutes", "code_information": [{"code": "99201", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "No Preference Card Available", "code_information": [{"code": "SNPC99999", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "Noninvasive assessment of blood oxygenation, gas exchange efficiency, and cardiorespiratory status, with physician or other qualified health care professional interpretation and report", "code_information": [{"code": "893T", "type": "CPT"}], "standard_charges": [{"minimum": 257.01, "maximum": 403.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 257.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 403.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 403.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 403.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Noninvasive augmentative arrhythmia analysis derived from quantitative computational cardiac arrhythmia simulations, based on selected intervals of interest from 12-lead electrocardiogram and uploaded clinical parameters, including uploading clinical para", "code_information": [{"code": "897T", "type": "CPT"}], "standard_charges": [{"minimum": 4353.31, "maximum": 6843.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4353.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Noninvasive detection of heart failure derived from augmentative analysis of an echocardiogram that demonstrated preserved ejection fraction, with interpretation and report by a physician or other qualified health care professional", "code_information": [{"code": "932T", "type": "CPT"}], "standard_charges": [{"minimum": 1310.61, "maximum": 2060.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1310.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2060.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2060.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2060.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Noninvasive determination of absolute quantitation of myocardial blood flow (AQMBF), derived from augmentative algorithmic analysis of the dataset acquired via contrast cardiac magnetic resonance (CMR), pharmacologic stress, with interpretation and report", "code_information": [{"code": "899T", "type": "CPT"}], "standard_charges": [{"minimum": 3862.12, "maximum": 6071.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3862.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6071.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6071.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6071.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Noninvasive estimate of absolute quantitation of myocardial blood flow (AQMBF), derived from assistive algorithmic analysis of the dataset acquired via contrast cardiac magnetic resonance (CMR), pharmacologic stress, with interpretation and report by a ph", "code_information": [{"code": "900T", "type": "CPT"}], "standard_charges": [{"minimum": 3862.12, "maximum": 6071.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3862.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6071.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6071.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6071.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Noninvasive prostate cancer estimation map, derived from augmentative analysis of image-guided fusion biopsy and pathology, including visualization of margin volume and location, with margin determination and physician interpretation and report", "code_information": [{"code": "898T", "type": "CPT"}], "standard_charges": [{"minimum": 4353.31, "maximum": 6843.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4353.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine Study Of Red Blood Cell, Red Cell Survival, Organ Specific", "code_information": [{"code": "78135", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nursery General", "code_information": [{"code": "170", "type": "RC"}], "standard_charges": [{"minimum": 814.0, "maximum": 814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 814.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Nursery Newborn Level I", "code_information": [{"code": "171", "type": "RC"}], "standard_charges": [{"minimum": 814.0, "maximum": 814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 814.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Nursery Other", "code_information": [{"code": "179", "type": "RC"}], "standard_charges": [{"minimum": 814.0, "maximum": 814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 814.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Nursing Facility Annual Assessment, Typically 30 Minutes", "code_information": [{"code": "99318", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITH CC", "code_information": [{"code": "620", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10722.5, "maximum": 32119.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 30732.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 30732.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 53.06, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 24283.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10722.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15335.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16869.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18407.88, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 22380.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 22380.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32119.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26759.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITH MCC", "code_information": [{"code": "619", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18624.32, "maximum": 32119.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18624.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26636.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29300.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31973.33, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 22380.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 22380.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32119.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26759.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC", "code_information": [{"code": "621", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9715.16, "maximum": 32119.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 30732.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 30732.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 53.06, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 24283.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9715.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13894.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15284.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16678.52, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 22380.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 22380.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32119.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26759.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC", "code_information": [{"code": "940", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13509.73, "maximum": 23192.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13509.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19321.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21254.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23192.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC", "code_information": [{"code": "939", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20527.69, "maximum": 35240.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20527.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29359.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32294.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35240.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC", "code_information": [{"code": "941", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11698.22, "maximum": 20082.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11698.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16730.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18404.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20082.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB PE BIOCHEM ASSAY PGF ALG", "code_information": [{"code": "243U", "type": "CPT"}], "standard_charges": [{"minimum": 81.09, "maximum": 127.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB PE KDR ENG&RBP4 IA ALG", "code_information": [{"code": "390U", "type": "CPT"}], "standard_charges": [{"minimum": 81.09, "maximum": 127.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB PREIMPLTJ TST 300000 DNA", "code_information": [{"code": "404U", "type": "CPT"}], "standard_charges": [{"minimum": 465.06, "maximum": 1136.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 465.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 465.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB PRTRM BRTH IBP4 SHBG MEAS", "code_information": [{"code": "247U", "type": "CPT"}], "standard_charges": [{"minimum": 81.09, "maximum": 1080.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US < 14 WKS ADDL FETUS", "code_information": [{"code": "76802", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 96.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 151.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 151.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 151.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 49.84, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US < 14 WKS SINGLE FETUS", "code_information": [{"code": "76801", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 321.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 505.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 505.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 505.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 178.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US >= 14 WKS ADDL FETUS", "code_information": [{"code": "76810", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 297.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 297.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 297.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 97.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 103.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US >= 14 WKS SNGL FETUS", "code_information": [{"code": "76805", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 400.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 628.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 628.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 628.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 209.8, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 223.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US DETAILED ADDL FETUS", "code_information": [{"code": "76812", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 488.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 767.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 767.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 767.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 254.03, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 270.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US DETAILED SNGL FETUS", "code_information": [{"code": "76811", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 370.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 581.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 581.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 581.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 213.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 227.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US FOLLOW-UP PER FETUS", "code_information": [{"code": "76816", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 164.8, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 175.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US LIMITED FETUS(S)", "code_information": [{"code": "76815", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 120.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US NUCHAL MEAS 1 GEST", "code_information": [{"code": "76813", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 139.86, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 148.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US NUCHAL MEAS ADD-ON", "code_information": [{"code": "76814", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 127.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 200.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 200.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 200.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 65.12, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 69.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB XPND CAR SCR 145 GENES", "code_information": [{"code": "413U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1819.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1819.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1819.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB XPND CAR SCR 145 GENES", "code_information": [{"code": "414U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1017.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1017.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1017.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB/GYN SS", "code_information": [{"code": "G4018", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBALON BALLON METHYLENE BLUE 0.0006% 500 ML NACL 0.9%", "code_information": [{"code": "MED0132", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "OBS DEMINERALIZED BONE STRIP 50X20X5MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "OBS-205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5768.0, "discounted_cash": 2018.8, "setting": "both", "billing_class": "facility"}]}, {"description": "OBSTETRIC PANEL", "code_information": [{"code": "80055", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 121.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 191.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 191.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 68.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 68.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRIC PANEL", "code_information": [{"code": "80081", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 115.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 190.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 300.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 300.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 300.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 107.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 107.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59400", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59409", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59410", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBTAINING SCREEN PAP SMEAR", "code_information": [{"code": "Q0091", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.85, "maximum": 79.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 79.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 79.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 79.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBTURATEUR 24MM BOUCHON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EBO101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 457.0, "discounted_cash": 159.95, "setting": "both", "billing_class": "facility"}]}, {"description": "OBTURATOR 105MM EPF Y211A", "code_information": [{"code": "Y211A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "OBTURATOR ENDO 5MM SEALED RIGHT VERSAPORT V2 STRL DISP", "code_information": [{"code": "179101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "billing_class": "facility"}]}, {"description": "OBTURATOR THRD CLEAR CAN W MR214120RH", "code_information": [{"code": "MR214120RH", "type": "CDM"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "OBTURATOR VERSAPORT PLUA 12MM VZ RT SEAL", "code_information": [{"code": "179103P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 331.0, "discounted_cash": 115.85, "setting": "both", "billing_class": "facility"}]}, {"description": "OC NI PT DC", "code_information": [{"code": "M1109", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT DC", "code_information": [{"code": "M1114", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT DC", "code_information": [{"code": "M1119", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT DC", "code_information": [{"code": "M1129", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT DC", "code_information": [{"code": "M1133", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT DC 1-2 VIS", "code_information": [{"code": "M1124", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1108", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1113", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1118", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1123", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1128", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1132", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT SELFDC", "code_information": [{"code": "M1115", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT SELFDC", "code_information": [{"code": "M1120", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT SELFDC", "code_information": [{"code": "M1130", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT SELFDC", "code_information": [{"code": "M1134", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NI PT SELFDC 1-2 VIS", "code_information": [{"code": "M1125", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OC NOT P PT SELFDC", "code_information": [{"code": "M1110", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCIP HDACHE CHILD", "code_information": [{"code": "G2195", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCLUSION OF FALLOPIAN TUBE(S) 58615", "code_information": [{"code": "58615", "type": "CPT"}, {"code": "1481367", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCLUSIVE DEVICE IN VEIN ART", "code_information": [{"code": "G0269", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLD FECES 1-3 TESTS", "code_information": [{"code": "82272", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLOOD FECES", "code_information": [{"code": "82270", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLOOD OTHER SOURCES", "code_information": [{"code": "82271", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCT BREAST SURG CAVITY I&R", "code_information": [{"code": "354T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCT BRST/NODE I&R PER SPEC", "code_information": [{"code": "352T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCT MID EAR I&R BILATERAL", "code_information": [{"code": "486T", "type": "CPT"}], "standard_charges": [{"minimum": 146.09, "maximum": 229.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 146.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCT MID EAR I&R UNILATERAL", "code_information": [{"code": "485T", "type": "CPT"}], "standard_charges": [{"minimum": 146.09, "maximum": 229.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 146.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR BLOOD FLOW MEASURE", "code_information": [{"code": "198T", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 755.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR FUNCTION SCREEN", "code_information": [{"code": "99172", "type": "CPT"}], "standard_charges": [{"minimum": 211.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 332.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR INSTRUMNT SCREEN BIL", "code_information": [{"code": "99174", "type": "CPT"}], "standard_charges": [{"minimum": 25.45, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR INSTRUMNT SCREEN BIL", "code_information": [{"code": "99177", "type": "CPT"}], "standard_charges": [{"minimum": 20.68, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR LUBRICANT OINTMENT (ARTIFICIAL TEARS) 3.5 GM", "code_information": [{"code": "MED0010", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR PHOTODYNAMIC THER", "code_information": [{"code": "67221", "type": "CPT"}], "standard_charges": [{"minimum": 789.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65780", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65781", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65782", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF ASSIS EOL ISS", "code_information": [{"code": "G9380", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CNSLTJ NEW/EST LOW 30", "code_information": [{"code": "99243", "type": "CPT"}], "standard_charges": [{"minimum": 429.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 429.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 674.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 674.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 674.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CNSLTJ NEW/EST MOD 40", "code_information": [{"code": "99244", "type": "CPT"}], "standard_charges": [{"minimum": 689.77, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 689.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1083.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1083.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1083.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CONSLTJ NEW/EST HI 55", "code_information": [{"code": "99245", "type": "CPT"}], "standard_charges": [{"minimum": 853.47, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 853.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1341.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1341.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1341.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CONSLTJ NEW/EST SF 20", "code_information": [{"code": "99242", "type": "CPT"}], "standard_charges": [{"minimum": 306.76, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 306.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 482.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 482.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 482.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP EST MAY X REQ PHY/QHP", "code_information": [{"code": "99211", "type": "CPT"}], "standard_charges": [{"minimum": 41.32, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE EMERGENCY CARE", "code_information": [{"code": "99058", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P EST HI 40 MIN", "code_information": [{"code": "99215", "type": "CPT"}], "standard_charges": [{"minimum": 497.45, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 497.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 781.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 781.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 781.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P EST LOW 20 MIN", "code_information": [{"code": "99213", "type": "CPT"}], "standard_charges": [{"minimum": 228.88, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 228.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P EST MOD 30 MIN", "code_information": [{"code": "99214", "type": "CPT"}], "standard_charges": [{"minimum": 352.84, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 352.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 554.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 554.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 554.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P EST SF 10 MIN", "code_information": [{"code": "99212", "type": "CPT"}], "standard_charges": [{"minimum": 114.44, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P NEW HI 60 MIN", "code_information": [{"code": "99205", "type": "CPT"}], "standard_charges": [{"minimum": 754.95, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 754.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1186.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1186.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1186.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P NEW LOW 30 MIN", "code_information": [{"code": "99203", "type": "CPT"}], "standard_charges": [{"minimum": 341.69, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 341.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 536.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 536.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 536.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P NEW MOD 45 MIN", "code_information": [{"code": "99204", "type": "CPT"}], "standard_charges": [{"minimum": 578.5, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 578.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 909.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 909.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 909.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P NEW SF 15 MIN", "code_information": [{"code": "99202", "type": "CPT"}], "standard_charges": [{"minimum": 227.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 227.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFLOXACIN (FLOXIN) 0.3% 5ML OTIC", "code_information": [{"code": "MED0162", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "OFLOXACIN OPTH 0.3% SOL 5 ML", "code_information": [{"code": "MED0657", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "OFLOXACIN OTIC 0.3% SOLN 10 ML (FLOXIN)", "code_information": [{"code": "MED0640", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 388.0, "discounted_cash": 135.8, "setting": "both", "billing_class": "facility"}]}, {"description": "OIL EMULSION DRESSING, 3INX8IN, STERILE", "code_information": [{"code": "C-WNM38", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "OIL SILICONE ADATO", "code_information": [{"code": "C1814", "type": "HCPCS"}, {"code": "ES5000S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 948.0, "discounted_cash": 331.8, "setting": "both", "billing_class": "facility"}]}, {"description": "OL DIG E/M SVC 11-20 MIN", "code_information": [{"code": "99422", "type": "CPT"}], "standard_charges": [{"minimum": 120.79, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OL DIG E/M SVC 21+ MIN", "code_information": [{"code": "99423", "type": "CPT"}], "standard_charges": [{"minimum": 192.32, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 192.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 302.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 302.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 302.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OL DIG E/M SVC 5-10 MIN", "code_information": [{"code": "99421", "type": "CPT"}], "standard_charges": [{"minimum": 58.79, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OLIGOCLONAL BANDS", "code_information": [{"code": "83916", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 109.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 109.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 109.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OLIVE WIRE 1.6 X 100MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OLIVE-1.6/100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OLIVE WIRE 2.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-6000-201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 582.0, "discounted_cash": 203.7, "setting": "both", "billing_class": "facility"}]}, {"description": "OLIVE WIRE NON-THREADED CD-MF-0055", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CD-MF-0055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "OLIVE WIRE SMOOTH 1.3MM", "code_information": [{"code": "P99-200-1306", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "OLIVE WIRE TAC 2.0 BALL END", "code_information": [{"code": "8242-99-101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.0, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "OMEGA XP\u00e2\u201e\u00a2 9MM X 28MM X 11MM 4\u00c2\u00b0 LUMBAR EXPANDABLE INTERBODY CLOSE 72-00-092811-04", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72-00-092811-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 2800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OMENTAL FLAP EXTRA-ABDOM", "code_information": [{"code": "49904", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OMENTAL FLAP INTRA-ABDOM", "code_information": [{"code": "49905", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OMENTECTOMY 49255", "code_information": [{"code": "49255", "type": "CPT"}, {"code": "1481369", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OMEPRAZOLE DR 20 MG CAP 100 UD AHP 68084-128-01", "code_information": [{"code": "68084-128-01", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OMNI SURGICAL SYSTEM 1-102", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "1-102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3399.0, "discounted_cash": 1189.65, "setting": "both", "billing_class": "facility"}]}, {"description": "OMNI SURGICAL SYSTEM 1-112", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "1-112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3400.0, "discounted_cash": 1190.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OMNIPAQUE 240MG/ML INJECTION 10ML", "code_information": [{"code": "MED0352", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 142.0, "discounted_cash": 49.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ONC AML DNA DETCJ/NONDETCJ", "code_information": [{"code": "23U", "type": "CPT"}], "standard_charges": [{"minimum": 357.85, "maximum": 996.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 633.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 996.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 996.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 996.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 357.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 357.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC B CLL LYMPHM MRNA 58 GEN", "code_information": [{"code": "120U", "type": "CPT"}], "standard_charges": [{"minimum": 3614.7, "maximum": 10065.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6401.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10065.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10065.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10065.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3614.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3614.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BLADDER MRNA 219 GEN ALG", "code_information": [{"code": "16M", "type": "CPT"}], "standard_charges": [{"minimum": 1938.0, "maximum": 5025.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5025.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5025.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BLDR 10 FLWG TRURL RESCJ", "code_information": [{"code": "367U", "type": "CPT"}], "standard_charges": [{"minimum": 1299.14, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1299.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1299.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BLDR 10 PRB BLDR CA", "code_information": [{"code": "365U", "type": "CPT"}], "standard_charges": [{"minimum": 1291.68, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1291.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1291.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BLDR 10 PRB RECR BLDR CA", "code_information": [{"code": "366U", "type": "CPT"}], "standard_charges": [{"minimum": 1291.68, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1291.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1291.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 101 GENES", "code_information": [{"code": "153U", "type": "CPT"}], "standard_charges": [{"minimum": 4549.56, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4549.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4549.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 12 GENES", "code_information": [{"code": "81522", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 58 GENES", "code_information": [{"code": "81520", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 10065.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3873.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6401.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10065.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10065.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10065.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3614.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3614.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 70 GENES", "code_information": [{"code": "81521", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4841.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRN SPHRD CLL 12 RX PNL", "code_information": [{"code": "248U", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 4368.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1477.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4368.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4368.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST ALYS 32 PHSPRTN ALG", "code_information": [{"code": "249U", "type": "CPT"}], "standard_charges": [{"minimum": 722.7, "maximum": 3195.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3195.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3195.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA AI ASSMT 12 FEAT", "code_information": [{"code": "220U", "type": "CPT"}], "standard_charges": [{"minimum": 181.97, "maximum": 1017.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1017.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1017.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA DNA PIK3CA 11", "code_information": [{"code": "177U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 549.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA DNA PIK3CA GENE", "code_information": [{"code": "155U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 549.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA ERBB2 AMP/NONAMP", "code_information": [{"code": "9U", "type": "CPT"}], "standard_charges": [{"minimum": 154.08, "maximum": 429.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 272.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 429.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 429.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 429.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 154.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 154.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST DUX CARC 7 PROTEINS", "code_information": [{"code": "295U", "type": "CPT"}], "standard_charges": [{"minimum": 272.85, "maximum": 7826.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 272.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 429.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 429.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 429.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7826.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7826.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST DUX CARC IS 12 GENE", "code_information": [{"code": "45U", "type": "CPT"}], "standard_charges": [{"minimum": 5577.12, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST IMHCHEM PRFL 4 BMRK", "code_information": [{"code": "67U", "type": "CPT"}], "standard_charges": [{"minimum": 181.97, "maximum": 2731.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2731.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2731.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST MRNA 11 GENES", "code_information": [{"code": "81518", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST MRNA 70 CNT 31 GENE", "code_information": [{"code": "81523", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CHEMO RX CYTOTOX CSC 14", "code_information": [{"code": "564T", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 74.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CHEMO RX CYTOX CSC 14 RX", "code_information": [{"code": "435U", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT 3 UR METAB ALG PLP", "code_information": [{"code": "2U", "type": "CPT"}], "standard_charges": [{"minimum": 36.0, "maximum": 100.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT CA IMG ALYS W/AI", "code_information": [{"code": "261U", "type": "CPT"}], "standard_charges": [{"minimum": 181.97, "maximum": 7128.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7128.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT CA MUT&MTHYLTN MRK", "code_information": [{"code": "368U", "type": "CPT"}], "standard_charges": [{"minimum": 181.97, "maximum": 286.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT MICRORNA MIR-31-3P", "code_information": [{"code": "69U", "type": "CPT"}], "standard_charges": [{"minimum": 547.2, "maximum": 1523.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1523.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1523.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1523.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 547.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 547.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT SCR 3 PRTN ALG", "code_information": [{"code": "163U", "type": "CPT"}], "standard_charges": [{"minimum": 562.68, "maximum": 2040.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1297.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT SCR SGL AMP 8 RNA", "code_information": [{"code": "421U", "type": "CPT"}], "standard_charges": [{"minimum": 1297.62, "maximum": 2040.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1297.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT SCR WHL BLD ALG", "code_information": [{"code": "91U", "type": "CPT"}], "standard_charges": [{"minimum": 639.49, "maximum": 1005.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 639.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1005.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1005.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1005.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC COLON CA KRAS&NRAS ALYS", "code_information": [{"code": "111U", "type": "CPT"}], "standard_charges": [{"minimum": 982.5, "maximum": 2735.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1739.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 982.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 982.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CUTAN MLNMA MRNA 23 GENE", "code_information": [{"code": "90U", "type": "CPT"}], "standard_charges": [{"minimum": 2808.0, "maximum": 7819.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CUTAN MLNMA MRNA 31 GENE", "code_information": [{"code": "81529", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 28843.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18342.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28843.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28843.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28843.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10357.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10357.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CUTAN MLNMA MRNA 35 GENE", "code_information": [{"code": "314U", "type": "CPT"}], "standard_charges": [{"minimum": 2808.0, "maximum": 7819.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CUTAN SQ CLL CA MRNA 40", "code_information": [{"code": "315U", "type": "CPT"}], "standard_charges": [{"minimum": 4972.5, "maximum": 12240.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12240.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DLBCL MRNA 20 GENES ALG", "code_information": [{"code": "17M", "type": "CPT"}], "standard_charges": [{"minimum": 3614.7, "maximum": 10065.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6401.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10065.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10065.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10065.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3614.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3614.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST METASTIC/ RECUR", "code_information": [{"code": "G9075", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG1-2 NOPROGRES", "code_information": [{"code": "G9072", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG1-2B HR,NOPRO", "code_information": [{"code": "G9071", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG3-HR, NO PRO", "code_information": [{"code": "G9073", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG3-NOPROGRESS", "code_information": [{"code": "G9074", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX CML ACCELER PHASE", "code_information": [{"code": "G9124", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX CML BLAST PHASE", "code_information": [{"code": "G9125", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX CML CHRONIC PHASE", "code_information": [{"code": "G9123", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX CML REMISSION", "code_information": [{"code": "G9126", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON EXTENT UNKNOWN", "code_information": [{"code": "G9089", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON METAS EVID DX", "code_information": [{"code": "G9087", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON METAS NOEVID DX", "code_information": [{"code": "G9088", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T1-3,N1-2,NO PR", "code_information": [{"code": "G9084", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T1-4 NO DX PROG", "code_information": [{"code": "G9086", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T4, N0 W/O PROG", "code_information": [{"code": "G9085", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAG T1-T3 NOPROG", "code_information": [{"code": "G9096", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL METS RECUR", "code_information": [{"code": "G9098", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL T4 NO PROG", "code_information": [{"code": "G9097", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL UNKNOWN", "code_information": [{"code": "G9099", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC NO RECURRENCE", "code_information": [{"code": "G9100", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC P R1-R2NOPROG", "code_information": [{"code": "G9101", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC RECURRENT", "code_information": [{"code": "G9103", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC UNKNOWN NOS", "code_information": [{"code": "G9104", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC UNRESECTABLE", "code_information": [{"code": "G9102", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK EXT UNKNOWN", "code_information": [{"code": "G9112", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK M1 METS REC", "code_information": [{"code": "G9111", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK T1-T2NO PRG", "code_information": [{"code": "G9109", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK T3-4 NOPROG", "code_information": [{"code": "G9110", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX MULT MYELOMA STG2 HIG", "code_information": [{"code": "G9129", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX MULTI MYELOMA STAGE I", "code_information": [{"code": "G9128", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX MULTI MYELOMA UNKNOWN", "code_information": [{"code": "G9130", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC DX UNKNOWN NOS", "code_information": [{"code": "G9067", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG2 NO PROGRES", "code_information": [{"code": "G9064", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG3A NO PROGRE", "code_information": [{"code": "G9065", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG3B-4 METASTA", "code_information": [{"code": "G9066", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STGI NO PROGRES", "code_information": [{"code": "G9063", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN RECURRENCE", "code_information": [{"code": "G9116", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG1A-B NO PR", "code_information": [{"code": "G9113", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG1A-B OR 2", "code_information": [{"code": "G9114", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG3/4 NOPROG", "code_information": [{"code": "G9115", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN UNKNOWN NOS", "code_information": [{"code": "G9117", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATC P R0 RES NO", "code_information": [{"code": "G9105", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATC P R1/R2 NO", "code_information": [{"code": "G9106", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATIC UNKNWN NOS", "code_information": [{"code": "G9108", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATIC UNRESECTAB", "code_information": [{"code": "G9107", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE T1NO PROGRES", "code_information": [{"code": "G9077", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE T2NO PROGRES", "code_information": [{"code": "G9078", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE T3B-T4NOPROG", "code_information": [{"code": "G9079", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE UNKNWN NOS", "code_information": [{"code": "G9083", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE W/RISE PSA", "code_information": [{"code": "G9080", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL EXTENT UNKNWN", "code_information": [{"code": "G9095", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL M1 W/METS PROG", "code_information": [{"code": "G9094", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T1-2 NO PROGR", "code_information": [{"code": "G9090", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T1-3,N1-2NOPRG", "code_information": [{"code": "G9092", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T3 N0 NO PROG", "code_information": [{"code": "G9091", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T4,N,M0 NO PRG", "code_information": [{"code": "G9093", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC EXT AT DX", "code_information": [{"code": "G9069", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC EXT UNKNWN", "code_information": [{"code": "G9070", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC LIMITED", "code_information": [{"code": "G9068", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC EXPECTANT MANAGEMENT PT", "code_information": [{"code": "G9053", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC GASTRO 51 GENE NOMOGRAM", "code_information": [{"code": "7M", "type": "CPT"}], "standard_charges": [{"minimum": 956.25, "maximum": 1503.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1503.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1503.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1503.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC HEP GENE RISK CLASSIFIER", "code_information": [{"code": "6M", "type": "CPT"}], "standard_charges": [{"minimum": 382.5, "maximum": 601.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC HL NEO GEN SEQ ALYS ALG", "code_information": [{"code": "364U", "type": "CPT"}], "standard_charges": [{"minimum": 9562.5, "maximum": 15037.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9562.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC HL NEO OPT GEN MAPPING", "code_information": [{"code": "331U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 2683.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2683.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2683.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC HMTLMF NEO JAK2 MUT DNA", "code_information": [{"code": "17U", "type": "CPT"}], "standard_charges": [{"minimum": 131.99, "maximum": 367.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 233.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 367.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 367.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 367.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 131.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 131.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC HMTLMF NEO RNA BCR/ABL1", "code_information": [{"code": "16U", "type": "CPT"}], "standard_charges": [{"minimum": 236.1, "maximum": 657.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 418.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 657.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 657.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 657.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 236.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 236.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNCH SYN GEN DNA SEQ ALY", "code_information": [{"code": "238U", "type": "CPT"}], "standard_charges": [{"minimum": 842.26, "maximum": 2708.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1722.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2708.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 842.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNG 3 PRTN BMRK PLSM ALG", "code_information": [{"code": "92U", "type": "CPT"}], "standard_charges": [{"minimum": 3582.72, "maximum": 11512.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3582.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3582.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNG 5 CLIN RSK FACTR ALG", "code_information": [{"code": "80U", "type": "CPT"}], "standard_charges": [{"minimum": 5068.8, "maximum": 14115.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8976.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14115.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14115.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14115.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5068.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5068.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNG MULTIOMICS PLSM ALG", "code_information": [{"code": "401U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNG MULTIOMICS PLSM ALG", "code_information": [{"code": "403U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1094.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNG PLSM ALYS 388 PRTN", "code_information": [{"code": "436U", "type": "CPT"}], "standard_charges": [{"minimum": 9562.5, "maximum": 15037.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9562.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LUNG CA 4-PRB FISH ASSAY", "code_information": [{"code": "317U", "type": "CPT"}], "standard_charges": [{"minimum": 2923.2, "maximum": 8140.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5176.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2923.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2923.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LUNG ELISA 7 AUTOANT ALG", "code_information": [{"code": "360U", "type": "CPT"}], "standard_charges": [{"minimum": 1210.54, "maximum": 11512.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1210.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1210.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LUNG MRNA QUAN PCR 11&3", "code_information": [{"code": "288U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 5577.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LVR SURVEILANC HCC CFDNA", "code_information": [{"code": "333U", "type": "CPT"}], "standard_charges": [{"minimum": 953.74, "maximum": 2040.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1297.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 953.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 953.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MERKEL CLL CARC SRM +/-", "code_information": [{"code": "59U", "type": "CPT"}], "standard_charges": [{"minimum": 465.06, "maximum": 1295.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 823.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1295.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1295.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1295.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 465.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 465.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MERKEL CLL CARC SRM QUAN", "code_information": [{"code": "58U", "type": "CPT"}], "standard_charges": [{"minimum": 465.06, "maximum": 1295.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 823.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1295.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1295.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1295.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 465.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 465.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MLNMA AMBRA1&AMLO", "code_information": [{"code": "387U", "type": "CPT"}], "standard_charges": [{"minimum": 1365.84, "maximum": 7819.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1365.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1365.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MLNMA PRAME & LINC00518", "code_information": [{"code": "89U", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MRD NXT-GNRJ ALYS 1ST", "code_information": [{"code": "306U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 5584.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5584.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5584.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MRD NXT-GNRJ ALYS SBSQ", "code_information": [{"code": "307U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1144.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1144.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1144.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MRNA 5 GEN RECR URTHL CA", "code_information": [{"code": "13M", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MRNA 5 GEN RSK URTHL CA", "code_information": [{"code": "12M", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC NEO XOME&TRNS SEQ ALYS", "code_information": [{"code": "329U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 4950.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4950.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4950.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC NONSM CLL LNG CA 37 GEN", "code_information": [{"code": "388U", "type": "CPT"}], "standard_charges": [{"minimum": 827.68, "maximum": 1301.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 827.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC NONSM CLL LNG CA ALYS 23", "code_information": [{"code": "179U", "type": "CPT"}], "standard_charges": [{"minimum": 827.68, "maximum": 2798.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 827.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1301.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2798.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2798.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC ORL&/OROP CA 20 MLC FEAT", "code_information": [{"code": "296U", "type": "CPT"}], "standard_charges": [{"minimum": 382.5, "maximum": 2808.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC OROP/ANAL 17 DNA DDPCR", "code_information": [{"code": "356U", "type": "CPT"}], "standard_charges": [{"minimum": 382.5, "maximum": 601.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC OVAR 5 PRTN SER ALG SCOR", "code_information": [{"code": "3U", "type": "CPT"}], "standard_charges": [{"minimum": 1368.0, "maximum": 3809.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2422.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1368.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC OVRN BCHM ASY 7 PRTN ALG", "code_information": [{"code": "375U", "type": "CPT"}], "standard_charges": [{"minimum": 914.94, "maximum": 1438.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 914.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1438.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1438.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1438.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1291.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1291.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN CA ALYS MRD PLASMA", "code_information": [{"code": "340U", "type": "CPT"}], "standard_charges": [{"minimum": 5169.6, "maximum": 15719.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9996.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15719.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15719.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15719.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5169.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5169.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN SOLID TUM ALYS DNA", "code_information": [{"code": "422U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 549.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM GEN PRFLG 8 DNA", "code_information": [{"code": "332U", "type": "CPT"}], "standard_charges": [{"minimum": 1644.56, "maximum": 15037.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9562.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1644.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1644.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN OPT MAPG", "code_information": [{"code": "299U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 2683.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2683.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2683.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN SEQ DNA", "code_information": [{"code": "297U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 4204.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN SEQ&OPT", "code_information": [{"code": "300U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 6023.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6023.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6023.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL TRNS SEQ RNA", "code_information": [{"code": "298U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 4204.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN-TUM DNA&RNA GNRJ SEQ", "code_information": [{"code": "211U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 12175.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12175.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12175.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAP THYR CA RNA 82&10", "code_information": [{"code": "362U", "type": "CPT"}], "standard_charges": [{"minimum": 5184.0, "maximum": 14736.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9371.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14736.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14736.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14736.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PLSM CELL DO&MYELOMA ID", "code_information": [{"code": "337U", "type": "CPT"}], "standard_charges": [{"minimum": 3506.4, "maximum": 11512.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3506.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3506.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PNCRS DNA&MRNA SEQ 74", "code_information": [{"code": "313U", "type": "CPT"}], "standard_charges": [{"minimum": 5184.0, "maximum": 14436.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9180.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PNCRTC 59 MTHLTN BLK MRK", "code_information": [{"code": "M0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 663.71, "maximum": 1042.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 663.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1042.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1042.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1042.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PNCRTC CA MULT IA ECLIA", "code_information": [{"code": "342U", "type": "CPT"}], "standard_charges": [{"minimum": 53.07, "maximum": 1291.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1291.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1291.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRAC COND NOADD BY GUIDE", "code_information": [{"code": "G9061", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRAC GUIDE DIFFERS NOS", "code_information": [{"code": "G9062", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRAC MGMT ADHERES GUIDE", "code_information": [{"code": "G9056", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRAC MGMT DIF PT COMORB", "code_information": [{"code": "G9060", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRAC MGMT DISAGREE W/GUI", "code_information": [{"code": "G9058", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRAC MGMT PT OPT ALTERNA", "code_information": [{"code": "G9059", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRACT MGMT DIFFERS TRIAL", "code_information": [{"code": "G9057", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PROSTATE 3 GENES", "code_information": [{"code": "81551", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5176.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2923.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2923.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PROSTATE MRNA 22 CNT GEN", "code_information": [{"code": "81542", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PROSTATE MRNA 46 GENES", "code_information": [{"code": "81541", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4841.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 5 DNA REG MRK PCR", "code_information": [{"code": "433U", "type": "CPT"}], "standard_charges": [{"minimum": 1938.0, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 CA ALYS ALL PSA", "code_information": [{"code": "359U", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 CA IMG ALYS 128", "code_information": [{"code": "376U", "type": "CPT"}], "standard_charges": [{"minimum": 1017.0, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1017.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1017.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 CA MRNA 12 GEN ALG", "code_information": [{"code": "11M", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 DETCJ 8 AUTOANTB", "code_information": [{"code": "21U", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MA MOLEC PRFL ALG", "code_information": [{"code": "228U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 249.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 249.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 249.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MRNA 17 GENE ALG", "code_information": [{"code": "47U", "type": "CPT"}], "standard_charges": [{"minimum": 5577.12, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MRNA 18 GEN DRE UR", "code_information": [{"code": "G0018", "type": "HCPCS"}], "standard_charges": [{"minimum": 418.42, "maximum": 657.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 418.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 657.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 657.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 657.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MRNA HOXC6 & DLX1", "code_information": [{"code": "339U", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 PCA3&TMPRSS2-ERG", "code_information": [{"code": "113U", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 XOM ALY 442 SNCRNA", "code_information": [{"code": "343U", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 XOM ALYS 53 SNCRNA", "code_information": [{"code": "424U", "type": "CPT"}], "standard_charges": [{"minimum": 9876.15, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC RNA TISS PREDICT ALG", "code_information": [{"code": "19U", "type": "CPT"}], "standard_charges": [{"minimum": 5292.0, "maximum": 14736.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9371.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14736.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14736.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14736.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5292.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5292.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC RSPS RADJ CLL FR DNA TOX", "code_information": [{"code": "285U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 638.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 638.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 638.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC RSPSE CHEMO CNTRST TOMOG", "code_information": [{"code": "83U", "type": "CPT"}], "standard_charges": [{"minimum": 56.1, "maximum": 240.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 88.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 88.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 88.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 240.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 240.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SLD ORG NEO DNA 468 GENE", "code_information": [{"code": "48U", "type": "CPT"}], "standard_charges": [{"minimum": 4204.22, "maximum": 11707.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7444.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SLD ORG NEO DNA 505 GENE", "code_information": [{"code": "250U", "type": "CPT"}], "standard_charges": [{"minimum": 4204.22, "maximum": 14035.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8925.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SLD ORGN TGSA DNA 84/+", "code_information": [{"code": "334U", "type": "CPT"}], "standard_charges": [{"minimum": 8925.0, "maximum": 14035.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8925.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM ALYS BRCA1 BRCA2", "code_information": [{"code": "172U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 4363.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4363.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4363.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM CRCG TUM CL SLCT", "code_information": [{"code": "338U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 3506.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3506.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3506.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM DNA&RNA 437 GEN", "code_information": [{"code": "391U", "type": "CPT"}], "standard_charges": [{"minimum": 5184.0, "maximum": 15037.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9562.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM RT-PCR 7 GEN", "code_information": [{"code": "262U", "type": "CPT"}], "standard_charges": [{"minimum": 4608.0, "maximum": 15037.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9562.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4608.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4608.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SOLID ORGN DNA 257 GENES", "code_information": [{"code": "244U", "type": "CPT"}], "standard_charges": [{"minimum": 5040.0, "maximum": 14035.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8925.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SOLID TUMOR 30 PRTN TRGT", "code_information": [{"code": "174U", "type": "CPT"}], "standard_charges": [{"minimum": 1535.36, "maximum": 2414.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1535.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2414.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2414.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2414.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1879.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1879.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SUPERVISION PALLIATIVE", "code_information": [{"code": "G9054", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SURVEILLANCE FOR DISEASE", "code_information": [{"code": "G9052", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC THYR 10 MICRORNA SEQ ALG", "code_information": [{"code": "18U", "type": "CPT"}], "standard_charges": [{"minimum": 4323.01, "maximum": 12038.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7655.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12038.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12038.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12038.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4323.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4323.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC THYR DNA&MRNA 112 GENES", "code_information": [{"code": "26U", "type": "CPT"}], "standard_charges": [{"minimum": 5184.0, "maximum": 14436.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9180.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC THYR DNA&MRNA 112 GENES", "code_information": [{"code": "287U", "type": "CPT"}], "standard_charges": [{"minimum": 5184.0, "maximum": 14436.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9180.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC THYR MRNA 10,196 GEN ALG", "code_information": [{"code": "81546", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 14436.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9180.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC THYR MRNA XPRSN ALYS 593", "code_information": [{"code": "204U", "type": "CPT"}], "standard_charges": [{"minimum": 4204.22, "maximum": 4204.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC THYR MUT ALYS 10 GEN&37", "code_information": [{"code": "245U", "type": "CPT"}], "standard_charges": [{"minimum": 1823.14, "maximum": 12038.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7655.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12038.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12038.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12038.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1823.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1823.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC URTHL CA RNA FGFR3 GENE", "code_information": [{"code": "154U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 694.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 694.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 694.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC URTHL MRNA 5 GEN ALG", "code_information": [{"code": "363U", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC URTHL MRNA XPRSN 6 SNP", "code_information": [{"code": "420U", "type": "CPT"}], "standard_charges": [{"minimum": 1938.0, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC UVEAL MLNMA MRNA 15 GENE", "code_information": [{"code": "81552", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 11197.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11197.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11197.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC VISIT UNSPECIFIED NOS", "code_information": [{"code": "G9055", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCO (OVAR) FIVE PROTEINS", "code_information": [{"code": "81503", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1121.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1291.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1291.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCO (OVAR) TWO PROTEINS", "code_information": [{"code": "81500", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 325.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 375.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 375.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCO PRST8 3 GENE UR ALG", "code_information": [{"code": "5U", "type": "CPT"}], "standard_charges": [{"minimum": 1094.4, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY BREAST MRNA", "code_information": [{"code": "81519", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4841.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5577.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY COLON MRNA", "code_information": [{"code": "81525", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 12495.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3895.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7945.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12495.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12495.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12495.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4487.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4487.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY COLORECTAL SCR", "code_information": [{"code": "81528", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 636.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1297.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 732.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 732.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY GYNECOLOGIC", "code_information": [{"code": "81535", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 724.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1477.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 834.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 834.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY GYNECOLOGIC", "code_information": [{"code": "81536", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 221.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 452.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 712.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 712.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 712.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 255.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 255.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY LUNG", "code_information": [{"code": "81538", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 11512.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3588.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY PROSTATE PROB SCORE", "code_information": [{"code": "81539", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 950.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY TISSUE OF ORIGIN", "code_information": [{"code": "81504", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 650.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 748.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 748.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY TUM UNKNOWN ORIGIN", "code_information": [{"code": "81540", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 15037.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4687.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9562.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5400.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY TX DECISION-MGMT", "code_information": [{"code": "G9051", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY WORK-UP EVALUATION", "code_information": [{"code": "G9050", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY/HEMA SS", "code_information": [{"code": "G4019", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOPROTEIN DCP", "code_information": [{"code": "83951", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONCOPROTEIN HER-2/NEU", "code_information": [{"code": "83950", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON 2MG/ML INJ 20 ML", "code_information": [{"code": "MED0402", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ONDANSETRON 4MG/2ML", "code_information": [{"code": "MED0323", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ONE CASE REVISION AND COMPLEX BPREVCASE", "code_information": [{"code": "BPREVCASE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2190.0, "discounted_cash": 766.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ONGOING CARE NOT IND", "code_information": [{"code": "M1146", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OOCYTE IDENTIFICATION", "code_information": [{"code": "89254", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR CRYO", "code_information": [{"code": "47381", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR RF", "code_information": [{"code": "47380", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN AORTIC TUBE PROSTH REPR", "code_information": [{"code": "34830", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOFEMOR PROSTH REPR", "code_information": [{"code": "34832", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOILIAC PROSTH REPR", "code_information": [{"code": "34831", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN BIOPSY OF LUNG PLEURA", "code_information": [{"code": "32098", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN BOWEL TO SKIN", "code_information": [{"code": "44300", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN CHEST HEART MASSAGE", "code_information": [{"code": "32160", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN CORONARY ENDARTERECTOMY", "code_information": [{"code": "33572", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN DRAINAGE LIVER LESION", "code_information": [{"code": "47010", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN EXC CERV NODE(S) W/ ID", "code_information": [{"code": "C7503", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "35600", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN IMPLANT HYPOGLOSSAL NERVE NEUROSTIM 64582", "code_information": [{"code": "64582", "type": "CPT"}, {"code": "46008051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 16406.63, "gross_charge": 33898.0, "discounted_cash": 11864.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 16406.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN IMPLANTATION CRANIAL NERVE NEUROSTIM. ELEC ARRAY PULSE GEN. 64568", "code_information": [{"code": "64568", "type": "CPT"}, {"code": "1830946", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 23532.56, "gross_charge": 48621.0, "discounted_cash": 17017.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 23532.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE/NEUROMUSCULAR 64580", "code_information": [{"code": "64580", "type": "CPT"}, {"code": "1481075", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 14796.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE/PERIPHERAL NERVE 64575", "code_information": [{"code": "64575", "type": "CPT"}, {"code": "1481076", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 14796.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE/SACRAL 64581", "code_information": [{"code": "64581", "type": "CPT"}, {"code": "1481077", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "gross_charge": 6442.0, "discounted_cash": 2254.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3117.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN ISLET CELL TRANSPLANT", "code_information": [{"code": "586T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/ FIXJ", "code_information": [{"code": "21339", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/O FIXJ", "code_information": [{"code": "21338", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN OSTEOCHONDRAL AUTOGRAFT TALUS INC. OBTAINING GRAFT 28446", "code_information": [{"code": "28446", "type": "CPT"}, {"code": "2189129", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION ACROMIOCLAVICULAR DISLOCATION ACUTE/CHRON. 23550", "code_information": [{"code": "23550", "type": "CPT"}, {"code": "1481372", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION ACROMIOCLAVICULAR DISLOCATION W/GRAFT 23552", "code_information": [{"code": "23552", "type": "CPT"}, {"code": "1481373", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION ARTICULAR FRACTURE 26746", "code_information": [{"code": "26746", "type": "CPT"}, {"code": "1481374", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION CARPAL BONE FRACTURE 25645", "code_information": [{"code": "25645", "type": "CPT"}, {"code": "1481375", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION CARPOMETACARPAL DISLOCATION 26685", "code_information": [{"code": "26685", "type": "CPT"}, {"code": "1481376", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION CARPOMETACARPAL DISLOCATION COMPLEX 26686", "code_information": [{"code": "26686", "type": "CPT"}, {"code": "1481377", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION DEPRESSED ZYGOMATIC ARCH 21356", "code_information": [{"code": "21356", "type": "CPT"}, {"code": "1481378", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION ELBOW ACUTE/CHRONIC 24615", "code_information": [{"code": "24615", "type": "CPT"}, {"code": "1481379", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION HUMERAL SHAFT W/IMPLANT 24515", "code_information": [{"code": "24515", "type": "CPT"}, {"code": "1481380", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION ANKLE 27823", "code_information": [{"code": "27823", "type": "CPT"}, {"code": "1481381", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION BIMALLEOLAR FRACTURE 27814", "code_information": [{"code": "27814", "type": "CPT"}, {"code": "1481382", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION CALCANEAL FRACTURE 28415", "code_information": [{"code": "28415", "type": "CPT"}, {"code": "1481383", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION CALCANEUS W/AUTOGRAFT 28420", "code_information": [{"code": "28420", "type": "CPT"}, {"code": "1481384", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION DISTAL PHALANGEAL FX 26765", "code_information": [{"code": "26765", "type": "CPT"}, {"code": "1481386", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION DISTAL TIBIA 27827", "code_information": [{"code": "27827", "type": "CPT"}, {"code": "1481387", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION ELBOW MONTEGGIA FX 24635", "code_information": [{"code": "24635", "type": "CPT"}, {"code": "1481388", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION FACIAL FRACTURE 21365", "code_information": [{"code": "21365", "type": "CPT"}, {"code": "1481389", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "gross_charge": 7659.0, "discounted_cash": 2680.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3706.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION FEMORAL FRACTURE 27236", "code_information": [{"code": "27236", "type": "CPT"}, {"code": "1481390", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION FIBULA 27784", "code_information": [{"code": "27784", "type": "CPT"}, {"code": "1481393", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION GREAT TOE 28505", "code_information": [{"code": "28505", "type": "CPT"}, {"code": "1481394", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION GREATER HUMERAL FX 23630", "code_information": [{"code": "23630", "type": "CPT"}, {"code": "1481395", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION GREATER TROCHANTERIC FRACTURE 27248", "code_information": [{"code": "27248", "type": "CPT"}, {"code": "2401685", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1045.77, "maximum": 9735.0, "gross_charge": 3169.0, "discounted_cash": 1109.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1533.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1045.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION HUMERAL CONDYLE 24579", "code_information": [{"code": "24579", "type": "CPT"}, {"code": "1481396", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION HUMERUS 23615", "code_information": [{"code": "23615", "type": "CPT"}, {"code": "1481397", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION HUMERUS W/PROSTHE. 23616", "code_information": [{"code": "23616", "type": "CPT"}, {"code": "1481398", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION LATERAL MALLEOLOUS 27792", "code_information": [{"code": "27792", "type": "CPT"}, {"code": "1481399", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION MANDIBLE 21462", "code_information": [{"code": "21462", "type": "CPT"}, {"code": "1481400", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION MEDIAL MALLEOLOUS 27766", "code_information": [{"code": "27766", "type": "CPT"}, {"code": "1481401", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION METACARPAL FX SINGLE 26615", "code_information": [{"code": "26615", "type": "CPT"}, {"code": "1481402", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION METATARSAL FRACTURE 28485", "code_information": [{"code": "28485", "type": "CPT"}, {"code": "1481403", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION NASAL FRACTURE 21330", "code_information": [{"code": "21330", "type": "CPT"}, {"code": "1481404", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION ORBITAL W/IMPLANT 21407", "code_information": [{"code": "21407", "type": "CPT"}, {"code": "1481405", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION ORBITAL W/O IMPLANT 21406", "code_information": [{"code": "21406", "type": "CPT"}, {"code": "1481406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION PATELLA 27524", "code_information": [{"code": "27524", "type": "CPT"}, {"code": "1481407", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION PHALANGEAL SHAFT FX 26735", "code_information": [{"code": "26735", "type": "CPT"}, {"code": "1481409", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION RADIAL HEAD/NECK 24665", "code_information": [{"code": "24665", "type": "CPT"}, {"code": "1481410", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION RADIAL SHAFT 25525", "code_information": [{"code": "25525", "type": "CPT"}, {"code": "2401684", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1465.55, "maximum": 9735.0, "gross_charge": 3028.0, "discounted_cash": 1059.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1465.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION RADIAL SHAFT FRACTURE 25515", "code_information": [{"code": "25515", "type": "CPT"}, {"code": "1481411", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION RADIUS AND ULNA 25575", "code_information": [{"code": "25575", "type": "CPT"}, {"code": "1481412", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION RADIUS EXTRA-ARTICULAR 25607", "code_information": [{"code": "25607", "type": "CPT"}, {"code": "1481413", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION RADIUS INTRA-ARTICULAR W/2 FRAGMENTS 25608", "code_information": [{"code": "25608", "type": "CPT"}, {"code": "1481414", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION RADIUS INTRA-ARTICULAR W/3 FRAGMENTS 25609", "code_information": [{"code": "25609", "type": "CPT"}, {"code": "1481415", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION RADIUS W/PROSTHESIS 24666", "code_information": [{"code": "24666", "type": "CPT"}, {"code": "1481416", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION SESAMOID FRACTURE 28531", "code_information": [{"code": "28531", "type": "CPT"}, {"code": "1481417", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION SHOULDER 23585", "code_information": [{"code": "23585", "type": "CPT"}, {"code": "1481418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION SHOULDER DISLOCATION & FX 23670", "code_information": [{"code": "23670", "type": "CPT"}, {"code": "1481419", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION TALUS FRACTURE 28445", "code_information": [{"code": "28445", "type": "CPT"}, {"code": "1481421", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION TARSAL FRACTURE EXCEPT TALUS OR CALCANEUS 28465", "code_information": [{"code": "28465", "type": "CPT"}, {"code": "1481422", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION TARSOMETATARSAL DISLOCATION 28615", "code_information": [{"code": "28615", "type": "CPT"}, {"code": "1481423", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION TIBIA 27758", "code_information": [{"code": "27758", "type": "CPT"}, {"code": "1481424", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION TIBIA/UNICONDYLAR 27535", "code_information": [{"code": "27535", "type": "CPT"}, {"code": "1481426", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION TIBIOFIBULAR JOINT 27829", "code_information": [{"code": "27829", "type": "CPT"}, {"code": "1481427", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION TOE OTHER THAN GREAT TOE 28525", "code_information": [{"code": "28525", "type": "CPT"}, {"code": "1481428", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION TRIMALLEOLAR FRACTURE 27822", "code_information": [{"code": "27822", "type": "CPT"}, {"code": "1481429", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION ULNA 24685", "code_information": [{"code": "24685", "type": "CPT"}, {"code": "1481430", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION ULNAR SHAFT FRACTURE 25545", "code_information": [{"code": "25545", "type": "CPT"}, {"code": "1481431", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERNAL FIXATION WRIST 25628", "code_information": [{"code": "25628", "type": "CPT"}, {"code": "1481432", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION INTERPHALANGEAL DISLOCATION W/FIXATION 26785", "code_information": [{"code": "26785", "type": "CPT"}, {"code": "1481433", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION LUNATE DISLOCATION 25695", "code_information": [{"code": "25695", "type": "CPT"}, {"code": "1481434", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION MANDIBLE MULTIPLE APPROACH 21470", "code_information": [{"code": "21470", "type": "CPT"}, {"code": "1481435", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION MANDIBULAR FRACTURE 21461", "code_information": [{"code": "21461", "type": "CPT"}, {"code": "1481436", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION MANDIBULAR/MAXILLARY ALVEOLAR RIDGE 21445", "code_information": [{"code": "21445", "type": "CPT"}, {"code": "1481437", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION METACAROPOPHALANGEAL DISLOCATION 26715", "code_information": [{"code": "26715", "type": "CPT"}, {"code": "1481438", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION NASAL FRACTURE UNCOMPLICATED 21325", "code_information": [{"code": "21325", "type": "CPT"}, {"code": "1481439", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION NASAL FRACTURE W/SEPTUM FX 21335", "code_information": [{"code": "21335", "type": "CPT"}, {"code": "1481440", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION OF ILIAC SPINE 27215", "code_information": [{"code": "27215", "type": "CPT"}, {"code": "1481441", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION OF RADIUS AND ULNA SHAFT W/INTERNAL FIXATION OF RADIUS OR ULNA 25574", "code_information": [{"code": "25574", "type": "CPT"}, {"code": "1481442", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION TRANS-SCAPHOPERILUNAR FRACTURE 25685", "code_information": [{"code": "25685", "type": "CPT"}, {"code": "1481445", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCTION ULNAR STYLOID FRACTURE 25652", "code_information": [{"code": "25652", "type": "CPT"}, {"code": "1481446", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REPAIR OF NONUNION/MALUNION FIBULA 27726", "code_information": [{"code": "27726", "type": "CPT"}, {"code": "1481447", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 15527.0, "discounted_cash": 5434.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 7515.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61313", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61320", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61321", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN THROMBECT AV FISTULA", "code_information": [{"code": "36831", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF ACUTE SHOULDER DISLOCATION 23660", "code_information": [{"code": "23660", "type": "CPT"}, {"code": "21894239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5305.0, "discounted_cash": 1856.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2567.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF CARPOMETACARPAL FX W/INT. FIXATION 26665", "code_information": [{"code": "26665", "type": "CPT"}, {"code": "1810581", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5434.0, "discounted_cash": 1901.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2630.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF CLAVICULAR FX W/INT. FIXATION 23515", "code_information": [{"code": "23515", "type": "CPT"}, {"code": "1795847", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH FX 21365", "code_information": [{"code": "21365", "type": "CPT"}, {"code": "1481448", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF FX OF WT. BEARING ARTICULAR PORTION DISTAL TIB. W/INT. FIX. BOTH TIB/FIBULA 27828", "code_information": [{"code": "27828", "type": "CPT"}, {"code": "1915665", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF HUMERAL EPICONDYLAR FX. MEDIAL OR LATERAL W/INT. FIX. 24575", "code_information": [{"code": "24575", "type": "CPT"}, {"code": "1941673", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF INTERCONDYLAR SPINE AND/OR TUBEROSITY FX KNEE W/INT. FIX 27540", "code_information": [{"code": "27540", "type": "CPT"}, {"code": "13969492", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1794.21, "maximum": 9357.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1794.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION-W/ OR W/O INTERNAL/EXTERNAL FIXATION 28675", "code_information": [{"code": "28675", "type": "CPT"}, {"code": "1582405", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION-W/ OR W/O INTERNAL/EXTERNAL FIXATION 28645", "code_information": [{"code": "28645", "type": "CPT"}, {"code": "1582404", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF NASAL SEPTAL FX W/ ORW/O STABILIZATION 21336", "code_information": [{"code": "21336", "type": "CPT"}, {"code": "2025484", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW 24586", "code_information": [{"code": "24586", "type": "CPT"}, {"code": "2401683", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF POSTERIOR MALLEOLUS FRACTURE INC. INTERNAL FIXATION 27769", "code_information": [{"code": "27769", "type": "CPT"}, {"code": "39346916", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF RADIAL SHAFT FX AND RADIOULNAR JT. DISLOCATION W/INT FIX. W/REP. TRI. CART. 25526", "code_information": [{"code": "25526", "type": "CPT"}, {"code": "1941664", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2631.5, "maximum": 9735.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION-W/ OR W/O INTERNAL/EXTERNAL FIXATION 28585", "code_information": [{"code": "28585", "type": "CPT"}, {"code": "1582403", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT ORBITAL FLOOR BLOWOUT FRACTURE COMBINED APPROACH 21387", "code_information": [{"code": "21387", "type": "CPT"}, {"code": "1481721", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX COMPL FRONT SINUS FX", "code_information": [{"code": "21344", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX DPRSD FRONT SINUS FX", "code_information": [{"code": "21343", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX ILIAC SPINE UNI/BIL", "code_information": [{"code": "G0412", "type": "HCPCS"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX POST PELVIC FXCTURE", "code_information": [{"code": "G0415", "type": "HCPCS"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG INFILTR", "code_information": [{"code": "32096", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG NODULE", "code_information": [{"code": "32097", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT 1ST", "code_information": [{"code": "37236", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37237", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37239", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT SAME", "code_information": [{"code": "37238", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH AMD ALYS 3 GENE VARIANTS", "code_information": [{"code": "205U", "type": "CPT"}], "standard_charges": [{"minimum": 67.68, "maximum": 549.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 67.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 67.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX ANT SGM US UNI/BI", "code_information": [{"code": "76513", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 102.1, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 108.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN", "code_information": [{"code": "76512", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 42.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 45.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN&QUAN A-SCAN", "code_information": [{"code": "76510", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 183.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 476.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 749.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 749.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 749.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 75.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX QUAN A-SCAN ONLY", "code_information": [{"code": "76511", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 51.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 54.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC BIOMETRY", "code_information": [{"code": "92136", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC ENDOSCOPE ADD-ON", "code_information": [{"code": "66990", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMODYNAMOMETRY", "code_information": [{"code": "92260", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMOLOGY/OPTOMETRY SS", "code_information": [{"code": "G4020", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIATES 1 OR MORE", "code_information": [{"code": "80361", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOID &OPIATE ANALOG 5/MORE", "code_information": [{"code": "80364", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 1/2", "code_information": [{"code": "80362", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 3/4", "code_information": [{"code": "80363", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS", "code_information": [{"code": "34715", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS CNDT", "code_information": [{"code": "34716", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN BRACH ART EXPOS", "code_information": [{"code": "34834", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS", "code_information": [{"code": "34812", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS CNDT CRTJ", "code_information": [{"code": "34714", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN ILAC ART EXPOS CNDT CRTJ", "code_information": [{"code": "34833", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN ILIAC ART EXPOS", "code_information": [{"code": "34820", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN INSJ/RPLCMT INS PTN SUBF", "code_information": [{"code": "817T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN INSJ/RPLCMT INS PTN SUBQ", "code_information": [{"code": "816T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX COMPLX MALAR W/GRFT", "code_information": [{"code": "21366", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX DPRSD MALAR FRACTURE", "code_information": [{"code": "21360", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX MULTPLE", "code_information": [{"code": "21347", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/FIXJ", "code_information": [{"code": "21346", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/GRAFT", "code_information": [{"code": "21348", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX TRANSANTRAL", "code_information": [{"code": "21385", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/BONE GRFT", "code_information": [{"code": "21408", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT PERIORBT W/GRFT", "code_information": [{"code": "21395", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPPONENSPLASTY 26496", "code_information": [{"code": "26496", "type": "CPT"}, {"code": "42572033", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 7016.0, "discounted_cash": 2455.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3395.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPPONENSPLASTY SUPERFICIALIS TENDON TRANSFER TYPE EA. TENDON 26490", "code_information": [{"code": "26490", "type": "CPT"}, {"code": "16222629", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPPONENSPLASTY-TENDON TRANSFER W/ GRAFT 26492", "code_information": [{"code": "26492", "type": "CPT"}, {"code": "1482270", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPPS SERVICE,SCHED TEAM CONF", "code_information": [{"code": "G0175", "type": "HCPCS"}], "standard_charges": [{"minimum": 1551.39, "maximum": 2437.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1551.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2437.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2437.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2437.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND ON/MAC DRAW", "code_information": [{"code": "92202", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND RTA DRAW UNI/BI", "code_information": [{"code": "92201", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPT CARE KIDNEY HLTH MVP", "code_information": [{"code": "M0002", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTHALMOLOGICAL EXAMINATION/EVALUATION UNDER GENERAL ANES. COMPLETE 92018", "code_information": [{"code": "92018", "type": "CPT"}, {"code": "44756414", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1363.42, "maximum": 8450.0, "gross_charge": 2817.0, "discounted_cash": 985.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1363.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTICAL ENDOMICROSCPY INTERP", "code_information": [{"code": "88375", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 205.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 205.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 205.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 66.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 66.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTO-ACOUSTIC IMG BREAST UNI", "code_information": [{"code": "857T", "type": "CPT"}], "standard_charges": [{"minimum": 457.76, "maximum": 719.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 457.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 719.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 719.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 719.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92534", "type": "CPT"}], "standard_charges": [{"minimum": 19.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92544", "type": "CPT"}], "standard_charges": [{"minimum": 12.7, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX OF RIB FX W/FIXJ SCOPE", "code_information": [{"code": "21811", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC NECK FX FIXJ", "code_information": [{"code": "23680", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX STRCLV DSLC AQ/CHRN GRF", "code_information": [{"code": "23532", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX STRNCLAV DISLC AQT/CHRN", "code_information": [{"code": "23530", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX THIGH FX", "code_information": [{"code": "27269", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OR3O DM XLPE INSERT 28/42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71358218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3004.4, "discounted_cash": 1051.54, "setting": "both", "billing_class": "facility"}]}, {"description": "OR3O DUAL MOBILITY LINER 36/48", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71358201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4497.9, "discounted_cash": 1574.27, "setting": "both", "billing_class": "facility"}]}, {"description": "OR3O DUAL MOBILITY LINER 42/54", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71358204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4497.9, "discounted_cash": 1574.27, "setting": "both", "billing_class": "facility"}]}, {"description": "OR3O DUAL MOBILITY XLPE INSERT 22/36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71358213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3004.4, "discounted_cash": 1051.54, "setting": "both", "billing_class": "facility"}]}, {"description": "ORAL APP THXPY TITRATION VIS", "code_information": [{"code": "D9955", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL FUNCTION THERAPY", "code_information": [{"code": "92526", "type": "CPT"}], "standard_charges": [{"minimum": 387.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 387.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 609.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 609.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 609.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0435", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 48.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL SPEECH DEVICE EVAL", "code_information": [{"code": "92597", "type": "CPT"}], "standard_charges": [{"minimum": 327.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 327.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITAL IMPLANT;INSERTION 67550", "code_information": [{"code": "67550", "type": "CPT"}, {"code": "1481450", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "113", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13348.54, "maximum": 22916.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13348.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19091.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21000.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22916.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "114", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8805.75, "maximum": 15117.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8805.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12594.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13853.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15117.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITL IMPLANT OUTSIDE MUSCLE CONE REMOVAL OR REVISION 67560", "code_information": [{"code": "67560", "type": "CPT"}, {"code": "21976688", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61584", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61585", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61592", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITH BONE FLAP OR WINDOW FOR EXPLORATION WITH OR WITHOUT BIOPSY 67450", "code_information": [{"code": "67450", "type": "CPT"}, {"code": "1481452", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITH BONE FLAP OR WINDOW LATERAL APPROACH;WITH REMOVAL OF LESION 67420", "code_information": [{"code": "67420", "type": "CPT"}, {"code": "1481453", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITH BONE FLAP OR WINDOW WITH DRAINAGE 67440", "code_information": [{"code": "67440", "type": "CPT"}, {"code": "1481454", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITH BONE FLAP OR WINDOW WITH REMOVAL OF FOREIGN BODY 67430", "code_information": [{"code": "67430", "type": "CPT"}, {"code": "1481456", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITHOUT BONE FLAP;FOR EXPLORATION WITH OR WITHOUT BIOPSY 67400", "code_information": [{"code": "67400", "type": "CPT"}, {"code": "1481457", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITHOUT BONE FLAP;WITH DRAINAGE ONLY 67405", "code_information": [{"code": "67405", "type": "CPT"}, {"code": "1481458", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITHOUT BONE FLAP;WITH R EMOVAL OF BONE FOR DECOMPRESSION 67414", "code_information": [{"code": "67414", "type": "CPT"}, {"code": "1481459", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITHOUT BONE FLAP;WITH REMOVAL OF FOREIGN BODY 67413", "code_information": [{"code": "67413", "type": "CPT"}, {"code": "1481460", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITHOUT BONE FLAP;WITH REMOVAL OF LESION 67412", "code_information": [{"code": "67412", "type": "CPT"}, {"code": "1481461", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORCHIECTOMY PARTIAL 54522", "code_information": [{"code": "54522", "type": "CPT"}, {"code": "1481462", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORCHIECTOMY RADICAL FOR TUMOR;INGUINAL APPROACH 54530", "code_information": [{"code": "54530", "type": "CPT"}, {"code": "1481463", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORCHIECTOMY RADICAL FOR TUMOR;INGUINAL APPROACH WITH ABDOMINAL EXPLORATION 54535", "code_information": [{"code": "54535", "type": "CPT"}, {"code": "1481464", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORCHIECTOMY SIMPLE 54520", "code_information": [{"code": "54520", "type": "CPT"}, {"code": "1481465", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY ABDOMINAL APPROACH 54650", "code_information": [{"code": "54650", "type": "CPT"}, {"code": "1481466", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY; INGUINAL OR SCROTAL APPROACH 54640", "code_information": [{"code": "54640", "type": "CPT"}, {"code": "1481467", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACID SINGLE QUANT", "code_information": [{"code": "83921", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 85.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 85.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 85.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 30.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 30.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACIDS QUAL EACH", "code_information": [{"code": "83919", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 65.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 65.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 65.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACIDS TOTAL QUANT", "code_information": [{"code": "83918", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 60.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 94.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 94.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 94.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORIF SUPRACONDYLAR FRACTURE W/EXTENSION 24545", "code_information": [{"code": "24545", "type": "CPT"}, {"code": "1481470", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5228.0, "discounted_cash": 1829.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORIF SUPRACONDYLAR FRACTURE W/O EXTENSION 24546", "code_information": [{"code": "24546", "type": "CPT"}, {"code": "1481471", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2530.35, "maximum": 9735.0, "gross_charge": 5228.0, "discounted_cash": 1829.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHC/PROSTC MGMT SBSQ ENC", "code_information": [{"code": "97763", "type": "CPT"}], "standard_charges": [{"minimum": 227.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 227.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 357.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHOP TRAING PFRMD PHYS/QHP", "code_information": [{"code": "92065", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHOP TRAING SUPVJ PHYS/QHP", "code_information": [{"code": "92066", "type": "CPT"}], "standard_charges": [{"minimum": 146.57, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 146.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 230.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 230.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 230.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHOPAEDIC BUR TOOL MR8 10CM MATCH HEAD 3MM DIAMETER MR8-10MH30", "code_information": [{"code": "MR8-10MH30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.17, "discounted_cash": 149.51, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOPAEDIC BUR TOOL MR8 14CM MATCH HEAD 3MM DIAMETER MR8-14MH30", "code_information": [{"code": "MR8-14MH30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 161.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOPEDIC SURGERY SS", "code_information": [{"code": "G4021", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHOPOXVIRUS AMP PRB EACH", "code_information": [{"code": "87593", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHOPREP ORTHOPEDIC SUCTION SYSTEM", "code_information": [{"code": "800-01S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOTIC MGMT&TRAING 1ST ENC", "code_information": [{"code": "97760", "type": "CPT"}], "standard_charges": [{"minimum": 214.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 214.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 337.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 337.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 337.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSCILLATING TRACKING TEST", "code_information": [{"code": "92545", "type": "CPT"}], "standard_charges": [{"minimum": 12.7, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSSIMEND BLOCK BLOCK 10CC 62.5X20X8MM MCCB10", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "MCCB10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3605.0, "discounted_cash": 1261.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTECTOMY OF STERNUM PARTIAL 21620", "code_information": [{"code": "21620", "type": "CPT"}, {"code": "1480905", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2064.15, "maximum": 9357.0, "gross_charge": 6255.0, "discounted_cash": 2189.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3027.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2064.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTECTOMY PARTIAL EXCISION FIFTH METATARSAL HEAD 28110", "code_information": [{"code": "28110", "type": "CPT"}, {"code": "1481472", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTECTOMY W/EXCISION BONE SPUR CALCANEUS 28119", "code_information": [{"code": "28119", "type": "CPT"}, {"code": "1481473", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTECTOMY W/EXCISION OF TARSAL COALITION 28116", "code_information": [{"code": "28116", "type": "CPT"}, {"code": "1481474", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTECTOMY W/RESECTION 2ND-5TH METATARSAL HEAD 28114", "code_information": [{"code": "28114", "type": "CPT"}, {"code": "1481475", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTECTOMY W/RESECTION 5TH METATARSAL HEAD 28113", "code_information": [{"code": "28113", "type": "CPT"}, {"code": "1481476", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTECTOMY W/RESECTION FIRST METATARSAL HEAD 28111", "code_information": [{"code": "28111", "type": "CPT"}, {"code": "1481477", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTECTOMY W/RESECTION OTHER METATARSAL HEAD 2ND-4TH 28112", "code_information": [{"code": "28112", "type": "CPT"}, {"code": "1481478", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOAMP FLOWABLE 2.5CC OAFL-025", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "OAFL-025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOART ALGRFT W/SURF & B1", "code_information": [{"code": "20932", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL ALLOGRAFT KNEE OPEN 27415", "code_information": [{"code": "27415", "type": "CPT"}, {"code": "1481479", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5434.0, "discounted_cash": 1901.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2630.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL AUTOGRAFT KNEE OPEN 27416", "code_information": [{"code": "27416", "type": "CPT"}, {"code": "1481480", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOFLEX BONE CEMENT VCF-1009", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "VCF-1009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5871.0, "discounted_cash": 2054.85, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH CC", "code_information": [{"code": "540", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7917.63, "maximum": 13592.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7917.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11323.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12456.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13592.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH MCC", "code_information": [{"code": "539", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11847.86, "maximum": 20339.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11847.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16944.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18639.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20339.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITHOUT CC/MCC", "code_information": [{"code": "541", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5129.19, "maximum": 8805.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5129.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7335.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8069.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8805.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 1-2 REGIONS", "code_information": [{"code": "98925", "type": "CPT"}], "standard_charges": [{"minimum": 108.13, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 3-4 REGIONS", "code_information": [{"code": "98926", "type": "CPT"}], "standard_charges": [{"minimum": 108.13, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 5-6 REGIONS", "code_information": [{"code": "98927", "type": "CPT"}], "standard_charges": [{"minimum": 108.13, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 7-8 REGIONS", "code_information": [{"code": "98928", "type": "CPT"}], "standard_charges": [{"minimum": 108.13, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 9-10 REGIONS", "code_information": [{"code": "98929", "type": "CPT"}], "standard_charges": [{"minimum": 108.13, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPLASTY LENGTENING METACARPAL OR PHALANX 26568", "code_information": [{"code": "26568", "type": "CPT"}, {"code": "1481481", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPLASTY RADIAL OR ULNA W/AUTOGRAGT 25391", "code_information": [{"code": "25391", "type": "CPT"}, {"code": "1481482", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPLASTY-RADIUS OR ULNA; SHORTENING 25390", "code_information": [{"code": "25390", "type": "CPT"}, {"code": "1482099", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOSET RESORBABLE BEAD KIT FAST CURE 25CC 84000311", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "84000311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2724.89, "discounted_cash": 953.71, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1 VRT SGM CRV", "code_information": [{"code": "22220", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM EA", "code_information": [{"code": "22226", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM LMBR", "code_information": [{"code": "22224", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM THRC", "code_information": [{"code": "22222", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOT HUM XTRNL LNGTH DEV", "code_information": [{"code": "594T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOME 7MM HOOKED SN25", "code_information": [{"code": "SN25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 941.5, "discounted_cash": 329.53, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME 7MM SQUARE SN24", "code_information": [{"code": "SN24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 941.5, "discounted_cash": 329.53, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME FLEXIBLE SS 12 X 93MM", "code_information": [{"code": "6210-0-740", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 579.0, "discounted_cash": 202.65, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME FLEXIBLE SS 8 X 80MM", "code_information": [{"code": "6210-0-730", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 579.0, "discounted_cash": 202.65, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOMY 2ND-5TH METATARSAL W/AUTOGRAFT-EACH 28308", "code_information": [{"code": "28308", "type": "CPT"}, {"code": "1481484", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY 2ND-5TH METATARSAL W/AUTOGRAFT-MULTIPLE 28309", "code_information": [{"code": "28309", "type": "CPT"}, {"code": "1481485", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY ANGULAR OR ROTATIONAL CORRECTION PROX.PHALANX OTHER THAN FIRST TOE 28312", "code_information": [{"code": "28312", "type": "CPT"}, {"code": "1481486", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY CALCANEUS 28300", "code_information": [{"code": "28300", "type": "CPT"}, {"code": "1481487", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY CLAVICLE W/BONE GRAFT 23485", "code_information": [{"code": "23485", "type": "CPT"}, {"code": "1481488", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY CLAVICLE WITH OR WITHOUT INTERNAL FIXATION 23480", "code_information": [{"code": "23480", "type": "CPT"}, {"code": "1481489", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY FIBULA 27707", "code_information": [{"code": "27707", "type": "CPT"}, {"code": "1481491", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY FIRST METATARSAL W/AUTOGRAFT 28307", "code_information": [{"code": "28307", "type": "CPT"}, {"code": "1481492", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY HUMERUS 24400", "code_information": [{"code": "24400", "type": "CPT"}, {"code": "1481493", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY LEFORT I 3-PIECES 21143", "code_information": [{"code": "21143", "type": "CPT"}, {"code": "1481496", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY MAXILLA 21206", "code_information": [{"code": "21206", "type": "CPT"}, {"code": "1481502", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY METACARPAL 26565", "code_information": [{"code": "26565", "type": "CPT"}, {"code": "1481503", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY METATARSAL/FIRST METATARSAL 28306", "code_information": [{"code": "28306", "type": "CPT"}, {"code": "1481504", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY MULTIPLE 25370", "code_information": [{"code": "25370", "type": "CPT"}, {"code": "1481505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY OF SCAPULA PARTIAL 23190", "code_information": [{"code": "23190", "type": "CPT"}, {"code": "1481506", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY PHALANX OR FINGER 26567", "code_information": [{"code": "26567", "type": "CPT"}, {"code": "1481510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY PROXIMAL TIBIA INC. FIBULAR EXC. OR OSTEOTOMY BEFORE EPIPIHYSEAL CLOSURE 27455", "code_information": [{"code": "27455", "type": "CPT"}, {"code": "6704849", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2466.09, "maximum": 9735.0, "gross_charge": 7473.0, "discounted_cash": 2615.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3616.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2466.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY RADIUS AND ULNA 25365", "code_information": [{"code": "25365", "type": "CPT"}, {"code": "1481511", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY RADIUS AND ULNA MULTIPLE 25375", "code_information": [{"code": "25375", "type": "CPT"}, {"code": "1481512", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY RADIUS DISTAL THIRD 25350", "code_information": [{"code": "25350", "type": "CPT"}, {"code": "1481513", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY RADIUS MIDDLE OR PROXIMAL THIRD 25355", "code_information": [{"code": "25355", "type": "CPT"}, {"code": "1481514", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY SHORTENING ANGULAR OR ROTATIONAL CORRECTION PROXIMAL PHALANX FIRST TOE 28310", "code_information": [{"code": "28310", "type": "CPT"}, {"code": "1481515", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY TALUS 28302", "code_information": [{"code": "28302", "type": "CPT"}, {"code": "1481516", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY TARSAL BONES OTHER THAN CALCANEUS OR TALUS 28304", "code_information": [{"code": "28304", "type": "CPT"}, {"code": "1481517", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY TARSAL BONES OTHER THAN CALCANEUS OR TALUS W/AUTOGRAFT 28305", "code_information": [{"code": "28305", "type": "CPT"}, {"code": "1481518", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY TIBIA AND FIBULA 27709", "code_information": [{"code": "27709", "type": "CPT"}, {"code": "1481519", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY TIBIAL 27705", "code_information": [{"code": "27705", "type": "CPT"}, {"code": "1481520", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY ULNA 25360", "code_information": [{"code": "25360", "type": "CPT"}, {"code": "1481522", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY W/INSERTION INTRAMEDULLARY ROD TIBIA 27712", "code_information": [{"code": "27712", "type": "CPT"}, {"code": "1481524", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 3259.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT Body Position Goal Status G-8982 -> CJ At least 20% but less than 40% impaired", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "16164932", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Carry Goal Status G-8985 -> CI At least 1% but less than 20% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16164954", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Current Status G-9168 -> CK At least 40% but less than 60% impaired", "code_information": [{"code": "G9168", "type": "HCPCS"}, {"code": "16164959", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CH 0% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164969", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CI At least 1% but less than 20% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164968", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CJ At least 20% but less than 40% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164967", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CK At least 40% but less than 60% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164966", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CL At least 60% but less than 80% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164965", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CM At least 80% but less than 100% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164964", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CN 100% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164963", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OTH RESP PROC, GROUP", "code_information": [{"code": "G0239", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.61, "maximum": 87.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTH RESP PROC, INDIV", "code_information": [{"code": "G0238", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.5, "maximum": 69.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHE THERAPIST AT HOSPICE", "code_information": [{"code": "G9478", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "818", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8271.66, "maximum": 14200.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8271.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11830.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13013.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14200.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "817", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14032.26, "maximum": 24089.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14032.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20069.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22076.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24089.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "819", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6005.14, "maximum": 10309.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6005.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8588.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9447.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10309.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [{"code": "832", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4734.4, "maximum": 8127.79, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4734.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6771.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7448.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8127.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC", "code_information": [{"code": "831", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6823.91, "maximum": 11714.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6823.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9759.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10735.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11714.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "833", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3266.57, "maximum": 5607.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3266.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4671.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5139.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5607.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER BONE GRAFT MICROVASC", "code_information": [{"code": "20962", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [{"code": "228", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32424.21, "maximum": 55664.32, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32424.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46373.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51010.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55664.32, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [{"code": "229", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20932.82, "maximum": 110408.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 110408.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 110408.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 87241.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20932.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29938.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32932.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35936.45, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "315", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5921.19, "maximum": 10165.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5921.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8468.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9315.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10165.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "314", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12681.23, "maximum": 21770.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12681.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18136.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19950.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21770.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "316", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4400.44, "maximum": 7554.47, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4400.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6293.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6922.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7554.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM O.R. PROCEDURES", "code_information": [{"code": "264", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19791.65, "maximum": 33977.34, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19791.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28306.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31136.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33977.34, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER COUNSELOR AT HOSPICE", "code_information": [{"code": "G9475", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "394", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5723.49, "maximum": 9825.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5723.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8185.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9004.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9825.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "393", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10105.08, "maximum": 17347.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10105.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14452.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15897.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17347.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "395", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3963.07, "maximum": 6803.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3963.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5668.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6234.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6803.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC", "code_information": [{"code": "357", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13799.29, "maximum": 23689.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13799.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19735.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21709.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23689.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [{"code": "356", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26204.35, "maximum": 44986.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26204.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37477.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 41225.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 44986.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "358", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8206.58, "maximum": 14088.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8206.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11737.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12910.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14088.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [{"code": "92", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6015.48, "maximum": 10327.08, "estimated_discounted_cash": 89595.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6015.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8603.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9463.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10327.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC", "code_information": [{"code": "91", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10041.82, "maximum": 17239.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10041.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14361.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15798.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17239.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "93", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4758.12, "maximum": 8168.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4758.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6805.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7485.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8168.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT", "code_information": [{"code": "124", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8528.37, "maximum": 14641.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8528.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12197.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13417.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14641.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [{"code": "125", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5091.47, "maximum": 8740.79, "estimated_discounted_cash": 21124.01, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5091.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7281.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8010.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8740.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC", "code_information": [{"code": "155", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5532.49, "maximum": 9497.91, "estimated_discounted_cash": 63815.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5532.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7912.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8703.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9497.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC", "code_information": [{"code": "154", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9409.18, "maximum": 16153.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9409.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13457.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14802.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16153.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "156", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4005.05, "maximum": 6875.67, "estimated_discounted_cash": 26815.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4005.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5728.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6300.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6875.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC", "code_information": [{"code": "144", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10715.2, "maximum": 18395.34, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10715.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15325.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16857.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18395.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC", "code_information": [{"code": "143", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18126.12, "maximum": 31118.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18126.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25924.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28516.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31118.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "145", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7449.24, "maximum": 12788.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7449.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10654.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11719.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12788.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC", "code_information": [{"code": "629", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14266.46, "maximum": 24491.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14266.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20404.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22444.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24491.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC", "code_information": [{"code": "628", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22381.79, "maximum": 38423.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22381.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32010.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35211.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38423.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "630", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8572.77, "maximum": 14717.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8572.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12260.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13487.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14717.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC", "code_information": [{"code": "319", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26265.79, "maximum": 45091.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26265.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37565.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 41322.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 45091.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [{"code": "320", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14633.26, "maximum": 25121.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14633.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20928.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23021.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25121.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER FACTORS INFLUENCING HEALTH STATUS", "code_information": [{"code": "951", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3404.05, "maximum": 5843.9, "estimated_discounted_cash": 1172.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3404.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4868.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5355.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5843.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC", "code_information": [{"code": "749", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16508.05, "maximum": 28340.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16508.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23610.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25971.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28340.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "750", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8904.3, "maximum": 15286.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8904.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12735.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14008.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15286.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER HEART ASSIST SYSTEM IMPLANT", "code_information": [{"code": "215", "type": "MS-DRG"}], "standard_charges": [{"minimum": 64226.75, "maximum": 110261.37, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64226.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 91858.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 101043.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 110261.37, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC", "code_information": [{"code": "424", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13894.18, "maximum": 23852.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13894.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19871.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21858.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23852.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [{"code": "423", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25462.83, "maximum": 43713.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25462.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 36417.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40059.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43713.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "425", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9384.24, "maximum": 16110.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9384.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13421.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14763.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16110.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER IMMUNOELECTROPHORESIS", "code_information": [{"code": "86325", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC", "code_information": [{"code": "868", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6484.48, "maximum": 11132.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6484.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9274.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10201.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11132.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [{"code": "867", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13608.28, "maximum": 23362.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13608.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19462.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21409.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23362.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "869", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4431.47, "maximum": 7607.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4431.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6337.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6971.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7607.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [{"code": "922", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9661.02, "maximum": 16585.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9661.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13817.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15199.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16585.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC", "code_information": [{"code": "923", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5716.8, "maximum": 9814.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5716.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8176.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8993.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9814.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [{"code": "699", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6247.24, "maximum": 10724.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6247.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8934.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9828.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10724.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC", "code_information": [{"code": "698", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9797.28, "maximum": 16819.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9797.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14012.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15413.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16819.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "700", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4540.96, "maximum": 7795.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4540.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6494.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7144.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7795.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [{"code": "674", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14497.01, "maximum": 24887.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14497.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20733.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22807.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24887.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [{"code": "673", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21097.67, "maximum": 36219.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21097.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 30174.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 33191.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 36219.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "675", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10673.84, "maximum": 18324.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10673.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15265.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16792.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18324.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC", "code_information": [{"code": "271", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21688.33, "maximum": 37233.47, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21688.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31018.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34120.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37233.47, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [{"code": "270", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31552.52, "maximum": 54167.84, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31552.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 45126.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49639.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54167.84, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "272", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16352.93, "maximum": 28073.92, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16352.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23388.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25727.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28073.92, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC", "code_information": [{"code": "729", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6128.62, "maximum": 10521.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6128.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8765.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9641.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10521.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "730", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3460.62, "maximum": 5941.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3460.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4949.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5444.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5941.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC", "code_information": [{"code": "717", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10953.05, "maximum": 18803.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10953.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15665.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17231.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18803.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "718", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7510.07, "maximum": 12892.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7510.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10741.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11815.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12892.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC", "code_information": [{"code": "715", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12297.39, "maximum": 21111.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12297.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17587.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19346.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21111.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "716", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7760.69, "maximum": 13323.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7760.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11099.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12209.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13323.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [{"code": "964", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9074.62, "maximum": 15578.87, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9074.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12978.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14276.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15578.87, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [{"code": "963", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16605.98, "maximum": 28508.35, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16605.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23750.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26125.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28508.35, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "965", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5550.74, "maximum": 9529.24, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5550.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7938.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8732.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9529.24, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC", "code_information": [{"code": "565", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6139.57, "maximum": 10540.12, "estimated_discounted_cash": 44886.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6139.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8780.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9659.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10540.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [{"code": "564", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9268.06, "maximum": 15910.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9268.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13255.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14580.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15910.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "566", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4573.81, "maximum": 7852.09, "estimated_discounted_cash": 24446.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4573.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6541.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7195.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7852.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [{"code": "516", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11939.71, "maximum": 20497.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11939.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17076.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18784.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20497.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC", "code_information": [{"code": "515", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19104.27, "maximum": 32797.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19104.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27323.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30055.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32797.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "517", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8505.25, "maximum": 14601.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8505.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12164.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13380.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14601.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC", "code_information": [{"code": "844", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7203.49, "maximum": 12366.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7203.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10302.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11332.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12366.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC", "code_information": [{"code": "843", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11603.93, "maximum": 19921.07, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11603.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16596.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18255.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19921.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "845", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5163.86, "maximum": 8865.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5163.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7385.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8123.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8865.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITH CC", "code_information": [{"code": "908", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12472.58, "maximum": 21412.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12472.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17838.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19622.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21412.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITH MCC", "code_information": [{"code": "907", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24016.9, "maximum": 41231.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24016.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34349.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37784.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41231.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "909", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8339.79, "maximum": 14317.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8339.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11927.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13120.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14317.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [{"code": "958", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25583.27, "maximum": 43920.13, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25583.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 36589.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40248.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43920.13, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [{"code": "957", "type": "MS-DRG"}], "standard_charges": [{"minimum": 45141.33, "maximum": 77496.46, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45141.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64561.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71018.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 77496.46, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "959", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16643.7, "maximum": 28573.09, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16643.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23804.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26184.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28573.09, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC", "code_information": [{"code": "803", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11475.58, "maximum": 19700.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11475.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16412.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18053.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19700.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC", "code_information": [{"code": "802", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22578.27, "maximum": 38761.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22578.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32291.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35520.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38761.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC", "code_information": [{"code": "804", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8308.77, "maximum": 14264.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8308.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11883.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13071.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14264.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "205", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10248.64, "maximum": 17594.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10248.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14657.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16123.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17594.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC", "code_information": [{"code": "206", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5389.54, "maximum": 9252.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5389.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7708.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8479.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9252.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [{"code": "167", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11063.15, "maximum": 18992.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11063.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15822.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17404.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18992.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [{"code": "166", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22650.05, "maximum": 38884.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22650.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32394.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35633.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38884.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "168", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8238.82, "maximum": 14144.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8238.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11783.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12961.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14144.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [{"code": "580", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10516.29, "maximum": 18053.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10516.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15040.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16544.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18053.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC", "code_information": [{"code": "579", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19130.43, "maximum": 32842.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19130.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27360.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30096.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32842.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "581", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8375.07, "maximum": 14377.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8375.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11978.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13175.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14377.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER SOURCE ALBUMIN QUAN EA", "code_information": [{"code": "82042", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [{"code": "253", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16141.85, "maximum": 27711.54, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16141.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23086.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25394.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27711.54, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER VASCULAR PROCEDURES WITH MCC", "code_information": [{"code": "252", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20230.23, "maximum": 34730.29, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20230.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28933.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31826.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34730.29, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER VASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "254", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11046.12, "maximum": 18963.44, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11046.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15798.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17378.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18963.44, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [{"code": "152", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6572.68, "maximum": 11283.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6572.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9400.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10340.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11283.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [{"code": "153", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4338.4, "maximum": 7447.95, "estimated_discounted_cash": 19208.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4338.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6204.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6825.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7447.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA 92502", "code_information": [{"code": "92502", "type": "CPT"}, {"code": "6606467", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 497.06, "maximum": 8450.0, "gross_charge": 1027.0, "discounted_cash": 359.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 497.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTOLARYNGOLOGY SS", "code_information": [{"code": "G4022", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTOPLASTY PROTRUDING EAR WITH OR WITHOUT SIZE REDUCTION 69300", "code_information": [{"code": "69300", "type": "CPT"}, {"code": "1481525", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTORHINOLARYNGOSCOPE ASCOPE 4 RHINOLARYNGO SLIM 510101000", "code_information": [{"code": "510101000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 421.0, "discounted_cash": 147.35, "setting": "both", "billing_class": "facility"}]}, {"description": "OUT OF OFFICE EMERG MED SERV", "code_information": [{"code": "99060", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OUT-OF-HOSP ON CALL SERVICE", "code_information": [{"code": "99027", "type": "CPT"}], "standard_charges": [{"minimum": 101.74, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OUTPT ED OBS W INPT ADMIT", "code_information": [{"code": "G2176", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OVA AND PARASITES SMEARS", "code_information": [{"code": "87177", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 35.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 35.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OVAL SPONGE 3 X 5MM STYLE 506", "code_information": [{"code": "92-50-5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "OVARIAN CYSTECTOMY 58925", "code_information": [{"code": "58925", "type": "CPT"}, {"code": "1481526", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OVERDRILL 2.0MM SCREWS AO QC", "code_information": [{"code": "71174902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.76, "discounted_cash": 192.07, "setting": "both", "billing_class": "facility"}]}, {"description": "OVERDRILL 2.5 X 110MM CANNULATED", "code_information": [{"code": "P99-110-2511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "OVERDRILL 2.7MM EVOS SMALL W/AO QC SHORT", "code_information": [{"code": "71175025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 968.4, "discounted_cash": 338.94, "setting": "both", "billing_class": "facility"}]}, {"description": "OVERDRILL CALIBRATED SOLID SB 2.4MM POLYLOCK CD-SB-1524", "code_information": [{"code": "CD-SB-1524", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1602.0, "discounted_cash": 560.7, "setting": "both", "billing_class": "facility"}]}, {"description": "OVERDRILL DIST FIBULA AO FITTING OPTIONAL FOR 2.7 MM SCREWS", "code_information": [{"code": "45-27020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "OVERDRILL FOR 2.7MM SCREWS WITH AO QUICK CONNECT 71174912", "code_information": [{"code": "71174912", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.76, "discounted_cash": 192.07, "setting": "both", "billing_class": "facility"}]}, {"description": "OVERDRILL MINI MOD 1.5", "code_information": [{"code": "71177195", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.33, "discounted_cash": 336.12, "setting": "both", "billing_class": "facility"}]}, {"description": "OVERDRILL MINI MOD 1.8", "code_information": [{"code": "74462402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.33, "discounted_cash": 336.12, "setting": "both", "billing_class": "facility"}]}, {"description": "OVERDRILL MINI MOD 2.0", "code_information": [{"code": "71177197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.33, "discounted_cash": 336.12, "setting": "both", "billing_class": "facility"}]}, {"description": "OVERDRILLINSTR AO CONNECTION USE W/ 3.5 MM SCREWS", "code_information": [{"code": "703704", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 165.9, "setting": "both", "billing_class": "facility"}]}, {"description": "OVULATION TESTS", "code_information": [{"code": "84830", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OXINIUM FEM HD 12/14 22 MM +0 71342200", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71342200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 1540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OXYMETAZOLINE (AFIRN) NASAL 0.05% SPRAY 15 ML", "code_information": [{"code": "MED0009", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "OXYMETAZOLINE NASAL SPRAY 0.05% (AFRIN) 15ML SPRAY", "code_information": [{"code": "MED0169", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "OXYTOCIN 10 UNITS/ML INJ SOL", "code_information": [{"code": "MED0236", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "Obstetrics (fetal antigen noninvasive prenatal test), cell-free DNA sequence analysis for detection of fetal presence or absence of 1 or more of the Rh, C, c, D, E, Duffy (Fya), or Kell (K) antigen in alloimmunized pregnancies, reported as selected antige", "code_information": [{"code": "488U", "type": "CPT"}], "standard_charges": [{"minimum": 6243.83, "maximum": 9818.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6243.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Obstetrics (preeclampsia), biochemical assay of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF), serum, ratio reported for sFlt-1/PlGF, with risk of progression for preeclampsia with severe features within 2 weeks", "code_information": [{"code": "482U", "type": "CPT"}], "standard_charges": [{"minimum": 81.09, "maximum": 127.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Obstetrics (preeclampsia), sFlt-1/PlGF ratio, immunoassay, utilizing serum or plasma, reported as a value", "code_information": [{"code": "524U", "type": "CPT"}], "standard_charges": [{"minimum": 81.09, "maximum": 127.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 127.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Obstetrics (single-gene noninvasive prenatal test), cell-free DNA sequence analysis of 1 or more targets (eg, CFTR, SMN1, HBB, HBA1, HBA2) to identify paternally inherited pathogenic variants, and relative mutation-dosage analysis based on molecular count", "code_information": [{"code": "489U", "type": "CPT"}], "standard_charges": [{"minimum": 6243.83, "maximum": 9818.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6243.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9818.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy Evaluation Or Reevaluation", "code_information": [{"code": "444", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy General", "code_information": [{"code": "440", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy Group Rate", "code_information": [{"code": "433", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy Group Rate", "code_information": [{"code": "443", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy Hourly Charge", "code_information": [{"code": "432", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy Hourly Charge", "code_information": [{"code": "442", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy Other", "code_information": [{"code": "449", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy Visit Charge", "code_information": [{"code": "431", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy Visit Charge", "code_information": [{"code": "441", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy, Evaluation Or Reevaluation", "code_information": [{"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy, General", "code_information": [{"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy, Other", "code_information": [{"code": "439", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Oct Scan Of Skin Lesion With Interpretation And Report, Each Additional Lesion", "code_information": [{"code": "471T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oct Scan Of Skin Lesion With Interpretation And Report, First Lesion", "code_information": [{"code": "470T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (bladder), DNA, next-generation sequencing (NGS) of 60 genes and whole genome aneuploidy, urine, algorithms reported as minimal residual disease (MRD) status positive or negative and quantitative disease burden", "code_information": [{"code": "467U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (bladder), methylated PENK DNA detection by linear target enrichment-quantitative methylation-specific real-time PCR (LTE-qMSP), urine, reported as likelihood of bladder cancer", "code_information": [{"code": "452U", "type": "CPT"}], "standard_charges": [{"minimum": 1938.0, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (breast cancer), S100A8 and S100A9, by enzyme-linked immunosorbent assay (ELISA), tear fluid with age, algorithm reported as a risk score", "code_information": [{"code": "458U", "type": "CPT"}], "standard_charges": [{"minimum": 7321.05, "maximum": 11512.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11512.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (breast), quantitative enzyme-linked immunosorbent assay (ELISA) for secreted breast cancer protein marker (BF9 antigen), serum, result reported as indicative of response/no response to therapy or disease progression/regression", "code_information": [{"code": "559U", "type": "CPT"}], "standard_charges": [{"minimum": 722.7, "maximum": 1136.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (central nervous system), analysis of 30000 DNA methylation loci by methylation array, utilizing DNA extracted from tumor tissue, diagnostic algorithm reported as probability of matching a reference tumor subclass", "code_information": [{"code": "20M", "type": "CPT"}], "standard_charges": [{"minimum": 382.5, "maximum": 601.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (cervix), mRNA gene expression profiling of 14 biomarkers (E6 and E7 of the highest-risk human papillomavirus [HPV] types 16, 18, 31, 33, 45, 52, 58), by real-time nucleic acid sequence-based amplification (NASBA), exo- or endocervical epithelial", "code_information": [{"code": "463U", "type": "CPT"}], "standard_charges": [{"minimum": 2422.5, "maximum": 3809.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2422.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3809.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal and lung), DNA from formalin-fixed paraffin-embedded (FFPE) tissue, next-generation sequencing of 8 genes (NRAS, EGFR, CTNNB1, PIK3CA, APC, BRAF, KRAS, and TP53), mutation detection", "code_information": [{"code": "499U", "type": "CPT"}], "standard_charges": [{"minimum": 1739.84, "maximum": 2735.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1739.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal cancer), analysis of cell-free DNA for epigenomic patterns, next-generation sequencing, >2500 differentially methylated regions (DMRs), plasma, algorithm reported as positive or negative", "code_information": [{"code": "537U", "type": "CPT"}], "standard_charges": [{"minimum": 181.97, "maximum": 286.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal cancer), cell-free DNA (cfDNA), methylation-based quantitative PCR assay (SEPTIN9, IKZF1, BCAT1, Septin9-2, VAV3, BCAN), plasma, reported as presence or absence of circulating tumor DNA (ctDNA)", "code_information": [{"code": "453U", "type": "CPT"}], "standard_charges": [{"minimum": 181.97, "maximum": 286.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal cancer), qualitative real-time PCR of 35 variants of KRAS and NRAS genes (exons 2, 3, 4), formalin-fixed paraffin-embedded (FFPE), predictive, identification of detected mutations", "code_information": [{"code": "471U", "type": "CPT"}], "standard_charges": [{"minimum": 181.97, "maximum": 286.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal) screening, quantitative real-time target and signal amplification, methylated DNA markers, including LASS4, LRRC4 and PPP2R5C, a reference marker ZDHHC1, and a protein marker (fecal hemoglobin), utilizing stool, algorithm reported as", "code_information": [{"code": "464U", "type": "CPT"}], "standard_charges": [{"minimum": 1297.62, "maximum": 2040.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1297.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal), blood, quantitative measurement of cell-free DNA (cfDNA)", "code_information": [{"code": "501U", "type": "CPT"}], "standard_charges": [{"minimum": 181.97, "maximum": 286.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal), cell-free DNA, 8 genes for mutations, 7 genes for methylation by real-time RT-PCR, and 4 proteins by enzyme-linked immunosorbent assay, blood, reported positive or negative for colorectal cancer or advanced adenoma risk", "code_information": [{"code": "496U", "type": "CPT"}], "standard_charges": [{"minimum": 181.97, "maximum": 286.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal), next-generation sequencing for mutation detection in 43 genes and methylation pattern in 45 genes, blood, and formalin-fixed paraffin-embedded (FFPE) tissue, report of variants and methylation pattern with interpretation", "code_information": [{"code": "498U", "type": "CPT"}], "standard_charges": [{"minimum": 1739.84, "maximum": 2735.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1739.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal), quantitative enzyme-linked immunosorbent assay (ELISA) for secreted colorectal cancer protein marker (BF7 antigen), using serum, result reported as indicative of response/no response to therapy or disease progression/regression", "code_information": [{"code": "558U", "type": "CPT"}], "standard_charges": [{"minimum": 1297.62, "maximum": 2040.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1297.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (cutaneous or uveal melanoma), circulating tumor cell selection, morphological characterization and enumeration based on differential CD146, high molecular-weight melanoma-associated antigen, CD34 and CD45 protein biomarkers, peripheral blood", "code_information": [{"code": "490U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (hepatocellular carcinoma), next-generation sequencing methylation pattern assay to detect 6626 epigenetic alterations, cell-free DNA, plasma, algorithm reported as cancer signal detected or not detected", "code_information": [{"code": "565U", "type": "CPT"}], "standard_charges": [{"minimum": 1297.62, "maximum": 2040.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1297.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2040.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (lung), qPCR-based analysis of 13 differentially methylated regions (CCDC181, HOXA7, LRRC8A, MARCHF11, MIR129-2, NCOR2, PANTR1, PRKCB, SLC9A3, TBR1_2, TRAP1, VWC2, ZNF781), pleural fluid, algorithm reported as a qualitative result", "code_information": [{"code": "566U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (minimal residual disease [MRD]), genomic sequence analysis, cell-free DNA, whole blood and tumor tissue, baseline assessment for design and construction of a personalized variant panel to evaluate current MRD and for comparison to subsequent MRD", "code_information": [{"code": "560U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (minimal residual disease [MRD]), genomic sequence analysis, cell-free DNA, whole blood, subsequent assessment with comparison to initial assessment to evaluate for MRD", "code_information": [{"code": "561U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (multiple myeloma), LC-MS/MS, peptide ion quantification, serum, results compared with baseline to determine monoclonal paraprotein abundance", "code_information": [{"code": "451U", "type": "CPT"}], "standard_charges": [{"minimum": 63.75, "maximum": 100.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (multiple myeloma), liquid chromatography with tandem mass spectrometry (LC-MS/MS), monoclonal paraprotein sequencing analysis, serum, results reported as baseline presence or absence of detectable clonotypic peptides", "code_information": [{"code": "450U", "type": "CPT"}], "standard_charges": [{"minimum": 63.75, "maximum": 100.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (non-small cell lung cancer), DNA and RNA, digital PCR analysis of 9 genes (EGFR, KRAS, BRAF, ALK, ROS1, RET, NTRK 1/2/3, ERBB2, and MET) in formalin-fixed paraffin-embedded (FFPE) tissue, interrogation for single-nucleotide variants, insertions/", "code_information": [{"code": "478U", "type": "CPT"}], "standard_charges": [{"minimum": 1739.84, "maximum": 2735.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1739.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2735.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (oropharyngeal), detection of minimal residual disease by next-generation sequencing (NGS) based quantitative evaluation of 8 DNA targets, cell-free HPV 16 and 18 DNA from plasma", "code_information": [{"code": "470U", "type": "CPT"}], "standard_charges": [{"minimum": 382.5, "maximum": 601.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 601.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (ovarian), DNA, whole-genome sequencing with 5-hydroxymethylcytosine (5hmC) enrichment, using whole blood or plasma, algorithm reported as cancer detected or not detected", "code_information": [{"code": "507U", "type": "CPT"}], "standard_charges": [{"minimum": 914.94, "maximum": 1438.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 914.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1438.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1438.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1438.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (pan-solid tumor), ctDNA, utilizing plasma, next-generation sequencing (NGS) of 77 genes, 8 fusions, microsatellite instability, and tumor mutation burden, interpretative report for single-nucleotide variants, copy-number alterations, with therap", "code_information": [{"code": "530U", "type": "CPT"}], "standard_charges": [{"minimum": 1524.67, "maximum": 2397.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (pan-solid tumor), next-generation sequencing analysis of tumor methylation markers present in cell-free circulating tumor DNA, algorithm reported as quantitative measurement of methylation as a correlate of tumor fraction", "code_information": [{"code": "486U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 549.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (pancreas), 3 biomarkers (glucose, carcinoembryonic antigen, and gastricsin), pancreatic cyst lesion fluid, algorithm reported as categorical mucinous or non-mucinous", "code_information": [{"code": "573U", "type": "CPT"}], "standard_charges": [{"minimum": 9180.0, "maximum": 14436.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9180.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14436.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (pancreatic cancer), augmentative algorithmic analysis of 16 genes from previously sequenced RNA whole-transcriptome data, reported as probability of predicted molecular subtype", "code_information": [{"code": "510U", "type": "CPT"}], "standard_charges": [{"minimum": 9562.5, "maximum": 15037.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9562.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), analysis of circulating plasma proteins (tPSA, fPSA, KLK2, PSP94, and GDF15), germline polygenic risk score (60 variants), clinical information (age, family history of prostate cancer, prior negative prostate biopsy), algorithm report", "code_information": [{"code": "495U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), augmentative algorithmic analysis of digitized whole-slide imaging of histologic features for microsatellite instability (MSI) and homologous recombination deficiency (HRD) status, formalin-fixed paraffin-embedded (FFPE) tissue, repor", "code_information": [{"code": "513U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), augmentative algorithmic analysis of digitized whole-slide imaging of histologic features for microsatellite instability (MSI) status, formalin-fixed paraffin-embedded (FFPE) tissue, reported as increased or decreased probability of M", "code_information": [{"code": "512U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), enzyme-linked immunosorbent assays (ELISA) for total prostate-specific antigen (PSA) and free PSA, serum, combined with age, previous negative prostate biopsy status, digital rectal examination findings, prostate volume, and image and", "code_information": [{"code": "550U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), high-throughput telomere length quantification by FISH, whole blood, diagnostic algorithm reported as risk of prostate cancer", "code_information": [{"code": "572U", "type": "CPT"}], "standard_charges": [{"minimum": 5176.5, "maximum": 8140.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5176.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8140.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), mRNA gene-expression profiling by real-time RT-PCR of 6 genes (FOXM1, MCM3, MTUS1, TTC21B, ALAS1, and PPP2CA), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a risk score for prostate cancer", "code_information": [{"code": "497U", "type": "CPT"}], "standard_charges": [{"minimum": 9876.15, "maximum": 15530.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9876.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15530.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), microRNA, single-nucleotide polymorphisms (SNPs) analysis by RT-PCR of 32 variants, using buccal swab, algorithm reported as a risk score", "code_information": [{"code": "534U", "type": "CPT"}], "standard_charges": [{"minimum": 1938.0, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid organ neoplasia), targeted genomic sequence analysis panel of 361 genes, interrogation for gene fusions, translocations, or other rearrangements, using DNA from formalin-fixed paraffin-embedded (FFPE) tumor tissue, report of clinically sig", "code_information": [{"code": "444U", "type": "CPT"}], "standard_charges": [{"minimum": 7444.98, "maximum": 11707.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7444.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), DNA (80 genes) and RNA (10 genes), by next-generation sequencing, plasma, including single-nucleotide variants, insertions/deletions, copy-number alterations, microsatellite instability, and fusions, reported as clinically actionab", "code_information": [{"code": "571U", "type": "CPT"}], "standard_charges": [{"minimum": 9562.5, "maximum": 15037.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9562.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15037.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), DNA, qualitative, next-generation sequencing (NGS) of single-nucleotide variants (SNV) and insertion/deletions in 22 genes utilizing formalin-fixed paraffin-embedded tissue, reported as presence or absence of mutation(s), location ", "code_information": [{"code": "523U", "type": "CPT"}], "standard_charges": [{"minimum": 1524.67, "maximum": 2397.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), cell-free DNA and RNA by next-generation sequencing, interpretative report for germline mutations, clonal hematopoiesis of indeterminate potential, and tumor-derived single-nucleotide variants, small insertions/deletions, copy numb", "code_information": [{"code": "485U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 549.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), cell-free circulating DNA, targeted genomic sequence analysis panel of 84 genes, interrogation for sequence variants, aneuploidy-corrected gene copy number amplifications and losses, gene rearrangements, and microsatellite instabil", "code_information": [{"code": "487U", "type": "CPT"}], "standard_charges": [{"minimum": 1524.67, "maximum": 2397.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), cell-free circulating tumor DNA (ctDNA), 152 genes, next-generation sequencing, interrogation for single-nucleotide variants, insertions/deletions, gene rearrangements, copy number alterations, and microsatellite instability, using", "code_information": [{"code": "539U", "type": "CPT"}], "standard_charges": [{"minimum": 1524.67, "maximum": 2397.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), circulating tumor cell selection, morphological characterization and enumeration based on differential epithelial cell adhesion molecule (EpCAM), cytokeratins 8, 18, and 19, CD45 protein biomarkers, and quantification of PD-L1 prot", "code_information": [{"code": "492U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), circulating tumor cell selection, morphological characterization and enumeration based on differential epithelial cell adhesion molecule (EpCAM), cytokeratins 8, 18, and 19, CD45 protein biomarkers, and quantification of estrogen r", "code_information": [{"code": "491U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), next-generation sequencing (NGS) of DNA from formalin-fixed paraffin-embedded (FFPE) tissue with comparative sequence analysis from a matched normal specimen (blood or saliva), 648 genes, interrogation for sequence variants, insert", "code_information": [{"code": "473U", "type": "CPT"}], "standard_charges": [{"minimum": 7444.98, "maximum": 11707.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7444.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), next-generation sequencing analysis of tumor methylation markers (>20000 differentially methylated regions) present in cell-free circulating tumor DNA (ctDNA), whole blood, algorithm reported as presence or absence of ctDNA with tu", "code_information": [{"code": "569U", "type": "CPT"}], "standard_charges": [{"minimum": 3812.25, "maximum": 5994.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3812.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5994.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5994.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5994.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), next-generation sequencing of DNA from formalin-fixed paraffin-embedded (FFPE) tissue of 517 genes, interrogation for single- nucleotide variants, multi-nucleotide variants, insertions and deletions from DNA, fusions in 24 genes an", "code_information": [{"code": "543U", "type": "CPT"}], "standard_charges": [{"minimum": 7444.98, "maximum": 11707.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7444.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), next-generation targeted sequencing analysis, formalin-fixed paraffin-embedded (FFPE) tumor tissue, DNA analysis of 600 genes, interrogation for single-nucleotide variants, insertions/deletions, gene rearrangements, and copy number", "code_information": [{"code": "538U", "type": "CPT"}], "standard_charges": [{"minimum": 7444.98, "maximum": 11707.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7444.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), targeted genomic sequence analysis, 33 genes, detection of single-nucleotide variants (SNVs), insertions and deletions, copy-number amplifications, and translocations in human genomic circulating cell-free DNA, plasma, reported as ", "code_information": [{"code": "562U", "type": "CPT"}], "standard_charges": [{"minimum": 8925.0, "maximum": 14035.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8925.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), tumor cell culture in 3D microenvironment, 36 or more drug panel, reported as tumor-response prediction for each drug", "code_information": [{"code": "511U", "type": "CPT"}], "standard_charges": [{"minimum": 1477.62, "maximum": 2323.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1477.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (urothelial carcinoma), DNA, quantitative methylation-specific PCR of 2 genes (ONECUT2, VIM), algorithmic analysis reported as positive or negative", "code_information": [{"code": "465U", "type": "CPT"}], "standard_charges": [{"minimum": 1938.0, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology (urothelial), DNA, quantitative methylated real-time PCR of TRNA-Cys, SIM2, and NKX1-1, using urine, diagnostic algorithm reported as a probability index for bladder cancer and/or upper tract urothelial carcinoma (UTUC)", "code_information": [{"code": "549U", "type": "CPT"}], "standard_charges": [{"minimum": 1938.0, "maximum": 3047.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3047.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology, pharmacogenomic analysis of single-nucleotide polymorphism (SNP) genotyping by real-time PCR of 24 genes, whole blood or buccal swab, with variant analysis, including impacted gene-drug interactions and reported phenotypes", "code_information": [{"code": "461U", "type": "CPT"}], "standard_charges": [{"minimum": 1149.82, "maximum": 1808.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology, spheroid cell culture, 11-drug panel (carboplatin, docetaxel, doxorubicin, etoposide, gemcitabine, niraparib, olaparib, paclitaxel, rucaparib, topotecan, veliparib) ovarian, fallopian, or peritoneal response prediction for each drug", "code_information": [{"code": "525U", "type": "CPT"}], "standard_charges": [{"minimum": 1477.62, "maximum": 2323.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1477.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2323.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Oncology, whole blood or buccal, DNA single-nucleotide polymorphism (SNP) genotyping by real-time PCR of 24 genes, with variant analysis and reported phenotypes", "code_information": [{"code": "460U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Open implantation of integrated neurostimulation system, vagus nerve, including analysis and programming, when performed", "code_information": [{"code": "908T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Operating Room Services Organ Transplant - Other Than Kidney", "code_information": [{"code": "362", "type": "RC"}], "standard_charges": [{"minimum": 3700.0, "maximum": 3714.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3700.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3714.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Operating Room Services Other", "code_information": [{"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 3700.0, "maximum": 3714.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3700.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3714.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Operating Room Services, General", "code_information": [{"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3700.0, "maximum": 3714.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3700.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3714.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Operating Room Services, Kidney Transplant", "code_information": [{"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 3700.0, "maximum": 3714.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3700.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3714.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Operating Room Services, Minor Surgery", "code_information": [{"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 3700.0, "maximum": 3714.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3700.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3714.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Optimal care for patients with urologic conditions MIPS value pathway", "code_information": [{"code": "M1423", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Orthopedic implant movement analysis using paired computed tomography (CT) examination of the target structure, including data acquisition, data preparation and transmission, interpretation and report (including CT scan of the joint or extremity performed", "code_information": [{"code": "946T", "type": "CPT"}], "standard_charges": [{"minimum": 464.71, "maximum": 730.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 464.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 730.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 730.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 730.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Other Imaging Services Diagnostic Mammography", "code_information": [{"code": "401", "type": "RC"}], "standard_charges": [{"minimum": 297.0, "maximum": 347.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 347.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 297.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Other Imaging Services General", "code_information": [{"code": "400", "type": "RC"}], "standard_charges": [{"minimum": 459.0, "maximum": 536.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 536.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 459.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Imaging Services Other", "code_information": [{"code": "409", "type": "RC"}], "standard_charges": [{"minimum": 459.0, "maximum": 536.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 536.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 459.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Imaging Services Screening Mammography", "code_information": [{"code": "403", "type": "RC"}], "standard_charges": [{"minimum": 297.0, "maximum": 347.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 347.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 297.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Other Imaging Services Ultrasound", "code_information": [{"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 680.0, "maximum": 794.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 794.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 680.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Room And Board General", "code_information": [{"code": "160", "type": "RC"}], "standard_charges": [{"minimum": 988.0, "maximum": 988.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Other Room And Board Other", "code_information": [{"code": "169", "type": "RC"}], "standard_charges": [{"minimum": 988.0, "maximum": 988.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "P-MASTECTOMY W/LN REMOVAL", "code_information": [{"code": "19302", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PABPN1 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81312", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY KINGWOOD SPECIALTY PO44AAKWD", "code_information": [{"code": "PO44AAKWD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 219.0, "discounted_cash": 76.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ASSY SHIP CENA 9U 45 BAL 8065000134", "code_information": [{"code": "8065000134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 291.0, "discounted_cash": 101.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK AUTO GAS FILL 8065751014", "code_information": [{"code": "8065751014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.01, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK BASIN DOUBLE MAJOR", "code_information": [{"code": "SSK6003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK BONE MARROW 60CC ASPIRATE CONCENTRATE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "51422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4069.0, "discounted_cash": 1424.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK BONE MARROW HARVEST 20 X 120ML CONCENTRATE ASPIRATION", "code_information": [{"code": "51423", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5245.05, "discounted_cash": 1835.77, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK BUR BONE SAW MCP PYRO CARBON TOTAL JOINT COMMAND II TPS MICRO DRILL", "code_information": [{"code": "MCP-DIS-STR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1158.66, "discounted_cash": 405.53, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK COLD INSTANT HEAVY-WEIGHT 6X10 MDS138000", "code_information": [{"code": "MDS138000", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CONVENIENCE MPFL MEDIAL PATELLOFEMORAL LIGAMENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1360B-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4221.0, "discounted_cash": 1477.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM DR FERGUSON PPK-13458-01", "code_information": [{"code": "PPK-13458-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 567.72, "discounted_cash": 198.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM DR MAXHARUDDIN PPK13457-01", "code_information": [{"code": "PPK13457-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 563.12, "discounted_cash": 197.09, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM DR MCQUEEN", "code_information": [{"code": "PPK3303-08", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.57, "discounted_cash": 186.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM DR SHRUM", "code_information": [{"code": "PPK3200-06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 503.0, "discounted_cash": 176.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM DR THOMAS", "code_information": [{"code": "PPK3230-06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 559.71, "discounted_cash": 195.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM DR. FERGUSON PPK13458-01", "code_information": [{"code": "PPK13458-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 567.72, "discounted_cash": 198.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM EENT CARDINAL MHK", "code_information": [{"code": "PE44EMKWB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 244.0, "discounted_cash": 85.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM EXTREMITY CARDINAL MHK", "code_information": [{"code": "PO44EXKWB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 277.0, "discounted_cash": 96.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM GYN LAPAROSCOPY CARDINAL MHK", "code_information": [{"code": "PB44LSKWB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM GYN LAPROSCOPIC SMA44GLTOA", "code_information": [{"code": "SMA44GLTOA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM HAND CARDINAL MHK", "code_information": [{"code": "PO44HNKWB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM KNEE KWSH", "code_information": [{"code": "DYNJ901533", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LAP CHOLE", "code_information": [{"code": "LCB52S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 686.0, "discounted_cash": 240.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LITHOTOMY CARDINAL MHK", "code_information": [{"code": "PG44OTKW1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.0, "discounted_cash": 65.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TDC VITREC 23G VDP", "code_information": [{"code": "8523.21", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TDC VITREC 25G VDP", "code_information": [{"code": "8525.201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL PO44TKKWH", "code_information": [{"code": "PO44TKKWH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 521.0, "discounted_cash": 182.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM VITREC 27G TDC VGPC", "code_information": [{"code": "8310.27G02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CYSTOSCOPY PK III SIRUS 8 CS DYNJP5020SI", "code_information": [{"code": "DYNJP5020SI", "type": "CDM"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CYSTOSCOPY TIBURON 29471", "code_information": [{"code": "29471", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.35, "discounted_cash": 15.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK DART-FREE EDGE INST PACK 2.5MM HEADLESS D0025000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0025000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 454.74, "discounted_cash": 159.16, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK DORC SIL OIL VFI", "code_information": [{"code": "1363.DD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK DRSGINJECTABLE BIORESORBABLE NASAL DRESSING SINUS STENT AND OTOLOGIC GEL ME", "code_information": [{"code": "1518000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EENT CUSTOM KW PE44EMKWF", "code_information": [{"code": "PE44EMKWF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 67.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EENT CUSTOM KWSH", "code_information": [{"code": "DYNJ901536", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 259.0, "discounted_cash": 90.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ENDO BASIC W/ ONE SCOPROTECT ENDOSCOPE ISOLATION TOTE ONE ENDOZIME CLEANING", "code_information": [{"code": "DYKENDOBASIC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ENDOSCOPY CUSTOM KWSH", "code_information": [{"code": "DYKE1223", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY CARDINAL MHK CUSTOM VER D", "code_information": [{"code": "PO44EXKWD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 184.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY CARDINAL PO44EXKWE", "code_information": [{"code": "PO44EXKWE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 241.0, "discounted_cash": 84.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY CUSTOM KW PO44EXKWH", "code_information": [{"code": "PO44EXKWH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 241.0, "discounted_cash": 84.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY CUSTOM KWSH", "code_information": [{"code": "DYNJ901537", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EYE CUSTOM KWSH", "code_information": [{"code": "DYNJ31662C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 907.0, "discounted_cash": 317.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EYE CUSTOM SEY44EPKWC", "code_information": [{"code": "SEY44EPKWC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EYE KWSH DBD", "code_information": [{"code": "DYNJ31662A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 33.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 1.2CC ALLOGRAFT VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-1601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 1.2CC COMPRESSION RESISTANT VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-1401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 136.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 2.5CC VITOSS BA2X", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2826.0, "discounted_cash": 989.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 5CC VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1656.0, "discounted_cash": 579.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM VITOSS BBTRAUMA 2.5CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1870.42, "discounted_cash": 654.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM VITOSS BIMODAL 1.2CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "2102-1901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 950.0, "discounted_cash": 332.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM VITOSS BIMODAL 2.5CC", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "2102-1902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1870.42, "discounted_cash": 654.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK GASTROINTESTINAL KWSH", "code_information": [{"code": "DYK1220743E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 265.0, "discounted_cash": 92.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK GENERATOR GYRUS ACMI", "code_information": [{"code": "744000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1692.0, "discounted_cash": 592.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK GRAFTLINK AUTOGRAFT CONVENIENCE", "code_information": [{"code": "AR-1588AU-CP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2193.0, "discounted_cash": 767.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK GYN LAPAROSCOPY CUSTOM KWSH", "code_information": [{"code": "DYNJ901535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 293.0, "discounted_cash": 102.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK GYN LAPROSCOPIC SMA44GLT0A", "code_information": [{"code": "SMA44GLT0A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HAND CARDINAL MHK CUSTOM VER E", "code_information": [{"code": "PO44HNKWE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 233.0, "discounted_cash": 81.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HAND CUSTOM KW PO44HNKWH", "code_information": [{"code": "PO44HNKWH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HAND CUSTOM KWSH", "code_information": [{"code": "DYNJ901539", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 294.0, "discounted_cash": 102.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HEAD AND NECK 9194", "code_information": [{"code": "9194", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK INST MENISCAL ROOT REPAIR", "code_information": [{"code": "71935360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1783.0, "discounted_cash": 624.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK INSTRUMENT DISP", "code_information": [{"code": "ST0101-A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAPARASCOPY PELVISCOPY STERILE 6 CS DYNJP9150A", "code_information": [{"code": "DYNJP9150A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAPAROSCOPY PELVISCOPY NUMBER II", "code_information": [{"code": "DYNJP9170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LITHOTOMY CUSTOM KW PG44OTKWG", "code_information": [{"code": "PG44OTKWG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LITHOTOMY PK II SIRUS 12 CS DYNJP9010S", "code_information": [{"code": "DYNJP9010S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.3, "discounted_cash": 9.21, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LITHOTOMY PK VI W/ REINFORCED TABLE COVER UTILITY DRP W/ ADHSV 2 HND TOWELS", "code_information": [{"code": "DYNJP9050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LITHOYOMY CUSTOM KWSH", "code_information": [{"code": "DYNJ901538", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MIS INSTRUMENT SN35", "code_information": [{"code": "SN35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1533.0, "discounted_cash": 536.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MIS STERILE BUMP", "code_information": [{"code": "57S1MI08", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2098.0, "discounted_cash": 734.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK OPTHAMOLOGY DR SHRUM PAK", "code_information": [{"code": "PPK3200-09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 213.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK OSSIO TAP FOR 4.75MM SUTURE ANCHOR THN00239", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "THN00239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 850.0, "discounted_cash": 297.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PIN 1/8IN X 3IN STEINMANN PFC TRIANGULAR END W/ FOUR PIN AND 2 DRILL STRL", "code_information": [{"code": "86-4192", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1237.0, "discounted_cash": 432.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PIN FIXATION SNGL USE FOR CUTTING GUIDE 3.2MM X 2MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "249095000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE HAT-TRICK BIL", "code_information": [{"code": "72204326", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3259.0, "discounted_cash": 1140.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE MORPHIX SINGLE USE 3.5MM", "code_information": [{"code": "L2-1000-10-035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1067.0, "discounted_cash": 373.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE PROSTEP MICA SOLO 57S900PK", "code_information": [{"code": "57S900PK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4229.44, "discounted_cash": 1480.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE SHOULDER W/ POUCH STRL", "code_information": [{"code": "DYNJP8401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.76, "discounted_cash": 20.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE STERILE DYNACLIP UNIVERSAL", "code_information": [{"code": "3000-01-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 807.0, "discounted_cash": 282.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SHOULDER SUSPENSION TRAY II LF STRL", "code_information": [{"code": "DYNJSHOULDER2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SPINE PN44KSKWB", "code_information": [{"code": "PN44KSKWB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURG CYSTSCPY PACKINCLUDES: REINFORCED TABLE COVER ECLIPSE POLY REINFORCED", "code_information": [{"code": "DYNJP5020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURG EENT II EYE EAR NOSE THROAT W/ 50IN X 90IN MAYO STAND COVER 24IN X 53I", "code_information": [{"code": "DYNJP7010A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURG HEAD NECK EENT II EYE EAR NOSE THROAT W/ 2 GOWNS HND TOWEL MAYO STAND", "code_information": [{"code": "DYNJP7010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURG HIP V SHARPS FREE W/ HVY DTY TABLE COVER MAYO STAND COVER ECLIPSE POLY", "code_information": [{"code": "DYNJP8240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.0, "discounted_cash": 39.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL ARTHRO CARDINAL CUSTOM", "code_information": [{"code": "PO44AAKW3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL EENT CARDINAL MHK CUSTOM VER D", "code_information": [{"code": "PE44EMKWD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 72.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL EYE CARDINAL CUSTOM MHK VER B", "code_information": [{"code": "SEY44EPKWB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL EYE II STRL STND", "code_information": [{"code": "DYNJS0120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL GYN LAPAROSCOPY PB44LSKWG", "code_information": [{"code": "PB44LSKWG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL LITHOTOMY CARDINAL CUSTOM MHK VER C", "code_information": [{"code": "PG44OTKWC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 156.0, "discounted_cash": 54.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL LITHOTOMY CARDINAL PG44OTKWD", "code_information": [{"code": "PG44OTKWD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 146.0, "discounted_cash": 51.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICLA ARTHRO CARDINAL CUSTOM MHK VER B", "code_information": [{"code": "PO44AAKWB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICLA GYN LAPAROSCOPY CARDINAL CUSTOM MHK", "code_information": [{"code": "PB44LSKWC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICLA GYN LAPAROSCOPY CARDINAL CUSTOM MHK VER D", "code_information": [{"code": "PB44LSKWD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 156.0, "discounted_cash": 54.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SUSPENSION SHOULDER TRAY I LF STRL", "code_information": [{"code": "DYNJSHOULDER", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SYSTEM PROSTEP ORTHOPEDIC FIXATION INTERNAL MIS INSTRUMENT W/ BLADE STERILE DISPOSABLE 57S1MI07", "code_information": [{"code": "57S1MI07", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.83, "discounted_cash": 289.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK TOTAL KNEE CUSTOM KWSH", "code_information": [{"code": "DYNJ901534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 912.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK UNIVERSAL TENDONESIS", "code_information": [{"code": "1500-02-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1372.0, "discounted_cash": 480.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VGPC INPUT 25G EVA CUSTOM TDC VITRECTOMY 8525.401", "code_information": [{"code": "8525.401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 989.0, "discounted_cash": 346.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VISUAL 20GA 23GA 25GA CANNULA VISUAL FUNCTION CORE HIGH SPEED EXTRACTION SL", "code_information": [{"code": "8065750957", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITRECTOMY 23GA EVA TDC", "code_information": [{"code": "8310.23G02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITRECTOMY 25GA EVA TDC VGPC INPUT", "code_information": [{"code": "8310.25G02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITRECTOMY 25GA HYPERVIT BEVEL 20K CPM CASSETTE 8065753106", "code_information": [{"code": "8065753106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1380.0, "discounted_cash": 483.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITRECTOMY ANTINFINITI STRL", "code_information": [{"code": "8065750157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PACKAGE INSTRUMENT 3.2MM X 60", "code_information": [{"code": "9H00-T060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 973.0, "discounted_cash": 340.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PACKAGE INSTRUMENT 3.8 X 40", "code_information": [{"code": "9H00-T040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 973.0, "discounted_cash": 340.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ABDOMINAL 5IN X 9IN LF STRL", "code_information": [{"code": "NON21450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ABDOMINAL 8IN X 10IN WHT LF STRL", "code_information": [{"code": "NON21454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ADHSV ENT", "code_information": [{"code": "9732500XOM", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ARMBOARD 2IN X 8IN X 20IN CONVOLUTED FOAM WITHOUT COVER LF", "code_information": [{"code": "NON081343", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ELECTRODE 4 1/2IN X 6IN ORANGE MONITORING DEFIBRILLATOR UNIVERSAL LF", "code_information": [{"code": "2346N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ELECTRODE 4IN X 3.5IN PED EDGE SYS LF", "code_information": [{"code": "11996-000093", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ELECTROSURGICAL ADULT STANDARD NONWOVEN BACKING", "code_information": [{"code": "8149F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 143.0, "discounted_cash": 50.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD EYE 1 5/8IN X 2 5/8IN LF STRL", "code_information": [{"code": "NON21600Z", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD EYE 1 5/8IN X 2 5/8IN STRL", "code_information": [{"code": "NON21600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GENESIS BI-WING ARM ADDUCTION IHS-IT212", "code_information": [{"code": "IHS-IT212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 408.32, "discounted_cash": 142.91, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING ADULT W/ATTACHED CORD P4500", "code_information": [{"code": "P4500", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING ELECTRODE NEUTRAL", "code_information": [{"code": "4777-5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING ELECTRODE NON-REM POLYHESIVE PATIENT RETURN", "code_information": [{"code": "E7506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING ELECTROSURGICAL PATIENT PLATE SLF ADHSV MONOPOLAR", "code_information": [{"code": "406-650-205", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "discounted_cash": 54.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING NOVAPLUS SPLIT CORD", "code_information": [{"code": "9165V", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING PATIENT RETURN ELECTROSURGICAL REM POLYHESIVE DISP", "code_information": [{"code": "E7507A", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING SNGL USE RF ACCESSORY W/ CORD", "code_information": [{"code": "PMA-GP-BAY", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING UNIVERSAL SPLIT 9165", "code_information": [{"code": "9165", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING UNIVERSAL UNCORDED SOLID PAD9130", "code_information": [{"code": "PAD9130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD LEG HOLDER ARTHROSCOPY", "code_information": [{"code": "OZ-751-2075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.67, "discounted_cash": 27.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD MATRESS 2IN", "code_information": [{"code": "FP-OVER2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD NON ADHERENT 3IN X 8IN STRL NON25720", "code_information": [{"code": "NON25720", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD OR TABLE CONVOLUTED FOAM 20X72X2 FP-ORTBL2", "code_information": [{"code": "FP-ORTBL2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD POST PERINEAL POST PAD SUPINE HIP POSITIONING SYS PATIENT LIMIT 6FT 4IN 400", "code_information": [{"code": "72200634", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD TABLE ECONOMY POSITIONER FOAM DEVONO DISP", "code_information": [{"code": "580030", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD UNIVERSAL-STYLE GROUND SPLIT 9' CORD PAD9165", "code_information": [{"code": "PAD9165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.48, "discounted_cash": 7.17, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING CAST 3IN X 4YD UNDERCAST COTTON OR SYNTH MATERIAL LF STRL", "code_information": [{"code": "30-320", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING CAST 3IN X 4YD UNDERCAST COTTON SPECIALIST STRL", "code_information": [{"code": "9083S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING CAST 3IN X 4YD WHT UNDERCAST COTTON RAYON SPECIALIST STRL", "code_information": [{"code": "9043S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING CAST 4IN X 4YD WHT UNDERCAST COTTON RAYON SPECIALIST STRL", "code_information": [{"code": "9044S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.8, "discounted_cash": 2.73, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING CAST 4IN X 4YD WHT UNDERCAST COTTON SPECIALIST LF STRL", "code_information": [{"code": "9084S", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING CAST 4IN X 4YD WHT UNDERCAST NON STRL COTTON WEBRIL II", "code_information": [{"code": "3175", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING CAST COTTON BLEND 6 X 4 YD 9046S", "code_information": [{"code": "9046S", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING CST 3IN X 4YD COTTON OR SYNTH USE WHEN DRESSING EXTREMITY LF STRL", "code_information": [{"code": "D30-320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING CST 3IN X 4YD UNDERCAST PROVIDES A SOFT ENVIROMENT LOW LINTING COTTON WY", "code_information": [{"code": "DYNJ066003", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING CST 4IN X 4YD COTTON OR SYNTH USE WHEN DRESSING EXTREMITY LF STRL", "code_information": [{"code": "D30-321", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING UNDERCAST 2IN X 4YD STRL", "code_information": [{"code": "9082S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDING UNDRCAST WHT 100CTTN STR 6INX4YD 9086S", "code_information": [{"code": "9086S", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PADINSERT BOOT SNGL USE FOR HIP POSITIONING SYS DISP", "code_information": [{"code": "72200635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PADS DEFIBRILLATOR MDSPHY100", "code_information": [{"code": "MDSPHY100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.46, "discounted_cash": 29.91, "setting": "both", "billing_class": "facility"}]}, {"description": "PAIN MGMT 11 ENDOGENOUS ANAL", "code_information": [{"code": "117U", "type": "CPT"}], "standard_charges": [{"minimum": 29.4, "maximum": 1210.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1210.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1210.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAIN MGMT MRNA GEN XPRSN 36", "code_information": [{"code": "290U", "type": "CPT"}], "standard_charges": [{"minimum": 29.4, "maximum": 1094.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAIN MGT OPI USE GNOTYP PNL", "code_information": [{"code": "78U", "type": "CPT"}], "standard_charges": [{"minimum": 649.31, "maximum": 649.31, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 649.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAIN PACK", "code_information": [{"code": "PAIN0804C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PAIN TRAY MHKW", "code_information": [{"code": "PAIN0804D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.33, "discounted_cash": 29.17, "setting": "both", "billing_class": "facility"}]}, {"description": "PALATOPHARYNGOPLASTY 42145", "code_information": [{"code": "42145", "type": "CPT"}, {"code": "1482359", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALB2 GENE FULL GENE SEQ", "code_information": [{"code": "81307", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 721.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 974.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 974.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALB2 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81308", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 768.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALB2 MRNA SEQ ALYS", "code_information": [{"code": "137U", "type": "CPT"}], "standard_charges": [{"minimum": 407.35, "maximum": 1134.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 721.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1134.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G0031", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G0034", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G0048", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G9988", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G9992", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G9993", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G9994", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "M1309", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALMAR FASCIECTOMY PALM ONLY 26121", "code_information": [{"code": "26121", "type": "CPT"}, {"code": "1481527", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALMAR FASCIETOMY PALM PARTIAL 26123", "code_information": [{"code": "26123", "type": "CPT"}, {"code": "1481528", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALMAR FASCIOTOMY 26040", "code_information": [{"code": "26040", "type": "CPT"}, {"code": "1481529", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALMAR FASCIOTOMY OPEN/PARTIAL 26045", "code_information": [{"code": "26045", "type": "CPT"}, {"code": "1481530", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREAS REMOVAL/TRANSPLANT", "code_information": [{"code": "48160", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC", "code_information": [{"code": "406", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17524.51, "maximum": 30085.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17524.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25063.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27570.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 30085.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "405", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34901.82, "maximum": 59917.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34901.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49917.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54908.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59917.76, "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": 12883.79, "maximum": 22118.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12883.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18426.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20269.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22118.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48146", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48152", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48153", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48154", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATORRHAPHY", "code_information": [{"code": "48545", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANNICULECTOMY 15830", "code_information": [{"code": "15830", "type": "CPT"}, {"code": "1481537", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANORAMIC X-RAY OF JAWS", "code_information": [{"code": "70355", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 23.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANT MESH PROTECTION PLUS XL 32 48", "code_information": [{"code": "MBP3703", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PAPER ECG PRINTER 50MMX30M 3ROLL BOX 11240-000031", "code_information": [{"code": "11240-000031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.98, "discounted_cash": 8.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PAPER HIGH DENSITY 210 X 25MM BLACK AND WHITE", "code_information": [{"code": "UPP210-HD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAPPA SERUM", "code_information": [{"code": "84163", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARACENTESIS OF ANTERIOR CHAMBER OF EYE;WITH DIAGNOSTIC ASPIRATION OF AQUEOUS 65800", "code_information": [{"code": "65800", "type": "CPT"}, {"code": "1481538", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARACENTESIS OF ANTERIOR CHAMBER OF EYE;WITH REMOVAL OF BLOOD 65815", "code_information": [{"code": "65815", "type": "CPT"}, {"code": "1481539", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARACENTESIS OF ANTERIOR CHAMBER OF EYE;WITH REMOVAL OF VITREOUS 65810", "code_information": [{"code": "65810", "type": "CPT"}, {"code": "1481540", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARACENTESIS OF ANTERIOR CHAMBER OF EYE;WITH THERAPEUTIC RELEASE OF AQUEOUS 65805", "code_information": [{"code": "1481541", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PARAFFIN BATH THERAPY", "code_information": [{"code": "97018", "type": "CPT"}], "standard_charges": [{"minimum": 31.8, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARAINFLUENZA AG IF", "code_information": [{"code": "87279", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 65.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 65.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 65.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYRD PLANAR W/SPECT&CT", "code_information": [{"code": "78072", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1420.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2233.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2233.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2233.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 763.67, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 812.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYRD PLANAR W/WO SUBTRJ", "code_information": [{"code": "78071", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1354.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2129.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2129.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2129.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 624.6, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 664.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYROID PLANAR IMAGING", "code_information": [{"code": "78070", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1181.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1856.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1856.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1856.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 583.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYROIDECTOMY 60500", "code_information": [{"code": "60500", "type": "CPT"}, {"code": "1481542", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARAVAGINAL DEFECT REPAIIR;OPEN ABDOMINAL APPROACH 57284", "code_information": [{"code": "57284", "type": "CPT"}, {"code": "1481543", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARAVAGINAL DEFECT REPAIR 57423", "code_information": [{"code": "57423", "type": "CPT"}, {"code": "1481544", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARAVAGINAL DEFECT REPAIR;VAGINAL APPROACH 57285", "code_information": [{"code": "57285", "type": "CPT"}, {"code": "1481545", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARAVERTEBRAL BLOCK (PVB) THORACIC; CONT. INFUSION 64463", "code_information": [{"code": "64463", "type": "CPT"}, {"code": "42923654", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SUPP NOT OTHRWS C", "code_information": [{"code": "B9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARING OR CUTTING OF BENIGN LESION 2-4 11056", "code_information": [{"code": "11056", "type": "CPT"}, {"code": "1481546", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARING OR CUTTING OF BENIGN LESION 4+ 11057", "code_information": [{"code": "11057", "type": "CPT"}, {"code": "1481547", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARING OR CUTTING OF BENIGN SINGLE LESION 11055", "code_information": [{"code": "11055", "type": "CPT"}, {"code": "1481548", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42507", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42509", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42510", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROTIDECTOMY 42410", "code_information": [{"code": "42410", "type": "CPT"}, {"code": "1481549", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARS SUTURE IMPLANT KIT W/SUTURETAPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8862DS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3241.16, "discounted_cash": 1134.41, "setting": "both", "billing_class": "facility"}]}, {"description": "PART REMOVAL HIP BONE DEEP", "code_information": [{"code": "27071", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART REMOVE HIP BONE SUPER", "code_information": [{"code": "27070", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXC. POSTERIOR VERTEBRAL COMPONENT 22103", "code_information": [{"code": "22103", "type": "CPT"}, {"code": "45571552", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 157.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXC. VERTEBRAL BODY FOR BONY LESION W/O DEC. SPINE/NERVE RT. SINGLE SEG. EA . ADD. 22116", "code_information": [{"code": "22116", "type": "CPT"}, {"code": "19352184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 7713.0, "discounted_cash": 2699.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3733.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2545.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION BONE CLAVICLE 23180", "code_information": [{"code": "23180", "type": "CPT"}, {"code": "1481550", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION BONE PROXIMAL HUMERUS 23184", "code_information": [{"code": "23184", "type": "CPT"}, {"code": "1481551", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION BONE SCAPULA 23182", "code_information": [{"code": "23182", "type": "CPT"}, {"code": "1481552", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION DISTAL PHALANX FINGER 26236", "code_information": [{"code": "26236", "type": "CPT"}, {"code": "1481553", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION FEUMUR PROX.TIBIA AND OR FIBULA 27360", "code_information": [{"code": "27360", "type": "CPT"}, {"code": "1481554", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION HUMERUS 24140", "code_information": [{"code": "24140", "type": "CPT"}, {"code": "1481555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION METACARPAL BONE 26230", "code_information": [{"code": "26230", "type": "CPT"}, {"code": "1481556", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5953.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF BONE; ULNA 25150", "code_information": [{"code": "25150", "type": "CPT"}, {"code": "1482042", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40500", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40520", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OLECRANON PROCESS 24147", "code_information": [{"code": "24147", "type": "CPT"}, {"code": "1481558", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION PHALANX OF TOE 28124", "code_information": [{"code": "28124", "type": "CPT"}, {"code": "1481559", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1334.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1334.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION POSTERIOR VERTEBRAL 22102", "code_information": [{"code": "22102", "type": "CPT"}, {"code": "1481560", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION PROXIMAL OR MIDDLE FINGER 26235", "code_information": [{"code": "26235", "type": "CPT"}, {"code": "1481561", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION RADIUS 25151", "code_information": [{"code": "25151", "type": "CPT"}, {"code": "1481562", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION TALUS OR CALCANEUS 28120", "code_information": [{"code": "28120", "type": "CPT"}, {"code": "1481563", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION TARSAL OR METATARSAL 28122", "code_information": [{"code": "28122", "type": "CPT"}, {"code": "1481564", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION VERTEBRAL BODY CERVICAL W/O DECOMPRESSION 22110", "code_information": [{"code": "22110", "type": "CPT"}, {"code": "1481566", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2366.76, "maximum": 9735.0, "gross_charge": 7172.0, "discounted_cash": 2510.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3471.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2366.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL HIP REPLACEMENT", "code_information": [{"code": "27125", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL HYMENECTOMY 56700", "code_information": [{"code": "56700", "type": "CPT"}, {"code": "1481569", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45113", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45123", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL RELEASE OF LUNG", "code_information": [{"code": "32225", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47140", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47141", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47142", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51550", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51555", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44141", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44143", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44144", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44145", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44146", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44147", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43116", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43117", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43118", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43121", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43122", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43123", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33030", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33031", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF KIDNEY", "code_information": [{"code": "50240", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31367", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31368", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31370", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31375", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31380", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31382", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIP", "code_information": [{"code": "40530", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47120", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47125", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47130", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LUNG", "code_information": [{"code": "32480", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF NOSE", "code_information": [{"code": "30150", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF OVARY(S)", "code_information": [{"code": "58920", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48140", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48145", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48150", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PHARYNX", "code_information": [{"code": "42890", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45111", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45114", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45116", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21600", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21610", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TONGUE", "code_information": [{"code": "41130", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL THYROID LOBECTOMY 60210", "code_information": [{"code": "60210", "type": "CPT"}, {"code": "1481570", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL THYROID LOBECTOMY WITH CONTRALATERAL SUBTOTAL LOBECTOMY 60212", "code_information": [{"code": "60212", "type": "CPT"}, {"code": "1481571", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTICLE AGGLUT ANTBDY SCRN", "code_information": [{"code": "86403", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTICLE AGGLUT ANTBDY TITR", "code_information": [{"code": "86406", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 42.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 42.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 42.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTICULATE AMNIO VO 40.0MG", "code_information": [{"code": "AVI-5050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3914.0, "discounted_cash": 1369.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PARVOVIRUS ANTIBODY", "code_information": [{"code": "86747", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PASSER CATH 38 CM RADIOPAQUE TIP OBTURATOR SHAFT HANDLE", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "8583", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER CATHETER 38CM 8591-38", "code_information": [{"code": "8591-38", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 338.14, "discounted_cash": 118.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SLIDER WITH NITINOL PASSING WIRE 3910-500-764", "code_information": [{"code": "3910-500-764", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT 1.8MM 25 DEGREE TIGHT CURVE RIGHT SHOULDER SUTLASSO SD STRL", "code_information": [{"code": "AR-4068-25TR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 71.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT 1.8MM 90 DEGREE RIGHT CURVE SUTLASSO SD STRL DISP", "code_information": [{"code": "AR-4068-90R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT 1.8MM CRESCENT STIFF SHAFT A SHARP ATRAUMATIC TIP SUTLASSO SD", "code_information": [{"code": "AR-4068C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 557.0, "discounted_cash": 194.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT 1.8MM SUTLASSO SD STRL DISP", "code_information": [{"code": "AR-4068-90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT 14G 10-12MM 15MM GD", "code_information": [{"code": "RSG-14/18F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT 45 DEGREE LFT CURVE SUTLASSO SD STRL", "code_information": [{"code": "AR-4068-45L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT 45 DEGREE RIGHT CURVE SUTLASSO SD STRL DISP", "code_information": [{"code": "AR-4068-45R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT 6IN MICRO MINOR BEND SM CURVE SUTLASSO SSINSTR", "code_information": [{"code": "AR-8701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT 6IN MICRO STRAIGHT SUTLASSO SSINSTR", "code_information": [{"code": "AR-8703", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 428.0, "discounted_cash": 149.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT 70DEG MICRO TFCC TRIANGULAR FIBROCARTILAGE COMPLEX SHRT BEND SUTLASSO", "code_information": [{"code": "AR-8704", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT BANANA PERFORATING NDL CANNULA ARTHROSCOPIC W/ NITROL WIRE LOOP SURTU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4065B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT CHIA PERCPASSER", "code_information": [{"code": "214101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.63, "discounted_cash": 36.97, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT NDL FOR USE W/ E2 AND E3 EXPRESSEW III", "code_information": [{"code": "214141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 431.48, "discounted_cash": 151.02, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSER SUT SHOULDER ARTHROSCOPIC 70 DEGREE UPBEND FOR SUT SHUTTLES ACCU-PASS STR", "code_information": [{"code": "72200419", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH AMNIOTIC MEMBRANE NUSHIELD 4 X 4CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "NSU-1440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8652.0, "discounted_cash": 3028.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH COLLAGEN 6CM X 10CM TISSUEMEND", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "6495-9-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7243.0, "discounted_cash": 2535.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH DERM 40MM X 70MM 2.25MM DECELLUARIZED DERMIS W/ MATRACELL ARTHROFLEX STRL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AFLEX201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5569.2, "discounted_cash": 1949.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH DERMIS 40MM X 70MM DECELLULARIZED ROTATOR CUFF FLEXIGRAFT", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "AFLEX101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5669.0, "discounted_cash": 1984.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH MESH 18CM X 14CM LG DOUBLE LAYER OVAL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "10202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2066.0, "discounted_cash": 723.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH MESH 2.5IN X 2.5IN MED CIRC HERNIA W/ STRP VENTRALEX STRL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "10302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 962.0, "discounted_cash": 336.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH MESH 5.5IN X 4.3IN HERNIA EPTFE OVAL VENTRALEX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "10205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1632.0, "discounted_cash": 571.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH MESH 6IN CIRC VENTRALIGHT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5954600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH MESH HERNIA REPAIR V SHAPE CQUR", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "31202 (ATRIUM)", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1228.0, "discounted_cash": 429.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH PERICARDIUM HYDRATED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "10-0053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 589.0, "discounted_cash": 206.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH PROLENE 3D LG PRESHPD OVERLAY 5CM P3DPL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "P3DPL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 811.0, "discounted_cash": 283.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PATCH STERISHIELD II DUAL LAYER 4 X 6 CM", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "834", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4223.0, "discounted_cash": 1478.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA 10MM THICKNESS SIZE A32 TRIATHLON X3 ASYMMETRIC 5551-G-320-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5551-G-320-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA A29MM X 9MM ASYMMETRIC IMPLANT 5551-G-299-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5551-G-299-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA ASYMMETRIC SZ A 35MM X 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5551-G-350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 816.0, "discounted_cash": 285.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA ASYMMETRIC SZ A35 X 10MM 5551-G-350-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5551-G-350-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA POLY 35MM PROLONG ALL POLY NEXGEN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-5972-066-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2373.0, "discounted_cash": 830.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA RESURFACING 32MM STANDARD JOURNEY BCS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74024832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 886.0, "discounted_cash": 310.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA RESURFACING 35MM STANDARD JOURNEY BCS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74024835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1830.0, "discounted_cash": 640.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA RESURFACING 7.5MM X 26MM STANDARD ROUND JOURNEY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71932910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6118.0, "discounted_cash": 2141.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA RESURFACING 7.5MM X 32MM STANDARD ROUND JOURNEY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71932912", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA RESURFACING 7.5MM X 35MM STANDARD ROUND JOURNEY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71932913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4748.0, "discounted_cash": 1661.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA SURG 29MM POLYETHYLENE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5400-000-29", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA SURG 32MM POLYETHYLENE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5400-000-32", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2948.0, "discounted_cash": 1031.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA SYMMETRIC 27MM X 8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5550-G-278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1778.0, "discounted_cash": 622.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA SYMMETRIC 29MM X 8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5550-G-298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1858.0, "discounted_cash": 650.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA SZE S27MM THKNS 8MM TRIATHLON X3 SYMETRIC 5550-G-278-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5550-G-278-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA TRIATHLON X3 SZ S29MM X 8MM SYMMETRIC 5550-G-298-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5550-G-298-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLAR LIGAMENT PS 1.0 X 5.0 CM PLP-101", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PLP-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6386.0, "discounted_cash": 2235.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLECTOMY 27350", "code_information": [{"code": "27350", "type": "CPT"}, {"code": "1481572", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ HIGH 41-60", "code_information": [{"code": "80505", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 388.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 610.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 610.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 610.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ MOD 21-40", "code_information": [{"code": "80504", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 388.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 610.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 610.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 610.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ PROLNG SVC", "code_information": [{"code": "80506", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 180.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 180.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 180.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 59.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 59.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ SF 5-20", "code_information": [{"code": "80503", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 129.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 203.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 203.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 203.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH CONSLTJ SURG CYTO XM EA", "code_information": [{"code": "88334", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 30.14, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 31.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH REPORT NOT SENT", "code_information": [{"code": "G9786", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH REPORT SENT", "code_information": [{"code": "G9785", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH RPT TIS SPEC WLE/REEXC", "code_information": [{"code": "M1166", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH/DERM PROV 2ND BIOP OPIN", "code_information": [{"code": "G9784", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATHO RPT INCL PT CTG", "code_information": [{"code": "G9428", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATHO RPT NO PT CTG", "code_information": [{"code": "G9431", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATHOGEN REDUCED PLASMA POOL", "code_information": [{"code": "P9070", "type": "HCPCS"}], "standard_charges": [{"minimum": 82.37, "maximum": 129.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 82.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 129.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 129.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 129.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATHOGEN REDUCED PLASMA SING", "code_information": [{"code": "P9071", "type": "HCPCS"}], "standard_charges": [{"minimum": 204.28, "maximum": 321.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 204.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 321.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 321.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 321.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATHOGEN TEST FOR PLATELETS", "code_information": [{"code": "P9100", "type": "HCPCS"}], "standard_charges": [{"minimum": 83.93, "maximum": 142.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 90.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 142.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 142.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 142.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [{"code": "543", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6357.95, "maximum": 10915.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6357.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9093.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10002.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10915.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC", "code_information": [{"code": "542", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11005.36, "maximum": 18893.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11005.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15740.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17314.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18893.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "544", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4730.75, "maximum": 8121.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4730.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6765.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7442.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8121.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATHOLOGY SS", "code_information": [{"code": "G4023", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATIENT CONTROLLER 15500", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "15500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PATIENT CONTROLLER NEURO STIMULATOR PROCLAM 7 ELITE", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37904.0, "discounted_cash": 13266.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PATIENT EDUCATION MATERIALS", "code_information": [{"code": "99071", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATIENT MANUEL WITH VIRTUAL CLINIC 35500", "code_information": [{"code": "C1822", "type": "HCPCS"}, {"code": "35500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PATIENT RECORDED SPIROMETRY", "code_information": [{"code": "94014", "type": "CPT"}], "standard_charges": [{"minimum": 1603.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1603.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATIENT RECORDED SPIROMETRY", "code_information": [{"code": "94015", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATIENT TRACKER ENT", "code_information": [{"code": "9733534XOM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.97, "discounted_cash": 190.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PATIENT TRACKER NON-INVASIVE", "code_information": [{"code": "9734887XOM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 524.58, "discounted_cash": 183.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PATTERN ERG W/I&R", "code_information": [{"code": "509T", "type": "CPT"}], "standard_charges": [{"minimum": 148.87, "maximum": 234.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 148.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 234.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 234.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 234.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATTIE NEURO 1/2\" X 3\" 80-1407", "code_information": [{"code": "80-1407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PATTIES CODMAN SURGICAL 1/2 INCH X 1/2 INCH 801400", "code_information": [{"code": "801400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PCA3/KLK3 ANTIGEN", "code_information": [{"code": "81313", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 318.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 650.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1022.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1022.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1022.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 367.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 367.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PCV13 VACCINE IM", "code_information": [{"code": "90670", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PCV15 VACCINE IM", "code_information": [{"code": "90671", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PCV20 VACCINE IM", "code_information": [{"code": "90677", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PDGFRA GENE", "code_information": [{"code": "81314", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 411.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 840.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1321.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1321.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1321.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 474.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 474.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PDT DSTR PRMLG LES PHYS/QHP", "code_information": [{"code": "96573", "type": "CPT"}], "standard_charges": [{"minimum": 770.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PDT DSTR PRMLG LES SKN", "code_information": [{"code": "96567", "type": "CPT"}], "standard_charges": [{"minimum": 770.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEANUT ALLG ASMT EPI", "code_information": [{"code": "165U", "type": "CPT"}], "standard_charges": [{"minimum": 45.72, "maximum": 667.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 71.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 71.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 667.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 667.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEANUT ALLG ASMT EPI CLIN RX", "code_information": [{"code": "178U", "type": "CPT"}], "standard_charges": [{"minimum": 56.46, "maximum": 662.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 88.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 88.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 88.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 662.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 662.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED BLUNT HD TRAUM", "code_information": [{"code": "G0047", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE AGE 2-5 INIT", "code_information": [{"code": "99475", "type": "CPT"}], "standard_charges": [{"minimum": 2517.49, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2517.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3956.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3956.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3956.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 1567.09, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1567.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2462.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2462.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2462.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE TRANSPORT ADDL", "code_information": [{"code": "99467", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRITICAL CARE INITIAL", "code_information": [{"code": "99471", "type": "CPT"}], "standard_charges": [{"minimum": 3577.57, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3577.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5621.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5621.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5621.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 1832.49, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1832.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2879.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2879.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2879.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 1283.67, "maximum": 2018.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1283.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC COMPL", "code_information": [{"code": "94774", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC DOWNLD", "code_information": [{"code": "94776", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC HK-UP", "code_information": [{"code": "94775", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC REPORT", "code_information": [{"code": "94777", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED VSCLTS KD ALYS 3 BMRKS", "code_information": [{"code": "310U", "type": "CPT"}], "standard_charges": [{"minimum": 562.68, "maximum": 2018.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1283.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2018.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 562.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED WHL GEN MTHYLTN ALYS 50+", "code_information": [{"code": "318U", "type": "CPT"}], "standard_charges": [{"minimum": 120.49, "maximum": 2549.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 120.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 189.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2549.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2549.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEDIATRICS SS", "code_information": [{"code": "G4024", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEDICLE SCREW PROBE PHAN XL ML-0342S", "code_information": [{"code": "ML-0342S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 565.0, "discounted_cash": 197.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK 3.9MM KNOTLESS CORKSCREW DISPOSABLE KIT AR-1941DS", "code_information": [{"code": "AR-1941DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 817.0, "discounted_cash": 285.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK CERVICAL MEDIUM NEUTRAL 6MM C3106", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "C3106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK CERVICAL X-LARGE NEUTRAL 10MM C7110", "code_information": [{"code": "C7110 Peek", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK PLIF 28MM NEUTRAL 16MM P3016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P3016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG 2.3 X 18MM CRUCIFORM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-S2318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG 2.3 X 24MM CRUCIFORM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-S2324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.76, "discounted_cash": 76.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG 3.2MM X 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110025332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG ANCHOR 48MM GLENOID CROSS LINKED GLOBAL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "113642026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG ANCHOR 52MM GLENOID CROSS LINKED GLOBAL PREMIERON IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "113643026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG BONE 2.5MM 10MM FULLY THREADED SURG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG BONE 2.5MM 14MM FULLY THREADED SURG LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG COMP QUICK RELEASE DRILL ANTI ROTATION 16/64 INCH", "code_information": [{"code": "110003481", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1341.0, "discounted_cash": 469.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CORTICAL 2.3MM X 16MM SMOOTH LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-S2316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CRUCIFORM LOCKING 2.3 X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-S2320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.76, "discounted_cash": 76.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CRUCIFORM LOCKING 2.3 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-S2322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.76, "discounted_cash": 76.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG FULL THRED 2.5MM X 14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "FP14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG GLENOID ANCHOR X-LINKED 44MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1136-41-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG HIGH COMP LOCKING 2.7MM X 14MM TI HCLP-27140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCLP-27140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG HIGH COMP LOCKING 2.7MM X 16MM TI HCLP-27160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCLP-27160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG HIGH COMP LOCKING 2.7MM X 21MM HCLP-27210-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCLP-27210-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG HIGH COMP LOCKING 2.7MM X 22MM TI HCLP-27220-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCLP-27220-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG HIGH COMP LOCKING 2.7MM X 24MM TI HCLP-27240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCLP-27240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG HIGH COMP LOCKING 2.7MM X 26MM TI HCLP-27260-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCLP-27260-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG LOCKING 2.3MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-52318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG LOCKING 3.2MM X 26MM HUMERUS PLATING SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110025326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG LOCKING 3.2MM X 30MM PROXIMAL HUMERUS PLATING SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110025330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG LOCKING 3.2MM X 44MM HUMERUS PLATING SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110025344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG LOCKING 3.2MM X 46MM PROXIMAL HUMERUS PLATING SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110025346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG MULTIDIRECTIONAL 2.5MM X 10MM THREADED ANATOMIC VOLAR PLATING SYS DVR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-11-120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG MULTIDIRECTIONAL 2.5MM X 22MM THREADED ANATOMIC VOLAR PLATING SYS DVR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-11-122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5MM X 14MM NON STRL NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP14000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP20000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SCREW 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5755.20/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SCREW 2MM X 22MM SMOOTH LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P22000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SCREW 2MM X 24MM SMOOTH LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P24000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH 2.0 X 12MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "P12000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH 2.0 X 14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "P14000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 42.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH 2.2MM X 20MM LCKNG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1312-27-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH 2MM X 16MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P16000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 14MM SPLS-20140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 16MM SPLS-20160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.8, "discounted_cash": 35.28, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 18MM SPLS-20180-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20180-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 19MM SPLS-20190-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20190-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 20MM SPLS-20200-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20200-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 21MM SPLS-20210-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20210-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 22MM SPLS-20220-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20220-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 23MM SPLS-20230-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20230-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 24MM SPLS-20240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 26MM SPLS-20260-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20260-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 28MM SPLS-20280-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20280-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH LOCKING 2.0MM X 30MM SPLS-20300-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20300-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SURG 2.0 X 20MM CRUCIFORM SMOOTH IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P-20000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SURG 2.5 X 20MM CRUCIFORM THREADED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TP20000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 366.0, "discounted_cash": 128.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 10MM TPLS-23100-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23100-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 262.0, "discounted_cash": 91.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 12MM TPLS-23120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 14MM TPLS-23140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 16MM TPLS-23160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 17MM TPLS-23170-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23170-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 18MM TPLS-23180-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23180-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 19MM TPLS-23190-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23190-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 262.0, "discounted_cash": 91.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 20MM TPLS-23200-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23200-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 21MM TPLS-23210-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23210-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 22MM TPLS-23220-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23220-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 23MM TPLS-23230-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23230-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 262.0, "discounted_cash": 91.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 24MM TPLS-23240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 26MM TPLS-23260-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23260-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 28MM TPLS-23280-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23280-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD LOCKING 2.3MM X 30MM TPLS-23300-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23300-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD NON-LOCKING 2.7MM X 12MM TI TPNL-27120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD NON-LOCKING 2.7MM X 14MM TI TPNL-27140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD NON-LOCKING 2.7MM X 16MM TI TPNL-27160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 81.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD NON-LOCKING 2.7MM X 18MM TI TPNL-27180-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27180-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD NON-LOCKING 2.7MM X 20MM TI TPNL-27200-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27200-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD NON-LOCKING 2.7MM X 22MM TI TPNL-27220-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27220-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD NON-LOCKING 2.7MM X 24MM TI TPNL-27240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD NON-LOCKING 2.7MM X 26MM TI TPNL-27260-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27260-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 83.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD NON-LOCKING 2.7MM X 30MM TI TPNL-27300-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27300-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG VOLAR LOCKING 1.8MM X 16.0MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FDR 116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG VOLAR LOCKING 1.8MM X 20.0MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FDR 120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG VOLAR LOCKING 1.8MM X 22.0MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FDR 122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC", "code_information": [{"code": "734", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13530.42, "maximum": 23228.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13530.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19351.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21286.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23228.36, "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": 8598.93, "maximum": 14762.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8598.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12298.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13528.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14762.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION", "code_information": [{"code": "99459", "type": "CPT"}], "standard_charges": [{"minimum": 101.61, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION UNDER ANESTHESIA 57410", "code_information": [{"code": "57410", "type": "CPT"}, {"code": "1481573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 592.41, "maximum": 8450.0, "gross_charge": 1224.0, "discounted_cash": 428.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 592.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EXENTERATION", "code_information": [{"code": "45126", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EXENTERATION 58240", "code_information": [{"code": "58240", "type": "CPT"}, {"code": "1481574", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FRACTURE UNI/BIL", "code_information": [{"code": "G0413", "type": "HCPCS"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FX TREAT INT FIX", "code_information": [{"code": "G0414", "type": "HCPCS"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC SCREW 000-0163", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-0163", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PEN ADHESIVE TISSUE HI VISC 1ML M1261", "code_information": [{"code": "M1261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.34, "discounted_cash": 19.72, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL CAUTERY HOLSTER ELECTROSURGICAL LFINSTR DISP", "code_information": [{"code": "E2516H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELCTRD .093IN X 10FT CORD BLD HLSTR ROCKER SWITCH W/ ACCUVAC SMOKE EVACUA", "code_information": [{"code": "E2515HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL 10FT 2.4MM HANDSWITCH LFINSTR DISP", "code_information": [{"code": "E2515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL 10FT X .093IN SMOKE EVACUATION W/ 1IN STAINLESS STEEL BLA", "code_information": [{"code": "E2516HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL 10FTFT SWITCH LOCK BLADE STRL DISP", "code_information": [{"code": "E2504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL HANDSWITCH PUSH BTN", "code_information": [{"code": "E2516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL ROCKER HANDSWITCH COATED BLADE DISP", "code_information": [{"code": "E2450H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL HAND ROCKER W/HOLSTER CTD BLA E2350H", "code_information": [{"code": "E2350H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ROCKER SWITCH W HOLSTER E2515H", "code_information": [{"code": "E2515H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCILTUBINGBOVIE W/SMOKE EVAC E2350HS E2350HS", "code_information": [{"code": "E2350HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PENILE INJECTION", "code_information": [{"code": "54235", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93980", "type": "CPT"}], "standard_charges": [{"minimum": 281.31, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 281.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 442.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 442.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 442.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93981", "type": "CPT"}], "standard_charges": [{"minimum": 243.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 243.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 382.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 382.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 382.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VENOUS OCCLUSION", "code_information": [{"code": "37790", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITH CC/MCC", "code_information": [{"code": "709", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14087.62, "maximum": 24184.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14087.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20148.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22163.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24184.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "710", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9742.53, "maximum": 16725.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9742.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13933.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15327.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16725.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54240", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54250", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PER PM REEVAL EST PAT 65+ YR", "code_information": [{"code": "99397", "type": "CPT"}], "standard_charges": [{"minimum": 457.71, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 457.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 719.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 719.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 719.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PER PM REEVAL EST PAT INFANT", "code_information": [{"code": "99391", "type": "CPT"}], "standard_charges": [{"minimum": 314.7, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 314.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 494.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 494.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 494.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS MR", "code_information": [{"code": "C7502", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS STERO", "code_information": [{"code": "C7501", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC CRYO ABLATE RENAL TUM", "code_information": [{"code": "50593", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO ADD", "code_information": [{"code": "C9608", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO SIN", "code_information": [{"code": "C9607", "type": "HCPCS"}], "standard_charges": [{"minimum": 4218.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG B", "code_information": [{"code": "C9605", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG S", "code_information": [{"code": "C9604", "type": "HCPCS"}], "standard_charges": [{"minimum": 4218.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC W AMI S", "code_information": [{"code": "C9606", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 12000.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER BR", "code_information": [{"code": "C9603", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER S", "code_information": [{"code": "C9602", "type": "HCPCS"}], "standard_charges": [{"minimum": 4218.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT BRAN", "code_information": [{"code": "C9601", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT SING", "code_information": [{"code": "C9600", "type": "HCPCS"}], "standard_charges": [{"minimum": 4218.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC INSERT KIT FOR 3.0MM KNOTLESS", "code_information": [{"code": "AR-1938PK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1066.0, "discounted_cash": 373.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC RF ABLATE RENAL TUMOR", "code_information": [{"code": "50592", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC. INJ. CELLULAR/TISSUE BASED PRODUCT; LUMBAR FIRST LEVEL 0627T", "code_information": [{"code": "627T", "type": "CPT"}, {"code": "45892360", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 14773.61, "gross_charge": 30524.0, "discounted_cash": 10683.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 14773.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCT. INJ. ALLOGENEIC CELLULAR/TISSUE UNI/BILATERAL LUMBAR EA. ADD. 0628T", "code_information": [{"code": "628T", "type": "CPT"}, {"code": "46011600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 13553.93, "gross_charge": 28004.0, "discounted_cash": 9801.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 13553.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUT ABLATE LIVER RF", "code_information": [{"code": "47382", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUT ALLERGY SKIN TESTS", "code_information": [{"code": "95004", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4008.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6299.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6299.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6299.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [{"code": "273", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23277.82, "maximum": 39962.23, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23277.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 33292.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36621.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39962.23, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [{"code": "274", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19992.39, "maximum": 34321.96, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19992.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28593.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31452.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34321.96, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [{"code": "250", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15340.11, "maximum": 26335.16, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15340.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21939.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24133.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26335.16, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [{"code": "251", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10088.05, "maximum": 17318.67, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10088.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14428.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15870.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17318.67, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CATHETERIZATION URETERAL 50393", "code_information": [{"code": "1481575", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3047.0, "discounted_cash": 1066.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PERCUTANEOUS DECOMPRESSION OF NUCLEUS PULPOSUS OF DISC LUMBAR; SINGLE/MULTI LEVEL 62287", "code_information": [{"code": "62287", "type": "CPT"}, {"code": "1481576", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS FIXATION DISTAL PHALANGEAL FX 26756", "code_information": [{"code": "26756", "type": "CPT"}, {"code": "1481578", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS FIXATION HUMERAL CONDYLAR FX 24582", "code_information": [{"code": "24582", "type": "CPT"}, {"code": "1481580", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS FIXATION HUMERAL EPICONDYLAR FX 24566", "code_information": [{"code": "24566", "type": "CPT"}, {"code": "1481581", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS FIXATION INTERPHALANGEAL JOINT DISLOCATION 26776", "code_information": [{"code": "26776", "type": "CPT"}, {"code": "1481582", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS FIXATION METACARPAL FRACTURE 26608", "code_information": [{"code": "26608", "type": "CPT"}, {"code": "1481583", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS FIXATION UNSTABLE PHALANGEAL SHAFT FX 26727", "code_information": [{"code": "26727", "type": "CPT"}, {"code": "1481584", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODE ARRAY PERIPHERAL NERVE 64555", "code_information": [{"code": "64555", "type": "CPT"}, {"code": "1807634", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "gross_charge": 6573.53, "discounted_cash": 2300.74, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3181.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY EPIDURAL 63650", "code_information": [{"code": "63650", "type": "CPT"}, {"code": "1481585", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES;SACRAL NERVE 64561", "code_information": [{"code": "64561", "type": "CPT"}, {"code": "1481586", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS ISLET CELLTRANS", "code_information": [{"code": "G0341", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS LAMINOTOMY/LAMINECTOMY DECOM.NEURAL ELEM. W/IMAGE; SING/MULTI; UNI/BIL LUMBAR 0275T", "code_information": [{"code": "275T", "type": "CPT"}, {"code": "11267684", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3459.14, "maximum": 9735.0, "gross_charge": 7147.0, "discounted_cash": 2501.45, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3459.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS 62264", "code_information": [{"code": "62264", "type": "CPT"}, {"code": "1481588", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS USING SOLUTION INJ 62263", "code_information": [{"code": "62263", "type": "CPT"}, {"code": "43036777", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE 27756", "code_information": [{"code": "27756", "type": "CPT"}, {"code": "1481589", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBRAL AUG. INCL. CAVITY CREATION MECH. DEVICE 1 VERT.UNI OR BIL. LUMBAR 22514", "code_information": [{"code": "22514", "type": "CPT"}, {"code": "1481590", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBRAL AUG. INCL. CAVITY CREATION MECH. DEVICE 1 VERT.UNI OR BIL. THORACIC 22513", "code_information": [{"code": "22513", "type": "CPT"}, {"code": "1481592", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 6253.0, "discounted_cash": 2188.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3026.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBRAL AUGMENTATION LUMBAR MULTIPLE 22515", "code_information": [{"code": "22515", "type": "CPT"}, {"code": "1481591", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBROPLASTY (INCLUDING BIOPSY) 1 LUMBAR BODY 22511", "code_information": [{"code": "22511", "type": "CPT"}, {"code": "1481593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBROPLASTY (INCLUDING BIOPSY) 1 THORACIC BODY 22510", "code_information": [{"code": "22510", "type": "CPT"}, {"code": "1481594", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBROPLASTY EACH ADDITIONAL BODY 22512", "code_information": [{"code": "22512", "type": "CPT"}, {"code": "1481595", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERF ULTRSND TO LCT PREG DOC", "code_information": [{"code": "G8806", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERFORM HUMERAL SYSTEM SPACER SIZE 3 / 4 THICK 9MM DWX934", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX934", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3271.0, "discounted_cash": 1144.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PERFORM REVERSED CENTRAL SCREWS 6.5MM X 45MM NON STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAND", "code_information": [{"code": "D5996", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAX", "code_information": [{"code": "D5995", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERI-PX DEV EVAL ISDSS IP", "code_information": [{"code": "684T", "type": "CPT"}], "standard_charges": [{"minimum": 88.99, "maximum": 139.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 88.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 139.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 139.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 139.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERI-PX DEVICE EVAL & PRGR", "code_information": [{"code": "93287", "type": "CPT"}], "standard_charges": [{"minimum": 88.99, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 88.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 139.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 139.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 139.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERI-PX EVAL PM/LDLS PM IP", "code_information": [{"code": "93286", "type": "CPT"}], "standard_charges": [{"minimum": 88.99, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 88.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 139.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 139.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 139.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERICAPSULAR INJECTION 100 ML", "code_information": [{"code": "MED0156", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PERICARDIOCENTESIS W/IMAGING", "code_information": [{"code": "33016", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERINEOPLASTY 56810", "code_information": [{"code": "56810", "type": "CPT"}, {"code": "1481598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIP NERVE BLOCK", "code_information": [{"code": "G9770", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [{"code": "300", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6349.44, "maximum": 10900.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6349.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9081.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9989.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10900.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [{"code": "299", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9322.81, "maximum": 16004.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9322.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13333.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14666.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16004.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "301", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4520.28, "maximum": 7760.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4520.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6464.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7111.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7760.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR REHAB", "code_information": [{"code": "93668", "type": "CPT"}], "standard_charges": [{"minimum": 79.47, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 79.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 124.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 124.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 124.88, "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": 14293.23, "maximum": 24537.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14293.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20442.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22486.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24537.92, "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": 23509.58, "maximum": 40360.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23509.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 33623.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36986.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40360.11, "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": 11565.0, "maximum": 19854.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11565.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16540.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18194.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19854.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [{"code": "336", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13937.98, "maximum": 23928.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13937.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19934.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21927.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23928.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [{"code": "335", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23805.82, "maximum": 40868.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23805.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34047.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37452.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40868.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC", "code_information": [{"code": "337", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9959.7, "maximum": 17098.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9959.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14244.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15668.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17098.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL LAVAGE", "code_information": [{"code": "49084", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERM FLP TUBE OCCLS W/IMPLT", "code_information": [{"code": "567T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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": 15320.04, "maximum": 49208.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 49208.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 49208.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 38885.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15320.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21910.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24102.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26300.7, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [{"code": "242", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22674.99, "maximum": 38927.33, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22674.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32430.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35673.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38927.33, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC", "code_information": [{"code": "244", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12551.05, "maximum": 49208.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 49208.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 49208.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 38885.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12551.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17950.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19745.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21547.04, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERONEUS LONGUS FF 0.90 X 34.5 CM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "AT294FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERQ & ICUT ALLG TEST VENOMS", "code_information": [{"code": "95017", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ABLTJ LVR CRYOABLATION", "code_information": [{"code": "47383", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ACCESS & CLSR FEM ART", "code_information": [{"code": "34713", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ART M-THROMBECT &/NFS", "code_information": [{"code": "61645", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ CLSR TCAT L ATR APNDGE", "code_information": [{"code": "33340", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ CVT&LS INJ VERT BODIES", "code_information": [{"code": "C7504", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST MR GUIDE", "code_information": [{"code": "19287", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST STRTCTC", "code_information": [{"code": "19283", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST US IMAG", "code_information": [{"code": "19285", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD MR GUIDE", "code_information": [{"code": "19288", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD STRTCTC", "code_information": [{"code": "19284", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD US IMAG", "code_information": [{"code": "19286", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST 1ST IMAG", "code_information": [{"code": "19281", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST EA IMAG", "code_information": [{"code": "19282", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ IMPLTJ/RPLCMT ISDNS PTN", "code_information": [{"code": "587T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ISLET CELL TRANSPLANT", "code_information": [{"code": "584T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ LAMOT/LAM CRV/THRC", "code_information": [{"code": "274T", "type": "CPT"}], "standard_charges": [{"minimum": 4935.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ LS&CVT INJ VERT BODIES", "code_information": [{"code": "C7505", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ LUMB&THOR VERT AUG", "code_information": [{"code": "C7508", "type": "HCPCS"}], "standard_charges": [{"minimum": 2743.0, "maximum": 6125.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR 1ST", "code_information": [{"code": "629T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR EA", "code_information": [{"code": "630T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP CPLX>2CM", "code_information": [{"code": "50081", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 11235.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11235.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11235.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP SMPL<2CM", "code_information": [{"code": "50080", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 11235.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11235.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11235.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR BI", "code_information": [{"code": "33903", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR UNI", "code_information": [{"code": "33902", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT BI", "code_information": [{"code": "33901", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT UNI", "code_information": [{"code": "33900", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC EACH ADDL", "code_information": [{"code": "33904", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47538", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47539", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47540", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PRCRD DRG INSJ CATH CT", "code_information": [{"code": "33019", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT BILAT INJ", "code_information": [{"code": "201T", "type": "CPT"}], "standard_charges": [{"minimum": 3951.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT UNILAT INJ", "code_information": [{"code": "200T", "type": "CPT"}], "standard_charges": [{"minimum": 3951.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ STENT/CHEST VERT ART", "code_information": [{"code": "75T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT ILIAC ANAST IMPLT", "code_information": [{"code": "553T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT US ABLTJ NRV P-ART", "code_information": [{"code": "632T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ THOR&LUMB VERT AUG", "code_information": [{"code": "C7507", "type": "HCPCS"}], "standard_charges": [{"minimum": 2743.0, "maximum": 6125.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE EACH", "code_information": [{"code": "93592", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE PDA", "code_information": [{"code": "93582", "type": "CPT"}], "standard_charges": [{"minimum": 2347.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS AORTIC", "code_information": [{"code": "93591", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS MITRAL", "code_information": [{"code": "93590", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH SEPTAL REDUXN", "code_information": [{"code": "93583", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML ANGP NT/RECR COA", "code_information": [{"code": "33897", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML CORONRY LITHOTRP", "code_information": [{"code": "92972", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TX NASOETHMOID FX", "code_information": [{"code": "21340", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ&IC ALLG TEST DRUGS/BIOL", "code_information": [{"code": "95018", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PERSONALIZED KNEE SYSTEM VIVACIT-E HIGHLY CROSSLINKED POLYETHYLENE ARTICULAR SURFACE FIXED B", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5226-006-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8102.0, "discounted_cash": 2835.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PERTUSSIS AG IF", "code_information": [{"code": "87265", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE FULL BODY", "code_information": [{"code": "78813", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 9450.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2405.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6011.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE LTD AREA", "code_information": [{"code": "78811", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5372.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8445.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8445.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8445.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE SKULL-THIGH", "code_information": [{"code": "78812", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 9450.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2405.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6011.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT FULL BODY", "code_information": [{"code": "78816", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 9450.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2405.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6011.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT LMTD", "code_information": [{"code": "78814", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 9450.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2405.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6011.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT SKULL-THIGH", "code_information": [{"code": "78815", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 9450.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2405.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6011.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9450.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGING INITIAL DX", "code_information": [{"code": "G0252", "type": "HCPCS"}], "standard_charges": [{"minimum": 333.87, "maximum": 524.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 333.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 524.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 524.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 524.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMG WHOLBOD MELANO NONCO", "code_information": [{"code": "G0219", "type": "HCPCS"}], "standard_charges": [{"minimum": 9254.17, "maximum": 14548.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9254.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14548.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14548.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14548.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET NOT OTHERWISE SPECIFIED", "code_information": [{"code": "G0235", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFA FUNC", "code_information": [{"code": "85055", "type": "CPT"}, {"code": "1233833", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 188.0, "discounted_cash": 65.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 44.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 69.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 91.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 143.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 143.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 143.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 51.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 51.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PFA FUNC ASA", "code_information": [{"code": "85576", "type": "CPT"}, {"code": "1233832", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 186.0, "discounted_cash": 65.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 69.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 99.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 99.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 99.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 35.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 35.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PFAS 16 PFAS COMPND LC MS/MS", "code_information": [{"code": "398U", "type": "CPT"}], "standard_charges": [{"minimum": 365.93, "maximum": 575.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PFAS 16 PFAS COMPND LC MS/MS", "code_information": [{"code": "399U", "type": "CPT"}], "standard_charges": [{"minimum": 37.49, "maximum": 58.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHALANGEAL HEMI SZ 2 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HP1-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7488.0, "discounted_cash": 2620.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PHALANGECTOMY TOE 28150", "code_information": [{"code": "28150", "type": "CPT"}, {"code": "1481599", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHALINX ANGLED MED", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "5-052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2348.0, "discounted_cash": 821.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PHALINX ANGLED SM", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "5-051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2348.0, "discounted_cash": 821.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PHALINX ANGLED X-SML", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "5-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2348.0, "discounted_cash": 821.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PHANTOM FIBER SUTURE NEEDLED VIOLET SZ 2 METRIC 5", "code_information": [{"code": "SMSB0120N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PHANTOM XL DILATOR CLIP ML-0345", "code_information": [{"code": "ML-0345", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 421.0, "discounted_cash": 147.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PHARM THER OSTEO RX", "code_information": [{"code": "G8633", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHARMACIST AT HOSPICE", "code_information": [{"code": "G9479", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHARMACOLOGIC MGMT W/PSYTX", "code_information": [{"code": "90863", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENOL 120ML", "code_information": [{"code": "MED0525", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PHENOL TOPICAL 89% SWAB", "code_information": [{"code": "MED0785", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PHENOTYPE DNA HIV W/CLT ADD", "code_information": [{"code": "87904", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 40.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 104.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 104.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 37.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 37.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENOTYPE DNA HIV W/CULTURE", "code_information": [{"code": "87903", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 754.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1246.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1959.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1959.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1959.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 703.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 703.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENOTYPE INFECT AGENT DRUG", "code_information": [{"code": "87900", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 201.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 332.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 522.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 522.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 522.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 187.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 187.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENYLEPHRINE 2.5% OPHTHALMIC DROPS/MYDFRIN 3ML", "code_information": [{"code": "MED0170", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PHENYLEPHRINE REG-ST SPR 0.5% 15ML", "code_information": [{"code": "MED0171", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PHENYLEPHRINE/NEOSYNEPHRINE 100MCG/ML 5ML", "code_information": [{"code": "MED0172", "type": "CDM"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PHISOHEX 3% 5 OZ", "code_information": [{"code": "MED0301", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PHLEB VEINS - EXTREM 20+", "code_information": [{"code": "37766", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHLEBOTOMY", "code_information": [{"code": "99195", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHONE E/M PHYS/QHP 11-20 MIN", "code_information": [{"code": "99442", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHONE E/M PHYS/QHP 21-30 MIN", "code_information": [{"code": "99443", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHONE E/M PHYS/QHP 5-10 MIN", "code_information": [{"code": "99441", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSPHOLIPID PLTLT NEUTRALIZ", "code_information": [{"code": "85597", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTO PATCH TEST", "code_information": [{"code": "95052", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY UV-A OR B", "code_information": [{"code": "96913", "type": "CPT"}], "standard_charges": [{"minimum": 621.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 621.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 976.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 976.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 976.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY WITH UV-A", "code_information": [{"code": "96912", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY WITH UV-B", "code_information": [{"code": "96910", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTODYNAMIC TX ADDL 15 MIN", "code_information": [{"code": "96571", "type": "CPT"}], "standard_charges": [{"minimum": 131.9, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 131.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 207.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 207.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 207.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTODYNMC TX 30 MIN ADD-ON", "code_information": [{"code": "96570", "type": "CPT"}], "standard_charges": [{"minimum": 235.23, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 235.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 369.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 369.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 369.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOPHERESIS", "code_information": [{"code": "36522", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOSENSITIVITY TESTS", "code_information": [{"code": "95056", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHY/QHP OP PULM RHB W/MNTR", "code_information": [{"code": "94626", "type": "CPT"}], "standard_charges": [{"minimum": 125.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 125.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHY/QHP OP PULM RHB W/O MNTR", "code_information": [{"code": "94625", "type": "CPT"}], "standard_charges": [{"minimum": 87.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV AUTHRJ", "code_information": [{"code": "86079", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV REACTJ", "code_information": [{"code": "86078", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV XMATCH", "code_information": [{"code": "86077", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS REVIEW OF MOTION TESTS", "code_information": [{"code": "96004", "type": "CPT"}], "standard_charges": [{"minimum": 519.72, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 519.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 816.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 816.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 816.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS/OCC THERAPY SS", "code_information": [{"code": "G4026", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICAL MEDICINE SS", "code_information": [{"code": "G4025", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICAL PERFORMANCE TEST", "code_information": [{"code": "97750", "type": "CPT"}], "standard_charges": [{"minimum": 157.35, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 157.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 247.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICIAN STANDBY SERVICES", "code_information": [{"code": "99360", "type": "CPT"}], "standard_charges": [{"minimum": 274.96, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 274.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PICK DRILLING 1.5MM X 13 CM 45 DEGREE ORTHO POWERPICK STRL", "code_information": [{"code": "AR-8150PP-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PICK DRILLING 1.5MM X 13 CM 6MM 45 DEGREE ORTHO POWERPICK STRL", "code_information": [{"code": "AR8150PX-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 322.19, "discounted_cash": 112.77, "setting": "both", "billing_class": "facility"}]}, {"description": "PICK DRILLING 30 DEGREE ORTHO SURG POWERPICK STRL", "code_information": [{"code": "AR-8150PP-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PICK ILLUMINATED 23GA CHOW STIFF DULL", "code_information": [{"code": "56.07.23PS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 435.0, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PICK ILLUMINATED 25GA CHOW STIFF DULL", "code_information": [{"code": "56.07.25PS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 435.0, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIERCE EARLOBES", "code_information": [{"code": "69090", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61253", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61150", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61151", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61156", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIK3CA GENE TRGT SEQ ALYS", "code_information": [{"code": "81309", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILD/PLACEBO CONTROL CLIN TR", "code_information": [{"code": "G0276", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILLOW HEADREST 7ININTUBATION SLOT RIGHT GENTLETOUCH", "code_information": [{"code": "1937DZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW LARGE ABDUCTION FOAM POSITION FP-ABDUCTL", "code_information": [{"code": "FP-ABDUCTL", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 23.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW MEDIUM ABDUCTION FOAM POSITIO FP-ABDUCTM", "code_information": [{"code": "FP-ABDUCTM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW POSITIONING 7IN HEAD REST (USE ITEM 1937DZ)", "code_information": [{"code": "1937 (USE ITEM 1937DZ)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW PRONE STANDARD FACE DOWN", "code_information": [{"code": "PP-VOSS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW REUSABLE 20IN X 26IN BLUE FLUID REISTANT PP OVATION PLUS", "code_information": [{"code": "MDT219885", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PILOCARPINE 2% OPHTHALMIC SOLUTION 15 ML", "code_information": [{"code": "MED0173", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 238.0, "discounted_cash": 83.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PILOT TIP CANN REAMERS AEQUALIS II", "code_information": [{"code": "DWD164", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 1.1MM PROVISIONAL FIXATION WIRE 6MM VLP MINI-MOD 74461514", "code_information": [{"code": "74461514", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 763.96, "discounted_cash": 267.39, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 1.4MM 57S90004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S90004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 1.5 MM X 20 MM B-AP-1520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "B-AP-1520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3790.0, "discounted_cash": 1326.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 14MM 2.5MM PROVISIONAL FIXATION 71175093", "code_information": [{"code": "71175093", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1278.96, "discounted_cash": 447.64, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 2.0MM PROVISIONAL FIXATION 25MM 71175091", "code_information": [{"code": "71175091", "type": "CDM"}], "standard_charges": [{"gross_charge": 777.0, "discounted_cash": 271.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 2.4 MMX229 MM SPIN-SD-24229", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPIN-SD-24229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 2.5-3.5MM X 22MM 21-253522", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "21-253522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 2.5-3.5MM X 25MM 21-253525", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "21-253525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1390.0, "discounted_cash": 486.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 2.5-3.5MM X 30MM STRAIGHT 21-253530", "code_information": [{"code": "21-253530", "type": "CDM"}], "standard_charges": [{"gross_charge": 1550.0, "discounted_cash": 542.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 2.5-3.5MM X 35MM 21-253535", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "21-253535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1390.0, "discounted_cash": 486.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 2.5MM LOCATING", "code_information": [{"code": "510-25-005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 22MM BIORESORBABLE", "code_information": [{"code": "1910-2202S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1690.0, "discounted_cash": 591.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 3.0MM ALLOMATE CORTICAL BONE CBP-ABS-030 CBP-ABS-030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CBP-ABS-030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 3.0MM X 320MM DRILL GUIDE P31-951-3032", "code_information": [{"code": "P31-951-3032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 3.5-3.5MM X 16MM STRAIGHT 21-353516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "21-353516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1110.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 3.6 X 9MM STEINMANN 187-05-69", "code_information": [{"code": "187-05-69", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 3MM SMOOTH TRANSFIXING", "code_information": [{"code": "5045-5-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 426.0, "discounted_cash": 149.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 6.5MM NON-RIMMED SPEED 74026159", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74026159", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1989.4, "discounted_cash": 696.29, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN ACL TIGHTROPE AR-1588T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN ANCHORING 120.0MM AVS ARIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48755920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN ANCHORING 130MM AVS ARIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48755930", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN ANKLE DISTRACTOR 2.7 X 100MM MPX27100", "code_information": [{"code": "MPX27100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN ANTI SKIVE 0.9MM PROSTEP INSTRUMENTS 57S90005", "code_information": [{"code": "57S90005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.77, "discounted_cash": 92.67, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN APEX 4.0 X 120MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5023-3-120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 275.0, "discounted_cash": 96.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN APEX 4.0X90MM 5023-2-090", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5023-2-090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 275.0, "discounted_cash": 96.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN APEX 5.0MM X 120MM DRILLING 5018-5-120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5018-5-120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN APPLICATOR 01.6 MM DISP FOR 1.5 MM B-DIP-1500", "code_information": [{"code": "B-DIP-1500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2179.05, "discounted_cash": 762.67, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN ARROW-LOK 2.5-3.5MM X 19MM STRAIGHT 21-253519", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "21-253519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE -3 HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6541-4-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 489.04, "discounted_cash": 171.16, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE 12 MM DISP", "code_information": [{"code": "1007-1200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE 3.0 X 75MM SHOULDER REV STRL DISP", "code_information": [{"code": "9722908", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE 3IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "800-01-338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 158.0, "discounted_cash": 55.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE EXCHANGE 3.2MM 500375", "code_information": [{"code": "500375", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE GUIDE 3.2MM 500373", "code_information": [{"code": "500373", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE GUIDE BAYONET POINT 1.3 X 140MM", "code_information": [{"code": "128039", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 297.98, "discounted_cash": 104.29, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE HEADED TIBIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "801-01-053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE SYSTEM DIGIT WIDGET DWD-232", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWD-232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3450.0, "discounted_cash": 1207.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE TIBIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "801-01-338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN CLAVICLE 2.5MM SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1129-11-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3342.0, "discounted_cash": 1169.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN CONNECTION TO ROD CLAMPS 4 X 5/8 TO 5 X 8/11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4922-1-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1686.0, "discounted_cash": 590.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN COVERS YELLOW SMALL", "code_information": [{"code": "13-1001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.38, "discounted_cash": 5.03, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISPENSING MULTI ACCESS MINI SPIKE LF", "code_information": [{"code": "412012 PIN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.0, "discounted_cash": 43.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION 12MM BLUE CASPAR ANT CERVICAL FUSION TI", "code_information": [{"code": "DP-12-TB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION 12MM CASPER SELF DRILLING STERILE", "code_information": [{"code": "FF912SB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.79, "discounted_cash": 37.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION 14MM CASPER SLF DRILLING STRL", "code_information": [{"code": "FF904SB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.79, "discounted_cash": 37.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL .045IN X 4IN", "code_information": [{"code": "SFT-1003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL 1/8IN X 5IN QUICK CONNECT JOURNEY BCS", "code_information": [{"code": "74012905", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 183.0, "discounted_cash": 64.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL 3.7MM", "code_information": [{"code": "AR-2272", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 449.53, "discounted_cash": 157.34, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL 4MM CLOSED EYELET ACL TIGHTROPE STRL", "code_information": [{"code": "AR-1595TC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 445.0, "discounted_cash": 155.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL 4MM OPEN EYELET ACL TIGHTROPE STRL", "code_information": [{"code": "AR-1595T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL HEADLESS TROCAR KNEE", "code_information": [{"code": "-5901-020-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 848.0, "discounted_cash": 296.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL QUICK RELEASE PATELLOFEMORAL REPLACE SYS VANGUARD STRL", "code_information": [{"code": "32-486265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL TRIM-IT 1.5MMX100MM AR-4151DS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4151DS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 782.0, "discounted_cash": 273.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN EX FIX HALF TIN SHORT 5 X 45MM 71065458", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71065458", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN EX FIX HALF TIN SHORT 5.0 X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71065408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN EX FIX TIN SHORT HALF 5 X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71065308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION 1.1MMX10MM MMMPF1110", "code_information": [{"code": "MMPF1110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION 1.86IN SPECIALTY THREADED POSITIONING INSTRUMENT I-K2218FP00", "code_information": [{"code": "I-K2218FP00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 906.02, "discounted_cash": 317.11, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION 12MM TEMPORARY LS-499", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LS-499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION 1IN SPECIALTY THREADED I-K2218FP01", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "I-K2218FP01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3366.04, "discounted_cash": 1178.11, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION 2.0MM 14MM PROVISIONAL 71175090", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71175090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 934.0, "discounted_cash": 326.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION 2.7 X 25MM PERI-LOC PROVISIONAL", "code_information": [{"code": "71171229", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 795.0, "discounted_cash": 278.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION EXTERNAL 26MM PROVISIONAL LONG", "code_information": [{"code": "8242-99-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION LARGE 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-03P212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION PROVISIONAL 2.5MM 25MM 71175094", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71175094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 446.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION STRUXXURE THREADED ANT CERV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "I31-08-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION TEMP8801-90078", "code_information": [{"code": "8801-90078", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION TEMPUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-090-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 1/8IN X 3IN TROCAR QUICK CONNECT", "code_information": [{"code": "74012904", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 2.0MM X 30MM SMOOTH RESORABLE SLF REINFORCED SMARTPIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "122030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 2.7MM X 18MM PROVISIONAL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71173322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 632.0, "discounted_cash": 221.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 22.9 CM 2.8MM STEINMANN DIAMOND 1 END", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18700369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 22.9 CM 2MM STEINMANN DIAMOND 1 END SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18700169", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 22.9 CM 3.2MM STEIMANN DIAMOND 1 END", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18700469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 22.9 CM 3.6 CM STEINMANN DIAMOND 1 END", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18700569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 22.9 CM X 22.2 CM X 4.8MM STEINMANN DIAMOND 1 END", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "26200104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 22.9 CM X 22.2 CM X 4MM STEINMANN DIAMOND 1 END", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "26200204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 22.9 CM X 4 CM STEINMANN DIAMOND 1 END SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18700669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 2MM 40MM 1 PIN RED ORTHO REABSORBABLE ORTHOSORB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "84-2052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 133.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN 3.2MM X 2MM SNGL USE FOR CUTTING GUIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2490-95-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN ANCHORAGE IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XBR001002-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN OLIVE IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XGP2545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 131.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN TEMPORARY SPINEFRONT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SI70005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 719.0, "discounted_cash": 251.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN THREADED HEADED SIGMA HP STRL", "code_information": [{"code": "9505-02-303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 830.0, "discounted_cash": 290.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN THREADED HEADLESS SIGMA STRL", "code_information": [{"code": "9505-02-302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 398.75, "discounted_cash": 139.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GD 9MM FOR FLIPCUTTER TECHNIQUE FOR ACL RECONSTRUCTION FLIPCUTTER II STRLINS", "code_information": [{"code": "AR-1204AF-90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GENESIS TROCHLEAR 1/8 X 3 71210002", "code_information": [{"code": "71210002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 1.0 X 70MM FRS THREADED", "code_information": [{"code": "PA010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "discounted_cash": 54.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 1.2MM X 120MM SCREW SNGL USE DELTA XTEND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "230790004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 1.4MM X 610MM BLUNT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "530-0091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 1.9MM X 300MM THREADED TIP", "code_information": [{"code": "71110400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 2.4MM OSTEOTOMYINSTR", "code_information": [{"code": "AR-13303-2.4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 2.4MM X 230MM NON STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "410236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 347.36, "discounted_cash": 121.58, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 2MMINSTR", "code_information": [{"code": "5-0017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 53.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 3MM CANNULATED RETRODRILLINSTR", "code_information": [{"code": "AR-1250RP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 435.0, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 3MM NON CANNULATED RETRODRILLINSTR", "code_information": [{"code": "AR-1250RS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 421.0, "discounted_cash": 147.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 3MM X 700MM MWM100", "code_information": [{"code": "MWM100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 6MM FOR FLIPCUTTER TECHNIQUE FLIPCUTTER II STRLINSTR", "code_information": [{"code": "AR-1204AF-60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 996.0, "discounted_cash": 348.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 7.5MM FOR FLIPCUTTER TECHNIQUE FLIPCUTTER II STRLINSTR", "code_information": [{"code": "AR-1204AF-75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 8.5MM FOR FLIPCUTTER TECHNIQUE FLIPCUTTER IIINSTR", "code_information": [{"code": "AR-1204AF-85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1288.0, "discounted_cash": 450.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 8MM FOR FLIPCUTTER TECHNIQUE FLIPCUTTER II STRLINSTR", "code_information": [{"code": "AR-1204AF-80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE 9.5MM FOR FLIPCUTTER TECHNIQUE FLIPCUTTER II STRLINSTR", "code_information": [{"code": "AR-1204AF-95", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE BONE 3.2 X 343MM TRIGEN SURESHOT TAN", "code_information": [{"code": "7163-1436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 832.29, "discounted_cash": 291.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE DISCO", "code_information": [{"code": "112-00-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE ENCOMPASS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "386-1100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDE GUIDE PIN FOR SUBTALER SPACER SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GUIDEINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XGP4062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN HALF 3.0MM X 70MM 500-070-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "500-070-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN HALF 5MM X 180MM WITH 50MM THREAD DNE-6000-5050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-6000-5050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN HALF APEX 12MM 1.65 X 45MM SD ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5080-1-612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN IJS E AXIS 2.5MM X 35MM IJS-EAP-25350", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IJS-EAP-25350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 698.0, "discounted_cash": 244.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN IJS E AXIS 2.5MM X 40MM IJS-EAP-25400", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IJS-EAP-25400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 678.0, "discounted_cash": 237.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN IJS E AXIS 2.5MM X 45MM IJS-EAP-25450", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IJS-EAP-25450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 746.0, "discounted_cash": 261.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN IJS E AXIS 2.5MM X 50MM IJS-EAP-25500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IJS-EAP-25500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 698.0, "discounted_cash": 244.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN INTRODUCER 8G X 20.3CM BEVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "310-0011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN K-WIRE 0.8MM X 70MM LENGTH TROCAR POINT 71161008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71161008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 153.86, "discounted_cash": 53.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN KIT 01.5MM INION FREEDOM OPK-15K3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OPK-15K3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2668.0, "discounted_cash": 933.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN LOCKING 1.6MM", "code_information": [{"code": "510-16-005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN NAIL FLEXIBLE 2.5MM X 300MM 00-1001-0025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-1001-0025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1518.1, "discounted_cash": 531.34, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN NAVIGATION 3MM X 100MM 6007-003-100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6007-003-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 87.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN NAVIGATION 3MM X 150MMINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6007003150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.35, "discounted_cash": 140.12, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN O-ARM PIN 3.1MM THREADED SHARP", "code_information": [{"code": "500842", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 511.1, "discounted_cash": 178.89, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN PASSING 13.5MM X 2.4MM FLEXIBLE STRL", "code_information": [{"code": "72201594", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 77.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN PASSING 2.4MM X 15IN DRILL TIP W/ EYELET FOR GRAFT PASSAGE STRL DISP", "code_information": [{"code": "7208678", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 372.0, "discounted_cash": 130.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN PERI-LOC 3.5MM X 18MM TGR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71173416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 558.0, "discounted_cash": 195.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN PREFIXATION CP02-0705", "code_information": [{"code": "CP02-0705", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN PRELOADED 3.2 X 90MM SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6003-003-090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 679.0, "discounted_cash": 237.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN PROSTEP 0.9MM ANTI SKIVE 57790005", "code_information": [{"code": "57790005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 272.71, "discounted_cash": 95.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN PROSTEP 1.4MM ANTI SKIVE 57790004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57790004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 170.98, "discounted_cash": 59.84, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN PROVISIONAL FIXATION 2.5MM 40MM 71175095", "code_information": [{"code": "71175095", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1524.24, "discounted_cash": 533.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN REDUCTION, CANCELLOUS THREAD 5.0MM", "code_information": [{"code": "705527", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1206.69, "discounted_cash": 422.34, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN REUNITE 1.5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "948202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN REUNITE 2MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "948205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 523.0, "discounted_cash": 183.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN REUNITE 2MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "948207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 523.0, "discounted_cash": 183.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SAFETY #2 STERILE", "code_information": [{"code": "DYND73021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SERVICE 60M PER MONTH", "code_information": [{"code": "G0023", "type": "HCPCS"}], "standard_charges": [{"minimum": 374.54, "maximum": 588.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 374.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SHANZ 5.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8954-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SHANZ 5.0MM P99-300-5013", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-300-5013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SRV ADD 30 MIN PR M", "code_information": [{"code": "G0024", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.41, "maximum": 244.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 155.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN STEINMAN #6 48 X 229MM 3/16 DAVIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "187-07-69", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 1.6MM", "code_information": [{"code": "P06NO3O1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.11, "discounted_cash": 58.14, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 2.0MM X 9MM THREADED", "code_information": [{"code": "5500-319-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 2.2MM", "code_information": [{"code": "P06N0291", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.11, "discounted_cash": 58.14, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 2.4MM X 9MM THREADED", "code_information": [{"code": "5500-319-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 2.8MM X 9MM THREADED", "code_information": [{"code": "5500-319-28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 2MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CAT-040-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 3.2MM", "code_information": [{"code": "5500-19-32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 3.2MM X 9MM THREADED", "code_information": [{"code": "5500-319-32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 3.6MM X 9MM THREADED", "code_information": [{"code": "5500-319-36", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 4.0MM X 9MM THREADED", "code_information": [{"code": "5500-319-40", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 4.8MM X 9MM THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5500-319-48", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN PFC DRILL PACK", "code_information": [{"code": "864192", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 403.0, "discounted_cash": 141.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN PLAIN 5/64 X 9IN SMOOTH DOUBLE DIAMOND TROCAR 3 SIDE POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM168-39-56", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN SMOOTH 7/64IN X 9IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM168-39-76", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN THREADED SINGLE POINT 0.9 035IN X 9\"", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM173-49-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN THREADED SINGLE POINT 1.1MM X 9\"", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM173-49-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN THREADED SINGLE POINT 2.0MM 9\"", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM169-39-56", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN THREADED SINGLE POINT 2.4MM 9\"", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM169-39-33", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN THREADED SINGLE POINT 3.2MM X 9\"", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM169-39-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN THREADED SINGLE POINT 3.6MM X 9\"", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM169-39-96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN THREADED SINGLE POINT 4.0MM X 9\"", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM169-39-53", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN THREADED SINGLE POINT 4.8MM X 9\"", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM169-39-31", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN THREADED SINGLE POINT 7/64IN X 9IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM169-39-76", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 1/8IN X 2.5IN THREADED TIP", "code_information": [{"code": "406669", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 497.65, "discounted_cash": 174.18, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 2.0 X 9 INCH TROCAR W/ POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5500-19-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 2.0MM DIAMOND PARTIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "26200704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 2.4 X 229MM DIAMOND POINT SMOOTH STYLE 6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18700269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 2.4MM X 9IN TROCAR W/ POINT", "code_information": [{"code": "5500-19-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 2.5MM X 100MM SMOOTH", "code_information": [{"code": "45-80300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.0, "discounted_cash": 56.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 2.8MM DIAMOND PARTIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "26200504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 2MM STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "950093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 3.6MM DIAMOND PARTIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "26200304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 4.8MM DIAMOND PT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18700769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 9IN COMPREHENSIVEINSTR", "code_information": [{"code": "405800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 344.52, "discounted_cash": 120.58, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN 9IN X .189IN MICRO SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5500019048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN SINGLE TROCAR ROUND END 3.2MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KI-71-519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN SINGLE TROCAR ROUND END 3.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KI-71-522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN SINGLE TROCAR ROUND END 4.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KI-71-525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMANN SINGLE TROCAR ROUND END 4.5MM", "code_information": [{"code": "KI-71-528", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SURG 1.3MM X 40MM BLUE THREE TRAY ONE PIN RESORBABLE ORTHOSORB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "841052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SURG 5MM X 35MM SHRT HALF JET X TIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71065358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TEMP FIS SMOOTH 11 X 10MM MPPF1110", "code_information": [{"code": "MPPF1110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TEMP FIX AEQUALIS 2.5MM X 200MM", "code_information": [{"code": "DWD063", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TEMP FIX SMOOTH 1.14 X 15MM MPPF1115", "code_information": [{"code": "MPPF1115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TEMP FIXATION LS499", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LS499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN THREADED HP HEADED STRL", "code_information": [{"code": "950502303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 514.0, "discounted_cash": 179.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN THREADED TEMPORARY CZ0300001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CZ0300001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TROCAR 1/8IN X 5IN GNSII", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71210003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PINCH GRAFT UP TO 2 CM DIAM", "code_information": [{"code": "15050", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS CALCANEUS FRACTURE W/MANIPULATION 28406", "code_information": [{"code": "28406", "type": "CPT"}, {"code": "1481602", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS CARPOMETACARPAL DISLOCATION 26676", "code_information": [{"code": "26676", "type": "CPT"}, {"code": "1481603", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS CARPOMETACARPAL FX 26650", "code_information": [{"code": "26650", "type": "CPT"}, {"code": "1481604", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS DISTAL FEMUR 27509", "code_information": [{"code": "27509", "type": "CPT"}, {"code": "1481605", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS DISTAL RADIOULNAR DISLOCATION 25671", "code_information": [{"code": "25671", "type": "CPT"}, {"code": "1481606", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS DISTAL RADIUS OR EPIPHYSEAL SEPARATION 25606", "code_information": [{"code": "25606", "type": "CPT"}, {"code": "1481607", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS FOOT", "code_information": [{"code": "28666", "type": "CPT"}, {"code": "1481608", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5228.0, "discounted_cash": 1829.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS GREAT TOE 28496", "code_information": [{"code": "28496", "type": "CPT"}, {"code": "1481609", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS METACARPOPHALANGEAL DISLOCATION 26706", "code_information": [{"code": "26706", "type": "CPT"}, {"code": "1481610", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS METATARSAL FRACTURE 28476", "code_information": [{"code": "28476", "type": "CPT"}, {"code": "1481611", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS METATARSOPHALANGEAL JOINT DISLOCATION 28636", "code_information": [{"code": "28636", "type": "CPT"}, {"code": "1481612", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS OF TARSAL BONE FIXATION 28546", "code_information": [{"code": "28546", "type": "CPT"}, {"code": "1481613", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS SHOULDER", "code_information": [{"code": "24538", "type": "CPT"}, {"code": "1481614", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS TALOTARSAL JOINT DISLOCATION 28576", "code_information": [{"code": "28576", "type": "CPT"}, {"code": "1481615", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS TALUS FRACTURE W/ MANIPULATION 28436", "code_information": [{"code": "28436", "type": "CPT"}, {"code": "1481616", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS TARSAL FRACTURE-EXCEPT TALUS/CALCANEUS 28456", "code_information": [{"code": "28456", "type": "CPT"}, {"code": "1481617", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS TARSOMETATARSAL JOINT DISLOCATION 28606", "code_information": [{"code": "28606", "type": "CPT"}, {"code": "1481618", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINNING PERCUTANEOUS ULNAR STYLOID FRACTURE 25651", "code_information": [{"code": "25651", "type": "CPT"}, {"code": "1481619", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINS ADULT DORO LUCENT SKULL 1106.003", "code_information": [{"code": "1106.003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 545.0, "discounted_cash": 190.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS ADULT SKULL A1072", "code_information": [{"code": "A1072", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1363.0, "discounted_cash": 477.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS DISPOSABLE FLUTED HEADLESS SIZE 6 LEFT CR 7650-2038A", "code_information": [{"code": "7650-2038A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS DORO STAINLESS STEEL BLU SKULL 6910-3006-00", "code_information": [{"code": "6910-3006-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.63, "discounted_cash": 46.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS DORO TITANIUM SKULL (ADULT) 6910-3006-2", "code_information": [{"code": "6910-3006-2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 139.94, "discounted_cash": 48.98, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS HALF 3MM X 80MM WITH 20MM THREAD DNE-4000-380-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-4000-380-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS HIP 3 X 100 100-980-120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-980-120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 502.0, "discounted_cash": 175.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS HIP 3MM X 100MM 1000-980-120", "code_information": [{"code": "1000-980-120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.19, "discounted_cash": 236.32, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS STEINMAN (NS) 5/32 KM-168-19-53", "code_information": [{"code": "KM-168-19-53", "type": "CDM"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PINWORM EXAM", "code_information": [{"code": "87172", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAMINATIONS", "code_information": [{"code": "Q0113", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 17.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIP DISPOSABLE PACK", "code_information": [{"code": "PIP-DIS-STR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1181.96, "discounted_cash": 413.69, "setting": "both", "billing_class": "facility"}]}, {"description": "PIP IMPLANT 2.9MM X 19MM STRAIGHT APA-003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "APA-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1796.0, "discounted_cash": 628.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PITUITARY EVALUATION PANEL", "code_information": [{"code": "80418", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 894.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1477.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2323.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2323.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2323.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 834.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 834.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PJP PROPH ORDERED CD4 LOW", "code_information": [{"code": "G9223", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE BREAST CATH FOR RAD", "code_information": [{"code": "19297", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE BREAST RAD TUBE/CATHS", "code_information": [{"code": "19298", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTD ART", "code_information": [{"code": "36224", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36222", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36223", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH INTRACRANIAL ART", "code_information": [{"code": "36228", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH SUBCLAVIAN ART", "code_information": [{"code": "36225", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH THORACIC AORTA", "code_information": [{"code": "36221", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH VERTEBRAL ART", "code_information": [{"code": "36226", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH XTRNL CAROTID", "code_information": [{"code": "36227", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN AORTA", "code_information": [{"code": "36200", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36013", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36014", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36015", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36215", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36216", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36217", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36218", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36010", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36011", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36012", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CECOSTOMY TUBE PERC", "code_information": [{"code": "49442", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE DEVICE/MARKER, NON PRO", "code_information": [{"code": "C9728", "type": "HCPCS"}], "standard_charges": [{"minimum": 642.0, "maximum": 642.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49441", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE ENDORECTAL APP", "code_information": [{"code": "C9725", "type": "HCPCS"}], "standard_charges": [{"minimum": 2110.0, "maximum": 2827.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43830", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43831", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43832", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE PERC", "code_information": [{"code": "49440", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NDL MUSC/TIS FOR RT", "code_information": [{"code": "20555", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLE IN VEIN", "code_information": [{"code": "36000", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES H&N FOR RT", "code_information": [{"code": "41019", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES PELVIC FOR RT", "code_information": [{"code": "55920", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE PERM PACING CARDIOVERT", "code_information": [{"code": "G0448", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE PO BREAST CATH FOR RAD", "code_information": [{"code": "19296", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE RT DEVICE/MARKER PROS", "code_information": [{"code": "55876", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACEMENT BILE DUCT SUPPORT", "code_information": [{"code": "47801", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF AMNIOTIC MEMBRANE ON THE OCULAR SURFACE W/O SUTURES 65778", "code_information": [{"code": "65778", "type": "CPT"}, {"code": "36927823", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1874.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF DRAIN PANCREAS", "code_information": [{"code": "48001", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INFUSION 36680", "code_information": [{"code": "36680", "type": "CPT"}, {"code": "42748051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 199.89, "maximum": 8450.0, "gross_charge": 413.0, "discounted_cash": 144.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 199.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF SETON 46020", "code_information": [{"code": "46020", "type": "CPT"}, {"code": "9467887", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACEMNT REMOVABLE APPLIANCE", "code_information": [{"code": "D9939", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACENTAL LACTOGEN", "code_information": [{"code": "83632", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 81.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 81.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 81.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLANAR 6.5MM CANNULATED 1.6MM 45765004", "code_information": [{"code": "45765004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 181.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASMA BUTTON ESG 12 DEGREE- 30 DEGREE WA22760S", "code_information": [{"code": "WA22760S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1150.0, "discounted_cash": 402.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASMA CRYO REDU PATH EACH", "code_information": [{"code": "P9025", "type": "HCPCS"}], "standard_charges": [{"minimum": 167.54, "maximum": 263.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 167.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 263.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 263.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 263.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA FRESH FROZEN", "code_information": [{"code": "86927", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA PLATELET RICH ARTERIOCYTE", "code_information": [{"code": "AMS310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3138.0, "discounted_cash": 1098.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASMA RICH PLATLETS KIT PRP", "code_information": [{"code": "51406", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2244.0, "discounted_cash": 785.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASMA SYSTEM PEAK PLATELET RICH 30ML", "code_information": [{"code": "278001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASMA VOLUME MULTIPLE", "code_information": [{"code": "78111", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 289.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 455.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 455.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 455.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 196.12, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 209.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA VOLUME SINGLE", "code_information": [{"code": "78110", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 277.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 435.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 435.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 435.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 149.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 160.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMABLADE ADENOID TIP PS300-003", "code_information": [{"code": "PS300-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 165.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASMABLADE SUCTION COAGULATOR PS300-004", "code_information": [{"code": "PS300-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASMALOOP LONG MEDIUM OLYMPUS WA22737S", "code_information": [{"code": "WA22737S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1213.41, "discounted_cash": 424.69, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASTIC OPERATION OF PENIS FOR INJURY 54440", "code_information": [{"code": "54440", "type": "CPT"}, {"code": "1481620", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASTIC OPERATION OF PENIS FOR STRAIGHTENING OF CHORDEE 54300", "code_information": [{"code": "54300", "type": "CPT"}, {"code": "1482154", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASTIC REPAIR OF CANALICULI 68700", "code_information": [{"code": "68700", "type": "CPT"}, {"code": "2042287", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASTIC REPAIR OF INTROITUS 56800", "code_information": [{"code": "56800", "type": "CPT"}, {"code": "3170907", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASTIC REPAIR OF SALIVARY DUCT; SIALODOCHOPLASTY 42500", "code_information": [{"code": "42500", "type": "CPT"}, {"code": "4239294", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASTIC SURGERY NECK", "code_information": [{"code": "15819", "type": "CPT"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASTIC SURGERY SS", "code_information": [{"code": "G4027", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1 HOLE MEDIAL DISTAL HUMERUS 2.7/3.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.117.701S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2985.0, "discounted_cash": 1044.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1 LEVEL 14MM 10-01-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-01-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1 LEVEL HELIX REVOLUTION 32MM 7800132", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7800132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1680.0, "discounted_cash": 588.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1 LEVEL SIZE 18 MM AA01-41F18V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-41F18V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1 LEVEL SIZE 20 MM OZARK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-41F20V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1 LEVEL SIZE 22 MM AA01-41F22V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-41F22V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1-LEVEL SIZE 11 CYCLOPS ANTERIOR CERVICAL 0220-1011T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "220-1011T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1-LEVEL SIZE 21 0220-1021T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "220-1021T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2200.0, "discounted_cash": 770.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1.7MM DELTA TRIANGULAR 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-92014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1793.0, "discounted_cash": 627.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1.7MM STRAIGHT WITH SLOTS 4H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFP 094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1313.0, "discounted_cash": 459.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1.7MM STRAIGHT WITH SLOTS 5H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFP 095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1313.0, "discounted_cash": 459.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1.7MM STRAIGHT WITH SLOTS 6H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFP 096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3131.0, "discounted_cash": 1095.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1.7MM UTILITY 4H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFP 014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1581.0, "discounted_cash": 553.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 1/3 TUBULAR 8 HOLE 58880108", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58880108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1128.0, "discounted_cash": 394.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 10 HOLE 118MM EVOS 3.5MM 1/3 TUBULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72440810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 10 HOLE 2.8 TRILOCK DIST. HUM. PI LATERAL L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4856.43", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3117.0, "discounted_cash": 1090.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 10 HOLE 3.5MM 108MM EVOS SUP MS CLAVICULAR RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72469610N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3059.0, "discounted_cash": 1070.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 10 HOLE 84MM EVOS 2.7MM COMPRESSION 72440410", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72440410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2370.0, "discounted_cash": 829.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 10 HOLE EVOS 2.7MM SUPERIOR MEDIAL CLAVICLE 67MM 72468910", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72468910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4920.0, "discounted_cash": 1722.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 10 HOLE EVOS 3.5MM COMPRESSION 127MM 72441010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72441010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1248.0, "discounted_cash": 436.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 109MM TI 4 HOLE VARIAX BONE HUMERUS RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2592.0, "discounted_cash": 907.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 11 HOLE 120MM EVOS 2.7MM INFERIOR MEDSHAFT CLAVICLE 72469911", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72469911", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4254.0, "discounted_cash": 1488.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 11 HOLE LEFT 147MM 2.7MM/3.5MM LDF 72465111", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6740.0, "discounted_cash": 2359.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 12 HOLE 2.5 ADAPTIVE II TRILOCK DISTRAD NARROW LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3026.0, "discounted_cash": 1059.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 12 HOLE EVOS 3.5MM CVD PROX HUM R 180MM 72467212", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72467212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6777.0, "discounted_cash": 2371.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 12HL 2.4MM STOUT MINI-MOD 74442434", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74442434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5170.0, "discounted_cash": 1809.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 13 HOLE 2.5 ADAPTIVE II TRILOCK DISTRAD VOL L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3178.0, "discounted_cash": 1112.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 13 HOLES 2.7MM/3.5MM VARIABLE ANGLE LCP ELBOW 02.107.1025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.107.1025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2367.0, "discounted_cash": 828.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 13H 87MM EVOS 2.7MM SUPERIOR MEDIAL CLAVICLE 72468913", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72468913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3718.0, "discounted_cash": 1301.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 13MM 15 DEGREE KDA13000B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KDA13000B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 13MM X 15 DEG 860-15-13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "860-15-13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10000.0, "discounted_cash": 3500.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 14 HOLE 4.5MM TI VA-LCP CURVED DONDYLAR 301MM RIGHT 04.124.414", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.124.414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5190.0, "discounted_cash": 1816.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 14 HOLE LEFT EVOS 2.7MM SUPERIOR MIDSHAFT CLAVICLE 93MM 72469714", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72469714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3224.0, "discounted_cash": 1128.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 14H EVOS 2.7MM SUP CLAV 72469814", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72469814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3646.0, "discounted_cash": 1276.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 14MM 1 LEVEL CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 15 HOLE 2.5 ADAPTIVE II TRILOCK DISTRAD WIDE LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3026.0, "discounted_cash": 1059.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 16 HOLE OFFSET 1.2/1.5 FIXATION T0.6 A-4300.06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4300.06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1110.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 16 HOLE S PLUS STRAIGHT 57-08216", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-08216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 882.0, "discounted_cash": 308.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 16MM 4 HOLE CORNER FUSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "QUA-4F-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5206.0, "discounted_cash": 1822.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 18MM 1HOLE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7908-41F18R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5356.0, "discounted_cash": 1874.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 HOLE 2 HOOKS 1.5 HOOK A-4200.40", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4200.40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 919.0, "discounted_cash": 321.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 HOLE 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7908-42F203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5356.0, "discounted_cash": 1874.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 HOLE EVOS 2.7/3.5MM OLCRNN W/TNS 61MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72466302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4656.0, "discounted_cash": 1629.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 HOLE LATERAL SIZE 8 63-02-08", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "63-02-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 HOLE MINI LONG 300-81-008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-81-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3718.0, "discounted_cash": 1301.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 HOLE SMALL BONES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52020302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 952.0, "discounted_cash": 333.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 LEVEL HELIX REVOLUTION 40MM 7800240", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7800240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1890.0, "discounted_cash": 661.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 LEVEL SIZE 32 0220-2032T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "220-2032T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2200.0, "discounted_cash": 770.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 LEVEL SIZE 36 MM AA01-42F36V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-42F36V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 LEVEL SIZE 40 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-42F40V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 LVL 41MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-71004-41", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3245.0, "discounted_cash": 1135.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.0 H 8 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MCH-8", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.0MM NARROW LOCK 6-HOLES L 34MM 629626", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1542.0, "discounted_cash": 539.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.5 ADAPTIVE II TRILOCK DISTRAD PIT VOL L 11 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3304.0, "discounted_cash": 1156.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.5 ADAPTIVE II TRILOCK DISTRAD VOL L 10 HOLE NARROW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2340.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.5 ADAPTIVE II TRILOCK DISTRAD VOL R 10 HOLE, NARROW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3304.0, "discounted_cash": 1156.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.5 ADAPTIVE II TRILOCK DISTRAD VOL R 13 HOLE WIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2821.0, "discounted_cash": 987.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.5 TRILOCK DIST RAD FPL PI VOLAR LEFT A-4750.123", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3345.0, "discounted_cash": 1170.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.5MM DISTAL RADIUS LOCKING 13H WIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2686.0, "discounted_cash": 940.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.7/3.5MM VA DISTAL FIBULA 5 HOLE LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2258.0, "discounted_cash": 790.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.7MM 10 HOLE FLEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72442760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3327.0, "discounted_cash": 1164.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.7MM ULS DUAL COMP 7 HOLE 84MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4928-007-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 510.0, "discounted_cash": 178.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.7MM/3.5MM EXTRAARTICULAR DISTAL HUMERUS 72469220", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72469220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7128.0, "discounted_cash": 2494.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.8 LOCKING WING PI 11H T1.6 SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4850.71", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 937.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2/4 HOLE LEFT TRILOCK DIST RAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.53", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1887.0, "discounted_cash": 660.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 20 HOLE EVOS 2.4MM STRENGTH 72442476N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72442476N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3028.0, "discounted_cash": 1059.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 21MM ONE LEVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6513-1721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 22MM 1 LEVEL 436-0122", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "436-0122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 23MM 2 LEVEL CERVICAL AP232", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 24MM BUTTRESS FP1224", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP1224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7210.0, "discounted_cash": 2523.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 24MM CERVICAL OZARK AA01-41F24V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-41F24V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 25X25MM THREADED POST BASESPECIAL ORDER DWE725", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWE725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 25X40MM THREADED POST BASESPECIAL ORDER DWE740", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWE740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2LVL 12MM X-LORDOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11.1062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2MM LEFT ORTHOLOC 2 LAPIFUSE 3814002L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3814002L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4970.0, "discounted_cash": 1739.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE 35MM RECON TAB TTP35-3U", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TTP35-3U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 1256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE 92MM EVOS 3.5MM STRAIGHT PROXIMAL HUMERUS 72466903", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72466903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5840.0, "discounted_cash": 2044.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE ARSENAL MINI VLC 300-81-003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-81-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE EVOS 2.7/3.5 L-D FIBULA R 59MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3080.0, "discounted_cash": 1078.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE EVOS 2.7/3.5 P/A M-D TIBIA R 64MM 72454003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72454003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5387.0, "discounted_cash": 1885.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE EVOS 2.7/3.5MM M-D HUMERUS R 80MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "72465603N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4450.0, "discounted_cash": 1557.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE EVOS 3.5MM LATERAL DISTAL FIBULA RIGHT 59MM 72465003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3059.0, "discounted_cash": 1070.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE LATERAL DISTAL HUMERUS 2.7/3.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.117.103S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2985.0, "discounted_cash": 1044.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE LEFT 80MM EVOS 2.7MM/3.5MM MEDIAL DISTAL HUMERUS 72465503", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE LEFT 81MM EVOS 2.7MM INFERIOR DISTAL CLAVICLE 72468703", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72468703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4920.0, "discounted_cash": 1722.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE LEFT POSTEROLATERAL DISTAL TIBIA 7007-0303L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7007-0303L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1498.0, "discounted_cash": 524.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE PROX ULNAR LK RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2358-009-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1291.0, "discounted_cash": 451.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE RIGHT EVOS 2.7MM INF DIST CLAV 81MM 72468803", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72468803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4920.0, "discounted_cash": 1722.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE VDR NARROW LEFT 355-0100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "355-0100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1865.5, "discounted_cash": 652.93, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE Y BROAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2554.0, "discounted_cash": 893.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL 45MM ACP CA3000045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CA3000045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL 48MM 10-03-048", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-03-048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL 51MM CERVICAL AP351", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL 54MM AP354", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL 57MM AP357", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL ASSEMBLY 54MM 19-0354", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "19-0354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL ASSEMBLY 56MM 19-0356", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "19-0356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL SIZE 54 MM AA01-43F54V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-43F54V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1957.0, "discounted_cash": 684.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL SIZE 57 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-43F57V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL SIZE 60 MM AA01-43F60V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-43F60V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL SIZE 66 MM AA01-43F66V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-43F66V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1957.0, "discounted_cash": 684.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL SIZE 69 MM AA01-43F69V", "code_information": [{"code": "AA01-43F69V", "type": "CDM"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3-LEVEL SIZE 50 ANTERIOR CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "220-3050T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3.5MM LATERAL DISTAL FIBULA LEFT 72464905", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72464905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3883.0, "discounted_cash": 1359.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3.5MM LATERAL DISTAL FIBULA RIGHT 72465005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5260.0, "discounted_cash": 1841.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3/8 HOLE T OFFSET T0.6 1.2/1.5 COMPRESSION A-4340.11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4340.11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1249.0, "discounted_cash": 437.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 34MM 2 LEVEL CA2000034", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CA2000034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 36MM 2 LEVEL 19-0236", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "19-0236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 36MM 2 LEVEL CERVICAL AP236", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 38MM 2 LEVEL AA01-42F38V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-42F38V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3D ORBITAL FLOOR IMPLANT MTB RIGH-LARGE 81044 81044", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "81044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4893.0, "discounted_cash": 1712.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 3D ORBITAL FLOOR MTB LEFT-LARGE 81043", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "81043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4893.0, "discounted_cash": 1712.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 H L 92MM EVOS 3.5MM CVD PROX HUM 72467104", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72467104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6932.0, "discounted_cash": 2426.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE COLINK2 UNIVERSAL P42 ST014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P42 ST014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3698.0, "discounted_cash": 1294.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE EVOS 2.4MM FLEX 72442458", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72442458", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3036.0, "discounted_cash": 1062.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE EVOS 2.7/3.5 OLCRNN W/TNS R 82MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72466404N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10100.0, "discounted_cash": 3535.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE EVOS 3.5MM P/A L-P TIBIA L 70MM 72453104N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72453104N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4378.0, "discounted_cash": 1532.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE LEFT 82MM EVOS 2.7MM/3.5MM OLECRANON 72466304N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72466304N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10100.0, "discounted_cash": 3535.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE LEFT POSTEROLATERAL FIBULA 7007-0204L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7007-0204L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1585.5, "discounted_cash": 554.93, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE PRECIMAL TIBIA 72453204", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72453204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7100.0, "discounted_cash": 2485.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE SMALL RIGHT SIZE 1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "17-0635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 2163.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE STRAIGHT MPPM104U", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPM104U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2142.0, "discounted_cash": 749.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE Y 300-89-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-89-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3850.0, "discounted_cash": 1347.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLES 89MM TI VARIAX BONE ELBOW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2592.0, "discounted_cash": 907.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 LEVEL 61MM TI AP461", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 LEVEL 67MM AP467", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP467", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 LEVEL 68MM AP468", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP468", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 LEVEL 78MM 19-0478", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "19-0478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 LEVEL SIZE 69 MM AA01-44F69V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-44F69V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 LEVEL SIZE 73MM AA01-44F73V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-44F73V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 LEVEL SIZE 77MM AA01-44F77V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-44F77V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 LEVEL SIZE 81MM AA01-44F81V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-44F81V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4-HOLE SB-UP-0004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB-UP-0004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5974.0, "discounted_cash": 2090.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4.0 COMP 110M 8 HOLE 627508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "627508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3411.0, "discounted_cash": 1193.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4.5MM NARROW 6 HOLE 124MM 71829456 71829456", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71829456", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 985.0, "discounted_cash": 344.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 40MM RIGHT TMP40-0R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TMP40-0R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 1256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 42MM 2 LEVEL OZARK BONE SPINE CERVICAL AA01-42F42V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-42F42V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 43MM TWO LEVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5612-1743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 44MM 2 LEVEL OZARK BONE SPINE CERVICAL NONSTERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-42F44V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 48MM THREE LEVEL CA3000048", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CA3000048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4H MEDIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2541.0, "discounted_cash": 889.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4MM WEDGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "336-2734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3838.0, "discounted_cash": 1343.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE 2.5 TRILOCK DR SMALLFRAGPL CURVED R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.58", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1887.0, "discounted_cash": 660.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE 300-80-005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-80-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE DISTAL CLAVICLE PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2622DL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1751.0, "discounted_cash": 612.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE EVOS 2.7/3.5 L-D FIBULA L 81MM 72465105N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465105N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3028.0, "discounted_cash": 1059.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE EVOS 2.7MM/3.5MM INFERIOR DISTAL CLAVICLE RIGHT 107MM 72467805", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72467805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4439.0, "discounted_cash": 1553.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE EVOS 3.5MM STRAIGHT PROXIMAL HUMERUS 114MM 72466905", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72466905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7849.0, "discounted_cash": 2747.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE L 81MM EVOS 2.7/3.5 L-D FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5690.0, "discounted_cash": 1991.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE METATARSAL L MPPM202U", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPM202U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2142.0, "discounted_cash": 749.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE MINI 300-81-005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-81-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE R 81MM EVOS 2.7/3.5 L-D FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72464205N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2853.0, "discounted_cash": 998.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE R 82MM EVOS 2.7/3.5 L-D FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465205N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5690.0, "discounted_cash": 1991.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 HOLE UTILITY STRAIGHT AK-UP-0005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AK-UP-0005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8652.0, "discounted_cash": 3028.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5 SLOT RIGHT PROXIMAL ULNA PUPF-5SR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PUPF-5SR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 980.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5D REVISION PLATE SHORT LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-103-L151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5964.0, "discounted_cash": 2087.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5H CALCANEAL 622098", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "622098", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3488.0, "discounted_cash": 1220.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5H R 81MM EVOS 2.7/3.5 L-D FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3409.0, "discounted_cash": 1193.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 5TH METATARSAL SPIRAL RIGHT MPPM510R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPM510R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE 1/3 TUB HL 74MM 71809436", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71809436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 129.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE 2.0 L33MM 629606", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629606", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1117.0, "discounted_cash": 390.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE 2.4MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72442460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3036.0, "discounted_cash": 1062.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE 2.7MM 50MM 72440406", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72440406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1672.0, "discounted_cash": 585.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE EVOS 3.5MM COMPRESSION 77MM 72441006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72441006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 764.0, "discounted_cash": 267.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE FIBULA 540646", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "540646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3474.0, "discounted_cash": 1215.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE FIBULA LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "336-5106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4656.0, "discounted_cash": 1629.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE LEFT 85MM EVOS 2.7MM/3.5MM POSTEROLATERAL DISTAL HUMERUS 72466106", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72466106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE OLECRANON RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4429.0, "discounted_cash": 1550.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE RIGHT EVOS 3.5MM CURVED PROXIMAL HUMERUS 114MM 72467206", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72467206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8065.0, "discounted_cash": 2822.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52010-00306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1465.0, "discounted_cash": 512.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE ULNA SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PL-UL06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4136.0, "discounted_cash": 1447.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE UTILITY STRAIGHT AK-UP-0006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AK-UP-0006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8652.0, "discounted_cash": 3028.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE VLP MINI-MOD 2.0MM STRAIGHT 74442022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74442022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2390.0, "discounted_cash": 836.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLES MIS CANCANEAL U6 622100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "622100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3488.0, "discounted_cash": 1220.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6 HOLES VARIAX COMPRESSION BROAD STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6-HOLE T-8-4 626986", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626986", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2176.0, "discounted_cash": 761.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 64MM 4 LEVEL AP464", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP464", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 65MM TI 3 HOLE VARIAX BONE RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2351.0, "discounted_cash": 822.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6H 70MM EVOS 3.5MM 1/3 TUBULAR 72440806", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72440806", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6H 70MM EVOS 3.5MM LOCK 1/3 TOBULAR 72440506", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72440506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1401.0, "discounted_cash": 490.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6H 97MM EVOS 2.7 3.5 P A MD TIBIA 72454006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72454006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5129.0, "discounted_cash": 1795.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6HL VLP MINI-MOD 1.5MM COLUMN 74441532", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74441532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4530.0, "discounted_cash": 1585.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE 300-61-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-61-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4367.0, "discounted_cash": 1528.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE EVOS 2.7/3.5 L-D FIBULA L 103MM 72465107", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5280.0, "discounted_cash": 1848.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE EVOS 2.7/3.5 L-D FIBULA R 103MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465207N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6130.0, "discounted_cash": 2145.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE EVOS 2.7MM/3.5MM LATERAL DISTAL HUMERUS 72465907", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5670.0, "discounted_cash": 1984.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE EVOS 3.5MM L-D FIBULA L 103MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72464907N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2936.0, "discounted_cash": 1027.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE EVOS 3.5MM TUBULAR 82MM 72440507", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72440507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1970.0, "discounted_cash": 689.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE EVOS 4.5MM 72561007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72561007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2560.0, "discounted_cash": 896.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE EVOS GREATER TUBEROSITY 84MM 72466707", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72466707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7090.0, "discounted_cash": 2481.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE HOOK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "336-6007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4305.0, "discounted_cash": 1506.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE L LCP CLAVICLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.112.093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2066.0, "discounted_cash": 723.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE LEFT EVOS 2.7MM INFERIOR DISTAL CLAVICLE 109MM 72468707", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72468707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3636.0, "discounted_cash": 1272.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE LEFT SUPERION MEDIAL CLAVICLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71803412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3337.0, "discounted_cash": 1167.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE MEDICAL MAC 300-95-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-95-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3490.0, "discounted_cash": 1221.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE NARROW COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "427107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 414.0, "discounted_cash": 144.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE RIGHT EVOS 2.7MM INFERIOR DISTAL CLAVICLE 109MM 72568807", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72568807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3636.0, "discounted_cash": 1272.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE TRILLIANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-61-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE VL GRIDLOCK FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-60-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7H EVOS 3.5MM 1/3 72440807", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72440807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 134.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 7HL 2.7MM EVOS DIST. CLAV 72468807", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72468807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3636.0, "discounted_cash": 1272.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE 2.8 TRILOCK CLAVICLE ANTERIOR MIDSHAFT A-4851.42", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4851.42", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4584.0, "discounted_cash": 1604.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE 2.8 TRILOCK CLAVICLE SUPERIOR MIDSHAFT LEFT MEDIUM BEND A-4851.25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4851.25", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4455.0, "discounted_cash": 1559.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE AXSOS LOCK COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "627538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4352.0, "discounted_cash": 1523.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE CLAVICLE NARROW LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2487.0, "discounted_cash": 870.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE DISTAL THIRD LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2657DL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1842.8, "discounted_cash": 644.98, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE EVOS 3.5MM LCK 1/3 TUBULAR 94MM 72440508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72440508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2210.0, "discounted_cash": 773.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE EVOS 3.5MM SUP MED CLAV 87MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72467508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2884.0, "discounted_cash": 1009.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE EVOS RADIAL SHAFT 98MM 72468608", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72468608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2699.0, "discounted_cash": 944.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE LEFT 114MM EVOS 2.7MM/3.5MM OLECRANON 72466508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72466508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7097.0, "discounted_cash": 2483.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE RIGHTFREEFIX DISTAL HUMERUS SCR-224", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCR-224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5186.0, "discounted_cash": 1815.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE VLP MINI-MOD 1.5MM STRAIGHT 74441524", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74441524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE VLP MINI-MOD 2.0MM STRAIGHT 74442024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74442024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3760.0, "discounted_cash": 1316.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLE X-SMALL RIGHT FIBULA ADF72-08R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ADF72-08R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3455.0, "discounted_cash": 1209.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8 HOLES SPIDER FUSION 070005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4665.0, "discounted_cash": 1632.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8-HOLE BROAD STRAIGHT 629748", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629748", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2322.0, "discounted_cash": 812.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8-HOLE STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Jan-91", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 966.0, "discounted_cash": 338.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8H R 86MM EVOS 3.5MM SUP MS CLAV PL 72469608", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72469608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3327.0, "discounted_cash": 1164.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 9 HOLE 1/3 TUBULAR GRIDLOCK ANKLE 300-63-002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-63-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2050.0, "discounted_cash": 717.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 9 HOLE 3.5MM PRXHUM LOCKING L 165MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7107.0, "discounted_cash": 2487.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 9 HOLE FIBLUA LEFT ARSENAL ANKLE POSTERIOR 300-94-003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-94-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3490.0, "discounted_cash": 1221.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 9 HOLE LATERAL FIBULA UNIVERSAL AK-LF-2009", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AK-LF-2009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8652.0, "discounted_cash": 3028.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 9 HOLE LEFT EVOS 2.7MM/3.5MM LATERAL DISTAL HUMERUS 72465909", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7540.0, "discounted_cash": 2639.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 9 HOLE LEFT LDF 72465109", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6380.0, "discounted_cash": 2233.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 9 HOLE RIGHT 120MM 72454409", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72454409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8550.0, "discounted_cash": 2992.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ACDF TEMPUS 34MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-02-034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ACP 1.6V 20MM 1 LEVEL 18006120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18006120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1848.0, "discounted_cash": 646.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ACU-LOC 2VDR STANDARD LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2432.5, "discounted_cash": 851.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ACULOCK WIDE 2VDR RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4349.0, "discounted_cash": 1522.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ADAPTION 2.4MM X 36MM 6 HOLE LC DCP STRAIGHT TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ADAPTION 2.7MM 97.36MM 12 HOLE LCP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "247.37", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1112.0, "discounted_cash": 389.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ADAPTIVE RADIUS 2.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.61", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2687.0, "discounted_cash": 940.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ALIF 11MM X 8 DEGREE 860-08-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "860-08-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10000.0, "discounted_cash": 3500.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANATOMIC SHRT NARROW LFT DVR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DVRANSL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANGUALTION 13MM 5\u00c2\u00b0 UU041-02-1305", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "UU041-02-1305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2916.0, "discounted_cash": 1020.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANKLE 9 HOLE GRIDLOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-60-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANKLE FIX TITANIUM STANDARD RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "28.14.102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2802.0, "discounted_cash": 980.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANKLE TWO HOLE SS STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8958-01S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1751.0, "discounted_cash": 612.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANOTOMIC 21.6MM X 48.9MM SHRT NARROW LFT DIST VOLAR RADIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DVRAN-L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.0, "discounted_cash": 412.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANT CERV LEVEL 2 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "31-2-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANTERIOR 7H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "628307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2837.0, "discounted_cash": 992.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANTERIOR CERVICAL CONSTRAINED 3LVL 63MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AA01-43F63V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1957.0, "discounted_cash": 684.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANTERIOR CERVICAL TEMPUS 37MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-02-037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANTERIOR LUMBAR 23MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10000-023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12360.0, "discounted_cash": 4326.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ANTERIOR LUMBAR 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10000-025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12360.0, "discounted_cash": 4326.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE APTUS 2.0 TRILOLK CORNOID LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4656.81", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4841.0, "discounted_cash": 1694.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE APTUS 7H 13 X 1.6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.91", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1999.0, "discounted_cash": 699.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARROW-LOK 2.5-3.5MM LENGTH 28MM STRAIGHT HYBRID 21-253528", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "21-253528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1390.0, "discounted_cash": 486.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARSENAL 1ST MPJ 0 DEGREE 300-82-013", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-82-013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4260.0, "discounted_cash": 1491.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARSENAL 5 HOLE UNIVERSAL R 300-88-002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-88-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARSENAL 8-HOLE FIBULA 300-92-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-92-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3490.0, "discounted_cash": 1221.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARSENAL EVANS 300-86-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-86-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3461.0, "discounted_cash": 1211.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARSENAL LONG MEDIAL COLUMN RIGHT 300-87-004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-87-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5603.0, "discounted_cash": 1961.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARSENAL MINI CONDYLAR LONG 300-81-002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-81-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3502.0, "discounted_cash": 1225.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARSENAL MINI VLC 6 HOLE 300-81-006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-81-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2122.0, "discounted_cash": 742.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARSENAL NC LEFT 300-85-003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-85-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5768.0, "discounted_cash": 2018.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARSENAL PETITE FIRST MPJ 5DEGREE 300-82-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-82-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4260.0, "discounted_cash": 1491.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARSENAL SHORT MEDIAL COLUMN RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-87-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6386.0, "discounted_cash": 2235.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARSENAL TN FUSION 300-85-002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-85-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3720.0, "discounted_cash": 1302.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ARTHRODESIS LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9F00-100L-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2957.0, "discounted_cash": 1034.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ASSEMBLED GEMINUS VOLAR DISTAL RADIUS PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-LTN-120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5047.0, "discounted_cash": 1766.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE AVIATOR THREE LEVEL SIZE 54 48811354", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48811354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE AXOS 3 5.0 COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "627570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4352.0, "discounted_cash": 1523.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE AXSOS 4 HOLE RT PROXIMAL TIBIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "627334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4477.0, "discounted_cash": 1566.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BASE POROUS TIBIA W/JRNY 71425305", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71425305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BASE SZ 4 TIBL FOR TOTAL KNEE REPLACE IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTUUX400-K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BEAVER 28MM MEDIAL SLIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-107-2015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5552.0, "discounted_cash": 1943.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BENDERS S 2 PIECES", "code_information": [{"code": "FIS 231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 432.0, "discounted_cash": 151.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 0DEG MTP FUSION RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "587220RT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3138.0, "discounted_cash": 1098.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 1 LVL 28MM REX ACP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RC.PL.1028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8283.0, "discounted_cash": 2899.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 1.3MM THICKNESS 6 HOLE 38MM TRILOCK GRID STRAIGHT APTUS TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4655.03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1454.0, "discounted_cash": 508.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 1.5MM X 29MM 6 HOLE STRAIGHT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "446.031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 165.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 1.5MM X 59MM 12 HOLE STRAIGHT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "446.032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 1.7MM 2 X 2 HOLE 1.0MM PROFILE HEIGHT OSTEOSYNTHESIS HND PLATING SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10397", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1358.0, "discounted_cash": 475.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 1.7MM 4 X 2 HOLE 1.0MM PROFILE HEIGHT OSTEOSYNTHESIS HND PLATING SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 10 HOLE 131MM THIRD TUBULAR SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943T-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 577.0, "discounted_cash": 201.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 10MM MULTI HOLE OPEN DOOR PRE CUT INTRINSIC STAB TITANIUM IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "853-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 979.0, "discounted_cash": 342.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 12 HOLE 156MM THIRD TUBULAR SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943T-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 180MMFT DOUBLE ROW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "56-13655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2094.0, "discounted_cash": 732.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 1MM X 100MM 34 HOLE ADAPTION CRANIO MAXILLO FACIAL TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "224.581", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1100.0, "discounted_cash": 385.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.3MM 3 X 2 HOLE 1.5MM PROFILE HEIGHT 3D OSTEOSYNTHESIS HND PLATING S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.3MM 4 HOLE 1.5MM PROFILE HEIGHT OSTEOSYNTHESIS HND PLATING SYS STR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 257.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.3MM 4 X 2 HOLE 1.5MM PROFILE HEIGHT 3D OSTEOSYNTHESIS HND PLATING S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1358.0, "discounted_cash": 475.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.3MM 4 X 2 HOLE 1.5MM PROFILE HEIGHT REPLANTATION 3D OSTEOSYNTHESIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.3MM 5 HOLE 1.5MM PROFILE HEIGHT LFT MC5 OSTEOSYNTHESIS HND PLATING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.3MM 5 HOLE 1.5MM PROFILE HEIGHT RIGHT MC5 OSTEOSYNTHESIS HND PLATIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.3MM 6 HOLE LFT HND LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 257.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.47IN 1.24IN HEAD ANATOMIC LFT DVR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DVRAW-L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.4MM 3 HOLE SHAFT 3 HOLE HEAD LFT ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 875.0, "discounted_cash": 306.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.4MM 4 HOLE SHAFT 2 HOLE HEAD RIGHT ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 920.0, "discounted_cash": 322.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.4MM 4 HOLE SHAFT 3 HOLE HEAD LFT ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 920.0, "discounted_cash": 322.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.4MM 4 HOLE SHAFT 3 HOLE HEAD OBLIQUE LFT ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 920.0, "discounted_cash": 322.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.4MM 54MM 8 HOLE SHAFT 3 HOLE HEAD T ADAPTION TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.912", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.4MM DIST RADIUS 3 HOLE HEAD 3 HOLE SHAFT LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 875.0, "discounted_cash": 306.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.4MM TO 2.7MM X 24MM EXTRA SM X VAR ANGLE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2.4MM X 88MM 12 HOLE LCP ADAPTION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "247.366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1174.0, "discounted_cash": 410.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 22MM X 51MM LFT NARROW LOCKED DVR CROSSLOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1318-21-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1578.0, "discounted_cash": 552.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 24.4MM X 51.3MM SHRT ANATOMIC LFT DIST VOLAR RADIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DVRAS-L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.0, "discounted_cash": 412.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 2MM X 35MM 6 HOLE STRAIGHT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "447.031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 182.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 3 HOLE 61MM MEDIAL DELTOID AVULSION SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943H-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2429.0, "discounted_cash": 850.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 3 HOLE 72MM LAT HOOK SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943TH-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 3.5MM 114MM 5 HOLE PROXIMAL HUMERAL PHILOS SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3221.0, "discounted_cash": 1127.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 3.5MM 76MM X 9MM 6 HOLE ONE THIRD TUBULAR CLLR 12 MM AND 16 MM HOLE S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 3.5MM 88MM X 9MM 7 HOLE ONE THIRD TUBULAR 12 MM AND 16 MM HOLE SPACIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 445.0, "discounted_cash": 155.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 3.5MM X 124MM 9 HOLE LCP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "423.591", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 916.0, "discounted_cash": 320.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 3.5MM X 74MM 6 HOLE ONE THIRD TUBULAR VLP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72823006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1084.0, "discounted_cash": 379.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 3.5MM X 85MM 6 HOLE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "423.561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 798.0, "discounted_cash": 279.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 30MM ANT CERVICAL 2 LEVEL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48811230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 39MM X 15MM X 13MM ANT LUMBARINTERBODY FUSION VAULT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-P3915-13P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10599.0, "discounted_cash": 3709.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 4 HOLE 55MM THIRD TUBULAR SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943T-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 4.5MM X 141MM 7 HOLE BROAD IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71829487", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 553.0, "discounted_cash": 193.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 4.5MM X 98.0MM LCP 5 HOLE NARROW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "224.551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 786.0, "discounted_cash": 275.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 45MM 2 LEVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-71004-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3451.0, "discounted_cash": 1207.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 5.6MM X 50MM HIGH STRENGTH STRAIGHT FRAGMENT PLATING SYS F3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-17-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 936.0, "discounted_cash": 327.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 51MM 3D LEFT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-15061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1919.0, "discounted_cash": 671.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 5DEG MED RIGHT FIRST MTP FUSION ORTHOLOC 3DI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "587225RT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3138.0, "discounted_cash": 1098.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 6MM COTTON LOW PROFILE FOR PLATE AND SCREW SYS TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8948-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2340.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 7 HOLE 93MM THIRD TUBULAR SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943T-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 7.5MM STEP CALCANEUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8949-075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2884.0, "discounted_cash": 1009.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 8 HOLE 106MM THIRD TUBULAR SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943T-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 781.0, "discounted_cash": 273.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 8 HOLE ONE THIRD TUBULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "427007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 90MM 3 HOLE PROXIMAL HUMERAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2513.0, "discounted_cash": 879.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE A.L.P.S. LOCKING 3H LAT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240-73-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1401.0, "discounted_cash": 490.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE ALPHA SLOTLESS LAPIDUS MAXLOCK EXTREME IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MXL-002-0A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2804.0, "discounted_cash": 981.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE ANATOMIC NARROW SHRT RIGHT DVR IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DVRANS-R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.0, "discounted_cash": 412.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE ANATOMIC SHRT RIGHT W/ FAST GUIDE DVRINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DVRAS-R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.0, "discounted_cash": 412.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE LC-DCP TITANIUM STRAIGHT 4 HOLE NONSTERILE 24 X 2.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.931", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE LCP 10 HOLE PROXIMAL RIGHT 4.5 X 190MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "240.042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3275.0, "discounted_cash": 1146.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE LFT ANATOMIC DVR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DVRAXL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE MTP RIGHT 5.0DEG MD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-103-R052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4141.0, "discounted_cash": 1449.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE NARROW RIGHT VOLAR DISTAL RADIUS 9 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2432.5, "discounted_cash": 851.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE REV RIGHT FIRST MTP FUSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "587338RT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5066.0, "discounted_cash": 1773.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE STANDARD 0.96IN HEAD LFT ANATOMIC STANDARD DIST VOLAR RADIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DVRA-L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE SZ 2 3 TARSO METATARSAL RIGHT STANDARD IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TMT-002-23MC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3374.0, "discounted_cash": 1180.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE SZ 6 BASEPLATE TRIATHLON TS PLUS IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5521-B-600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2081.0, "discounted_cash": 728.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE SZ1 RIGHT CROSSCHECK CX MTP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CCP-MPX1R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4031.0, "discounted_cash": 1410.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE VA-LCP DISTAL LATERAL FIBULA 2.7 X 131MM 7-HOLE LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2233.0, "discounted_cash": 781.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE VARIAX 6 HOLE 75MM LOCKING ANT MIDSHAFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "628306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2293.0, "discounted_cash": 802.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE VOLAR DISTAL RADIUS RIGHT STANDARD ACU LOC II IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2432.5, "discounted_cash": 851.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE Y TYPEINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-002-Y", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3565.0, "discounted_cash": 1247.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BROAD LOCKING 2.0 L67MM 10 HOLES 629650", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1735.0, "discounted_cash": 607.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BROAD LOCKING 2.4 L 65MM 8 HOLES 629708", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1914.0, "discounted_cash": 669.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CALCANEAL FRACTURE SINUS TARSI RIGHT MEDIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-102-R202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4481.0, "discounted_cash": 1568.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CENTERPIECE 10.0MM OPEN DOOR LAT HOLE POST CERV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "853010WM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 979.0, "discounted_cash": 342.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CENTRAL COLUMN P PRT-CCP-RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PRT-CCP-RT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2300.0, "discounted_cash": 805.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 1 LEVEL 12MM 30-0112", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2575.0, "discounted_cash": 901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 12MM 1 LEVEL AP112", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 14MM 1 LEVEL ANT 1 LEVEL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48811114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 2 LEVEL 26MM 30-0226", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2575.0, "discounted_cash": 901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 2 LEVEL 32MM 30-0232", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0232 Plate", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 3 LEVEL 45MM 30-0345", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 3 LEVEL 45MM AP345", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 3 LEVEL 48MM 30-0348", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0348 Plate", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 3 LEVEL 57MM 30-0357", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.26, "discounted_cash": 43.49, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 30MM 2 LEVEL AP230", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 37MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0237.", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 651.0, "discounted_cash": 227.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICAL 48MM 3 LEVEL AP348", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICLE 1 LVL 21MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6511-1721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CERVICLE 2 LVL 43MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6512-1743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CETRA 18 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "19-0118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CETRA 22 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "19-0122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAV EVOS 3.5MM SUP 10H L 108MM 72469510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72469510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3760.0, "discounted_cash": 1316.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAV KNOTLESS DIS BUTTON TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2658TR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2135.48, "discounted_cash": 747.42, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICAL 6H RHT SUPERIOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "628026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2064.0, "discounted_cash": 722.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICAL 7 HOLE SUPERIOR DECREASED CURVITURE LFT VARIAX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "628007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3096.0, "discounted_cash": 1083.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICAL 7H RHT SUPERIOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "628027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2064.0, "discounted_cash": 722.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICAL MID SHAFT 8H SUPERIOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "628028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2339.0, "discounted_cash": 818.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 7 H LFT SUP MED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3337.0, "discounted_cash": 1167.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 73MM 10 HOLE LEFT SUPERIOR MEDIAL LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 8 HOLE 97MM LFT SUPERIOR MEDIAL LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2093.0, "discounted_cash": 732.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 8 HOLE LG LFT MIDSHAFT NARROW PROFILE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4880.0, "discounted_cash": 1708.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 8 HOLE LG MIDSHAFT LFT LOW PROFILE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2546.0, "discounted_cash": 891.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 8 HOLE MIDSHAFT NARROW PROFILE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4647.0, "discounted_cash": 1626.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 81MM INFERIOR DISTAL LOCKING", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "71823407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2184.0, "discounted_cash": 764.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 8H 122MM LEFT VARIAX BRIDGE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "628048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3119.0, "discounted_cash": 1091.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE ANTERIOR MIDSHAFT 10-HOLE 118MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "628310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE MEDIAL SUPERIOR RIGHT 7 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2585.0, "discounted_cash": 904.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE RT 6-HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2546.0, "discounted_cash": 891.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE RT 8H 90MM 133515090", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "133515090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2866.0, "discounted_cash": 1003.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE SHRT LFT DIST SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2656DL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1842.8, "discounted_cash": 644.98, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE SUPERIOR MEDIAL 8H RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2184.0, "discounted_cash": 764.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLAW II TACK 40250010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40250010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 51.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CLUSTER 6 HOLE LOCKING CLST-6.6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CLST-6.6", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2760.0, "discounted_cash": 966.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COLUMN SHRT ULNAR RIGHT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1397.0, "discounted_cash": 488.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 148MM X 9MM 12 HOLE 3.5MM LCP ONE THIRD TUBULAR HOLE SPACING 12 MM A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 466.0, "discounted_cash": 163.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 2.4MM 45MM 3 HOLE X 5 HOLE LCP JUXTA ARTICULAR VOLAR DIST RADIUS RIG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "242.493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1949.0, "discounted_cash": 682.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 2.4MM 61MM 5 HOLE X 5 HOLE LCP JUXTA ARTICULAR VOLAR DIST RADIUS LFT LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "242.492", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2054.0, "discounted_cash": 718.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 2.4MM DSTL RAD 6H HD/ 2HL SHAFT RT STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.111.620S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2461.0, "discounted_cash": 861.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 2.4MM X 1.7MM 51MM X 6.5MM DYNAMIC HOLD SPACING 8 MM TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.926", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 895.0, "discounted_cash": 313.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 2.4MM X 42MM 6 HOLE 2 HOLE 2 COLUMN VOLAR DIST RADIUS VAR ANGLE NARR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.111.521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1976.0, "discounted_cash": 691.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 2.4MM X 45MM 6 HOLE 2 HOLE 2 COLUMN VOLAR DIST RADIUS VAR ANGLE LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.111.621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2139.0, "discounted_cash": 748.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 2.4MM X 54MM 6 HOLE 3 HOLE 2 COLUMN VOLAR DIST RADIUS VAR ANGLE LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.111.631", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2547.0, "discounted_cash": 891.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 2.4MM X 54MM 6 HOLE 3 HOLE 2 COLUMN VOLAR DIST RADIUS VAR ANGLE RIGH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.111.630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2224.0, "discounted_cash": 778.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 2.4MM X 55MM 7 HOLE 3 HOLE VOLAR 2 COLUMN LCP DIST RADIUS VAR ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.111.731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2440.0, "discounted_cash": 854.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 2.7MM 3.5MM 73MM 2 HOLE PROXIMAL OLECRANON VAR ANGLE LT LCKNG 02.107.102", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.107.102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2116.0, "discounted_cash": 740.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 3.5MM 64MM X 9MM 5 HOLE 12MM HOLE SPACING LCP ONE THIRD TUBULAR 1 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 398.0, "discounted_cash": 139.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 3.5MM 98MM X 11MM X 3.4MM 7 HOLE DISTANCE BETWEEN CENTER OF HOLE 13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.924", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 798.0, "discounted_cash": 279.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 3.5MM X 105MM 6 HOLE CLAVICLE LCP SUPERIOR LT W/ LAT EXTENSION LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.112.091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2012.0, "discounted_cash": 704.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPR 69MM 6 HOLE LCP ONE THIRD TUBULAR COLLAR SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 413.0, "discounted_cash": 144.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 118MM WRIST FUSION STANDARD BEND LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.110.150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4204.0, "discounted_cash": 1471.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 2.4MM X 31MM 4 HOLE LC-DCP FOR COMPACT HND 2.4 TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 788.52, "discounted_cash": 275.98, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 2.4MM X 52MM 6 HOLE LCP STRAIGHT SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "249.676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 955.0, "discounted_cash": 334.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 2.7MM 3.5MM 90MM 2 HOLE POLECRANON VAR ANGLE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.107.202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2632.0, "discounted_cash": 921.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 2.7MM 5 HOLE STRAIGHT FPS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "324-1101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 341.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 2.7MM PROXIMAL OLECRANON VAR ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.107.102S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2367.0, "discounted_cash": 828.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 2MM X 36MM 6 HOLE DYNAMIC TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 2MM X 48MM 8 HOLE DYNAMIC TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.938", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 267.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 3.5MM X 100MM 7 HOLE CLAVICLE SUPERIOR LCP RIGHT LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.112.082", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2346.0, "discounted_cash": 821.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 3.5MM X 117MM 10 HOLE LCP ONE THIRD TUBULAR W/ COLLAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 428.0, "discounted_cash": 149.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 3.5MM X 62MM 3 HOLE HOOK LCP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.113.103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1369.14, "discounted_cash": 479.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 6 HOLE 123MM BROAD NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71829486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 7 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1062.0, "discounted_cash": 371.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 7H NARROW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "627537", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5282.0, "discounted_cash": 1848.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION 8 HOLE 93MM LCP ONE THIRD TUBULAR COLLAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 161.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION STR 5H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "336-2700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3378.0, "discounted_cash": 1182.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COMPRESSION VARIAX 2 8 HOLE 103MM BROAD STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629548S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1685.0, "discounted_cash": 589.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CONDYLAR 1.5MM X 36MM 7 HOLE LFT TI RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "443.62.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 737.0, "discounted_cash": 257.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CONDYLAR 2.4MM 57MM 8 HOLE PIN LFT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "446.63.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CONDYLAR 2.4MM X 57MM 8 HOLE SHAFT PIN RIGHT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.917", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CONDYLAR 2MM X 39MM 7 HOLE LFT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "443.61.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 737.0, "discounted_cash": 257.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CONDYLAR 2MM X 39MM 7 HOLE RIGHT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "446.64.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COPRESSION 2.7MM 3.5MM 116MM POLECRANON VAR ANGLE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.107.204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2632.0, "discounted_cash": 921.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE COVER LARGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CROSS-LOCKING RIGHT T10 POLYAXIAL LADIPUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4744.0, "discounted_cash": 1660.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CROSSLOCK 22MM X 41MM MINI NARROW LOCKED LFT DVR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1318-21-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1578.0, "discounted_cash": 552.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CURVED 4-HOLES 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-15011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1543.0, "discounted_cash": 540.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DELTA 36 X 36MM TRIANGLE 0.5MM THICK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-92015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1832.0, "discounted_cash": 641.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL 69MM 1H HUMERAL SHORT RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.117.801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2878.0, "discounted_cash": 1007.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL ANTERILATERAL TIBIA FOR LEFT TIBIA 10 HOLE / L178MM 627460", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "627460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4741.0, "discounted_cash": 1659.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL FIBULA 6 HOLE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "336-5206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3607.0, "discounted_cash": 1262.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL HUMERAL 72MM 1H MEDIAL SHORT LT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.117.701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2967.0, "discounted_cash": 1038.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL HUMERUS 75MM RIGHT DHP-MDR-3HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DHP-MDR-3HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4530.0, "discounted_cash": 1585.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL HUMERUS LATERAL 85MM RIGHT DHP-LDR-3HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DHP-LDR-3HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4942.0, "discounted_cash": 1729.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL HUMERUS SUPRACONDYLAS 250 RIGHT SCR-250", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCR-250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6281.0, "discounted_cash": 2198.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL LATERAL FIBULA RIGHT 2.37/3.5 MM 95MM/5 HOLES 540665", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "540665", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3474.0, "discounted_cash": 1215.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL RADIUS NARROW LEFT 3H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FDR 001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1713.0, "discounted_cash": 599.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL RADIUS NARROW RIGHT 3H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FDR 002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL RADIUS VOLAR 2 COL 6H 2.4MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.11.630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2224.0, "discounted_cash": 778.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL RADIUS VOLAR STAND 3 HOLE LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8916VSL-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2340.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL RADIUS VOLAR STAND 3 HOLE RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8916VSR-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2340.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DISTAL ULNA GEMINUS PROTEAN FRAGMENT SPECIFIC PRT-FSP-DU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PRT-FSP-DU", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2204.0, "discounted_cash": 771.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DITAL HUMERUS 115MM LEFT DHPF-LDL-5HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DHPF-LDL-5HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4300.0, "discounted_cash": 1505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DOG BONE SLANTED 20MM P53-151-1003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-151-1003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.0, "discounted_cash": 1438.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DOUBLE HOCKEY STICK ASSEMBLED PROTEAN FRAGMENT PRT-FSP-LR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PRT-FSP-LR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2258.0, "discounted_cash": 790.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DUR SHORT LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DURASL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.0, "discounted_cash": 412.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DVR ANATOMIC NARW SHORT LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DVRANS-L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.0, "discounted_cash": 412.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DVR CROSSLOCK 24 X 85MM LFT COBALT CHROME T SHAPED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "131822090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1920.0, "discounted_cash": 672.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DVR MINI IT NARROW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1318-11-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1644.0, "discounted_cash": 575.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DVR SHORT NARROW LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DURANSL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2267.0, "discounted_cash": 793.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DVR STANDARD SHORT RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DVRASSR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1135.0, "discounted_cash": 397.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE DYNAFORCE MPJ SHORT 18MM 0D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7150-0018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5265.0, "discounted_cash": 1842.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE EVOS 2.7/3.5 L-D FIBULA 3 HOLE L 59MM 72465103", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72465103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3080.0, "discounted_cash": 1078.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE EVOS 2.7MM/3.5MM OLECRANON WITH TINES 2 HOLE RIGHT 61MM 72466402", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72466402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7980.0, "discounted_cash": 2793.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE EVOS 3.5MM COMP 8H 102MM 72441008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72441008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1434.0, "discounted_cash": 501.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE EVOS 3.5MM COMPRESSION 7 HOLE 90MM 72441007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72441007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2150.0, "discounted_cash": 752.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE EVOS 3.5MM LCK 1/3 TUBULAR PL 10H 118MM 72440510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72440510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2410.0, "discounted_cash": 843.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE EVOS 3.5MM LCK COMP 10H 116MM 72440710", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72440710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2670.0, "discounted_cash": 934.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE EVOS 3.5MM SUP MS CLAV PL 8H L 86MM 72469508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72469508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5710.0, "discounted_cash": 1998.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE EVOS POSTEROLATERAL DISTAL FIBULA 6 HOLE LEFT 69MM 72455306", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72455306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2627.0, "discounted_cash": 919.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE EVOS PROX HOM 4 HOLE 3.5MM X 92MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72467204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6932.0, "discounted_cash": 2426.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE EXPANDABLE LAMINOPLASTY STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48570300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FEMALE POST 2 HOLE DNE-2-FP", "code_information": [{"code": "DNE-2-FP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 559.52, "discounted_cash": 195.83, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIB LATERAL 89MM LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5888402L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3410.0, "discounted_cash": 1193.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIB STRT 6 HOLES 2.7MM/3.5MM/4.0 SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DLF-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 2.7MM 3.5MM 77MM 3 HOLE LCP POST LAT DIST RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.112.106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1756.0, "discounted_cash": 614.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 3 HOLES 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1602.0, "discounted_cash": 560.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 3.5MM 71MM 4 HOLE LAT DIST RIGHT PERI LOC VLP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72822004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2812.0, "discounted_cash": 984.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 3.5MM 83MM 5 HOLE LAT DIST RIGHT PERI LOC VLP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72822005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2977.0, "discounted_cash": 1041.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 3.5MM X 83MM 5 HOLE LAT DIST IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72821005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2153.0, "discounted_cash": 753.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 4 HOLE RIGHT DIST SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943BR-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1619.0, "discounted_cash": 566.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 5 HOLE LFT DIST SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943BL-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1339.0, "discounted_cash": 468.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 6 HOLE LFT DIST SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943BL-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 6 HOLE VARIAX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1662.0, "discounted_cash": 581.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 7 HOLE STRAIGHT VARIAX LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1285.0, "discounted_cash": 449.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 8 HOLE STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1114.0, "discounted_cash": 389.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA 9 HOLE 300-61-005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-61-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA ANKLE 10 HOLE LATERAL 300-92-002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-92-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3490.0, "discounted_cash": 1221.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA CLUSTER 2 HOLE RHT ANATOMIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-203-R011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5140.0, "discounted_cash": 1799.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA CLUSTER 9 HOLE RHT ANATOMIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-203-R009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3341.0, "discounted_cash": 1169.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA DIST MED RIGHT LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DFX-002-MR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3509.0, "discounted_cash": 1228.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA SHRT DIST LFT MAXLOCK EXTREME IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DFX-002-SL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3509.0, "discounted_cash": 1228.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULA SM LAT RIGHT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5888101R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4308.0, "discounted_cash": 1507.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULAR 106MM RIGHT PERIARTICULAR LOCKING 6 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2357-017-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1220.0, "discounted_cash": 427.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULAR 6 HOLE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DLF 506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1423.0, "discounted_cash": 498.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULAR 6H STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DLF 006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULAR 7 HOLE STR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-201-0007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2575.0, "discounted_cash": 901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULAR 8 HOLES LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DLF 508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIBULAR LEFT 7 HOLE ANATOMICAL ANKLE P53-203-L007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-203-L007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3341.0, "discounted_cash": 1169.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIRST RAY MEDIUM 58410002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58410002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3961.0, "discounted_cash": 1386.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIRST RAY SMALL 58410001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58410001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1982.0, "discounted_cash": 693.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIXATION 9H VARIAX ORTHOPEDIC NONSTERILE MIS CALCANEAL 9 HOLES 622106", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "622106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3488.0, "discounted_cash": 1220.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIXATION BONE MPX 51MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-51-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3245.0, "discounted_cash": 1135.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FIXATION EVOS 2.7/3.5 P/A M-D TIBIA 9H L 130MM 72453909", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72453909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9040.0, "discounted_cash": 3164.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FLEX FIBULA 7 HOLE MPPA007U", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPA007U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3502.0, "discounted_cash": 1225.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FOOT 180MM EX FIX DNE-180-DHFP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-180-DHFP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3072.0, "discounted_cash": 1075.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FOOT ORTHEX 205MM DF-R320-205", "code_information": [{"code": "DF-R320-205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6463.0, "discounted_cash": 2262.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FRACTURE 5 HOLE CLAVICLE DIST THIRD RIGHT SHRT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2656DR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1751.0, "discounted_cash": 612.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FRACTURE 8 HOLE CLAVICLE DIST THIRD RIGHT LNG SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2657DR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1619.0, "discounted_cash": 566.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FUSION IN-LINE 3.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240-77-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1380.0, "discounted_cash": 483.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FUSION METACARPAL PHALANGEAL FIRST RIGHT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240-71-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1513.0, "discounted_cash": 529.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FUSION MTP 2.8 TRILOCK PI 5D DORSIFL R A-4860.12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4860.12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4866.0, "discounted_cash": 1703.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE FUSION SM SNGL JOINT CLOSED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240-77-021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1401.0, "discounted_cash": 490.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE G5 MIS FUSION SIZE 10 10-0101-000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-0101-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 5250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GEMINUS VOLAR DISTAL RADIUS NARROW 3 HOLE RIGHT GMN-RTN-3HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-RTN-3HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1790.0, "discounted_cash": 626.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GEMINUS VOLAR DISTAL RADIUS NARROW 4 HOLE LEFT GMN-LTN-4HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-LTN-4HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1814.0, "discounted_cash": 634.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GEMINUS VOLAR DISTAL RADIUS NARROW 4 HOLE RIGHT GMN-RTN-4HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-RTN-4HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2153.0, "discounted_cash": 753.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GEMINUS VOLAR DISTAL RADIUS STANDARD 3 HOLE LEFT GMN-LTS-3HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-LTS-3HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1790.0, "discounted_cash": 626.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GEMINUS VOLAR DISTAL RADIUS STANDARD 3 HOLE RIGHT GMN-RTS-3HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-RTS-3HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1790.0, "discounted_cash": 626.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GEMINUS VOLAR DISTAL RADIUS STANDARD 4 HOLE LEFT GMN-LTS-4HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-LTS-4HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2212.0, "discounted_cash": 774.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GEMINUS VOLAR DISTAL RADIUS STANDARD 4 HOLE RIGHT GMN-RTS-4HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-RTS-4HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2212.0, "discounted_cash": 774.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GEMINUS VOLAR DISTAL RADIUS STANDARD 7 HOLE RIGHT GMN-RTS-7HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-RTS-7HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GEMINUS VOLAR DISTAL RADIUS WIDE 4 HOLE LEFT GMN-LTW-4HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-LTW-4HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2153.0, "discounted_cash": 753.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GEMINUS VOLAR DISTAL RADIUS WIDE 4 HOLE RIGHT GMN-RTW-4HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-RTW-4HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2050.0, "discounted_cash": 717.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GREAT TOE LRG RHT HEMI GREAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "375-0004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3698.0, "discounted_cash": 1294.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GRID LOCKING 3H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-50-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GRID LOCKING 4H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-50-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3935.0, "discounted_cash": 1377.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE H FLEX F3 STRT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-17-102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 936.0, "discounted_cash": 327.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE H MIDFOOT/HINDFOOT 3.5MM X 15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "336-3500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4295.0, "discounted_cash": 1503.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HALF RIING 180MM DNE-180-5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-180-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3486.0, "discounted_cash": 1220.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HAND 1.6MM FUSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "333-1614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1296.76, "discounted_cash": 453.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.5MM X 2.3MM 4 HOLE STRAIGHT VARIAX W/ BAR LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 257.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM 10 HOLE T S PROFYLE IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.0, "discounted_cash": 465.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM 16 HOLE S PROFYLE STRAIGHT IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM 2 X 2 HOLE S PROFILE 3 D IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM 3 X 2 HOLE S PROFYLE 3 D IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM 4 HOLE STRIAGHT S PROFYLE IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1005.0, "discounted_cash": 351.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM 5 HOLE ROTATION S PROFYLE IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1358.0, "discounted_cash": 475.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM 6 HOLE L S PROFYLE RIGHT IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 257.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM 6 HOLE NARROW T S PROFYLE IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1005.0, "discounted_cash": 351.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM 7 HOLE REG T S PROFYLE IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.0, "discounted_cash": 465.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM 8 HOLE WIDE T S PROFYLE IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM X 1MM 4 X 2 HOLE VARIAX 3D LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.0, "discounted_cash": 465.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM X 1MM 6 HOLE VARIAX L PLATE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 257.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 1.7MM X 1MM 9 HOLE VARIAX NARROW Z PLATE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-10379", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1358.0, "discounted_cash": 475.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 2.3MM X 1.5MM 16 HOLE STRAIGHT VARIAX LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1358.0, "discounted_cash": 475.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 2.3MM X 1.5MM 6 HOLE T PLATE NARROW VARIAX LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1005.0, "discounted_cash": 351.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 2.3MM X 1.5MM 7 HOLE T PLATE NARROW LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1358.0, "discounted_cash": 475.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HND 2.3MM X 1.5MM 8 HOLE WIDE T PLATE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HOLDING TAKS", "code_information": [{"code": "337-0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HOOK 2.7MM GRN LFT FPS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "324-1271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2785.0, "discounted_cash": 974.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HOOK 5TH METARSAL UNIVERSAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8956-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2066.0, "discounted_cash": 723.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HOOK 5TH METATARSAL LONG RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8956R-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3753.0, "discounted_cash": 1313.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HOOK R 300-84-002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-84-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4810.0, "discounted_cash": 1683.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HUMERAL 10 HOLE PROX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "627240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5397.0, "discounted_cash": 1888.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HUMERAL 3.5MM 230MM 10 HOLE ARTICULAR DIST LCP LFT STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.104.030S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3944.0, "discounted_cash": 1380.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HUMERUS 2 SLOT RIGHT TI PHPF-2R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PHPF-2R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5606.0, "discounted_cash": 1962.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HUMERUS 2.7MM 3.5MM 72MM 1 HOLE SHRT VAR ANGLE LCP EXTENDED MEDIAL DIST LT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.117.701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2985.0, "discounted_cash": 1044.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HUMERUS 2.7MM 3.5MM 75MM 3 HOLE SHRT VAR ANGLE LCP DIST POST LAT SUPPORT L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.117.103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2985.0, "discounted_cash": 1044.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HUMERUS 3 HOLE PROXIMAL LFT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71821403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4392.0, "discounted_cash": 1537.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE HUMERUS DISTAL SUPRACONDYLAR 10H L SCL-250", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCL-250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5246.0, "discounted_cash": 1836.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE IMPL DELIVERY SYSDISTAL BICEPS REPR AR-2260", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1751.0, "discounted_cash": 612.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE IMPLANT TIGHTROPE XP BUTTRESS AR-8959TDS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8959TDS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8661.16, "discounted_cash": 3031.41, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE JONES FRACTURE MINI HOOK 5 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MHOOK-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2142.0, "discounted_cash": 749.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE KIT IMPLANT TAILORS BUNION 977TIMPM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "977TIMPM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2896.0, "discounted_cash": 1013.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L 0.8MM 3 HOLE X 4 HOLE LFT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 640.0, "discounted_cash": 224.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L 12 HOLE 3.5MM/4.5MM 295MM 72586112", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72586112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24087.0, "discounted_cash": 8430.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L 2.4MM 2 HOLE HEAD X 4 HOLE SHAFT LCP DIST RADIUS NEGATIVE 90 DEGREE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1129.0, "discounted_cash": 395.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L 2.4MM 3 HOLE HEAD X 3 HOLE SHAFT LCP DIST RADIUS POSITIVE 20 DEGREE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 375.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L 2.4MM 3 HOLE HEAD X 4 HOLE SHAFT LCP DIST RADIUS POSITIVE 20 DEGREE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1129.0, "discounted_cash": 395.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L 2.4MM 3 HOLE HEAD X 4 HOLE SHAFT LCP DIST RADIUS POSITIVE 90 DEGREE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1129.0, "discounted_cash": 395.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L 2.4MM X 49MM 3 HOLE X 2 HOLE RIGHT ANGLED DIST RADIUS LCP DORSAL TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 875.0, "discounted_cash": 306.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L 40MM 2 HEAD HOLE 3 SHAFT HOLE DIST RADIUS LCP DORSAL LFT ANGLED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1033.0, "discounted_cash": 361.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L RIGHT 300-88-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-88-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS 0 DEGREE LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5820LPX0L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4619.0, "discounted_cash": 1616.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS 0 DEGREE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5820LPX0R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4619.0, "discounted_cash": 1616.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS 0 STEP LFT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLP20341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4126.0, "discounted_cash": 1444.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS 0MM 58510000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58510000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3170.0, "discounted_cash": 1109.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS 1MM 58510001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58510001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3170.0, "discounted_cash": 1109.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS 2.7MM LFT FPS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "324-1291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2785.0, "discounted_cash": 974.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS 2MM 58510002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58510002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2927.0, "discounted_cash": 1024.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS 4H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-106-R001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4038.0, "discounted_cash": 1413.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS 4H STNRD COMPRESSION LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-106-L001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5047.0, "discounted_cash": 1766.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS BETA 2.7/3.0/4.0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LFP-402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4017.0, "discounted_cash": 1405.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS CROSS PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4744.0, "discounted_cash": 1660.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS LEFT 300-83-003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-83-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS LEFT 3814000L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3814000L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4970.0, "discounted_cash": 1739.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS LOW PROFILEFT ANKLE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8941", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1838.0, "discounted_cash": 643.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS LZ ALPHA 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7100-LZ18-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5265.0, "discounted_cash": 1842.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS LZ BETA 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7100-LZ18-B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5265.0, "discounted_cash": 1842.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS MF-LA-2102", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-LA-2102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4738.0, "discounted_cash": 1658.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS NEUTRAL LEFT MF-LA-2100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-LA-2100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3605.0, "discounted_cash": 1261.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS RECON MEDIUM TLD36-7U", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLD36-7U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 1256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3814000R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5119.0, "discounted_cash": 1791.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS STEP 2MM CENTER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLP27372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4359.0, "discounted_cash": 1525.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS VLC GRIDLOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-53-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3955.0, "discounted_cash": 1384.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIDUS XP RIGHT P40 ST145", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P40 ST145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5590.0, "discounted_cash": 1956.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LAPIPLASTY MICRO-QUAD 14MM RAPID COMPRESSION SK61", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK61", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6974.0, "discounted_cash": 2440.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LARGE MPX GRIDLOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-51-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3245.0, "discounted_cash": 1135.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LARGE X 300-88-010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-88-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4330.0, "discounted_cash": 1515.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LATERAL DIST HUMERUS 3H VARIAX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629203S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2305.0, "discounted_cash": 806.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LATERAL FIBULA LEFT 77MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5888401L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3332.0, "discounted_cash": 1166.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LATERAL FIBULA MED LEFT MPPA102L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPA102L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2637.0, "discounted_cash": 922.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LATERAL FIBULA MED RIGHT MPPA102R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPA102R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2637.0, "discounted_cash": 922.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LATERAL FIBULA PLATE RT 77MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5888401R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3061.0, "discounted_cash": 1071.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LATERAL FIBULA SMALL LEFT MPPA101L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPA101L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2637.0, "discounted_cash": 922.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LATERAL FIBULA XS LEFT AOS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3051-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4575.0, "discounted_cash": 1601.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LATERAL FIBULA XSML LEFT MPPA100L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPA100L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2637.0, "discounted_cash": 922.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LATERAL FIBULA XSML RIGHT MPPA100R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPA100R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3502.0, "discounted_cash": 1225.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LC-DCP 2.4 X 63MM 8H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 967.0, "discounted_cash": 338.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LCP 11MM X 4MM 3.3MM THICK 12 HOLE COMPR HOLE SPACING 13 MM SS IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223.621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1003.0, "discounted_cash": 351.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LCP 11MM X 4MM X 3.3MM THICK 5 HOLE COMPR SS IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223.551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LCP 2.4MM 40MM DORSAL DIST RADIUS THREE SHAFT AND HEAD HOLE COMPRESSION T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.774", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LCP 3.5MM 11MM X 4MM 3.3MM THICK 9 HOLE COMPR HOLE SPACING 13 MM SS IMP LC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223.591", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 309.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LCP 3.5MM X 11MM X 4MM 3.3 THICK 6 HOLE COMPR 13 MM HOLE SPACING SS IMP LC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223.561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 640.0, "discounted_cash": 224.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LCP 3.5MM X 11MM X 4MM 3.3MM THICK 8 HOLE COMPR HOLE SPACING 13 MM SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223.581", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 849.0, "discounted_cash": 297.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LCP 3.5MM X 137MM 10 HOLE COMPRESSION SS IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223.601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 937.0, "discounted_cash": 327.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LCP 3.5MM X 189MM 14 HOLE COMPR SM FRAGMENT SS IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223.641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1506.0, "discounted_cash": 527.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LCP 3.5MM X 86MM 2 HOLE COMPR OLECRANON LFT DIRECTION SS STRL LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "236.503S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2071.0, "discounted_cash": 724.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LCP 3.5MM X 98MM 7 HOLE COMPR LIMITED CONTACT DYNAMIC SS IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "223.571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LCP 3H 69MM LEFT LATERAL EXTENSION SUPERIOR ANTERIOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-112-007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1927.0, "discounted_cash": 674.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LEFT ARSENAL PETITE LAPIDUS 300-83-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-83-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3976.0, "discounted_cash": 1391.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LEFT ARTIC RADIUS SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "242.461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1824.0, "discounted_cash": 638.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LEFT JONES FRACTURE COMPRESSION PS3-008-LC06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS3-008-LC06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3053.0, "discounted_cash": 1068.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LEFT VOLAR DISTAL RADIUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "242.991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1878.0, "discounted_cash": 657.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LEG A.L.P.S. 139MM 6H LEFT LOCKING ANATOMIC DISTAL FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "816206006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1386.0, "discounted_cash": 485.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LFT 6H 2.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "324-1011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 868.0, "discounted_cash": 303.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LISFRANC 300-85-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-85-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5974.0, "discounted_cash": 2090.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LISFRANC H SMALL OSTEOSYNTHESIS PL050201", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PL050201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LOCK DISTAL FIBULA SS RT 4 HOLE AR-8943DR-04", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943DR-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1267.0, "discounted_cash": 443.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LOCK DISTAL RT 5 HOLE AR-8943DR-05", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943DR-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LOCKING CURVED 2.0/2.3 BLUE 1.3MM 4 H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4655.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1460.0, "discounted_cash": 511.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LOCKING DISTAL FIBULA TI RT 6H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9943BR-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1680.2, "discounted_cash": 588.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LOCKING FIBULAR 7 HOLES DLF 507", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DLF 507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1450.0, "discounted_cash": 507.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LOCKING LPT 6 HOLE RIGHT 3.5 X 93MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72820406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3234.0, "discounted_cash": 1131.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LOCKING THIRD TUBULAR 3H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2429.0, "discounted_cash": 850.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE LT CALC FX PERC STD ANTERIOR PROC POST TUBER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8954YL-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3224.0, "discounted_cash": 1128.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MALLEOLUS HOOK SML LEFT MPPA301L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPA301L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3131.0, "discounted_cash": 1095.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MALLEOLUS HOOK SML RIGHT MPPA301R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPA301R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MATRIX 2.0MM 3 X 3 MANDIBLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.503.731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MATRIXMANDIBLE 8H STRUT PL CRVD MALLEABLE 1.0 THICK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.503.709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1111.0, "discounted_cash": 388.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MATRIXWAVE 10H MMF SHORT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.503.820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 204.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MED COLUMN ARCH 2.0MM THCKN LEFT LARGE P53-109-L103", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-109-L103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4278.0, "discounted_cash": 1497.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MEDIAL MALLEOUS HOOK 2-HOLE ANATOMICAL P53-206-0002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-206-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3475.0, "discounted_cash": 1216.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MEDIUM 45MM LEFT TMP45-OL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TMP45-OL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3490.0, "discounted_cash": 1221.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MET ALPS 3.5MM 4H FUSION COMP SING JOINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240-77-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1566.0, "discounted_cash": 548.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE METATARSAL T 7 HOLE MPPM303U", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPM303U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2142.0, "discounted_cash": 749.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE METATARSOPHALANGEAL RIGHT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLP14342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4263.0, "discounted_cash": 1492.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MIDSHAFT HUMERUS BROAD 172MM MHB-172", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MHB-172", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3047.0, "discounted_cash": 1066.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MIDSHAFT HUMERUS NARROW 136MM MHN-136", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MHN-136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2676.0, "discounted_cash": 936.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MIDSHAFT ULNA 81MM MUP-081", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MUP-081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2944.0, "discounted_cash": 1030.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MINI CONDYLAR 300-81-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-81-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2290.0, "discounted_cash": 801.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MINI CONSTRUCT KIT CASEFFT1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CASEFFT1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MINI LOCKING 24MM X 43MM LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1318-22-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1578.0, "discounted_cash": 552.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MINIMALLY INVASIVE BUNION PLATE RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-70-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MIS CALCANEAL S7 7 HOLES 622102", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "622102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3488.0, "discounted_cash": 1220.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MIS FUSION 14 10-0103-000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-0103-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 5250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MIS FUSION MINUTEMAN G5 SIZE 12 10-0102-000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-0102-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 5250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MP FUSION 10 DEG SML RIGHT MPP1003R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPP1003R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MTP 0 DEG MED RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-103-R002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3167.0, "discounted_cash": 1108.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MTP FIRST LFT FUSION TOTALFT SYS ALPS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240-71-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1513.0, "discounted_cash": 529.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MTP FUSION MEDIUM 0DG LT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "587220LT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3138.0, "discounted_cash": 1098.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MTP METATARSAL PHALANGEAL LFT CROSS PLATE ANCHORAGE IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLP14341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4400.0, "discounted_cash": 1540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MTP REVISION RIGHT P40 ST137", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P40 ST137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5990.0, "discounted_cash": 2096.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MTP SMALL 0* LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPP1001L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4450.0, "discounted_cash": 1557.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MTP TMP530R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TMP530R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 1256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MTP V1 6H LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLP10341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2398.0, "discounted_cash": 839.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE MTP V1 6H RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLP10342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2398.0, "discounted_cash": 839.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE NARROW 3 HOLE LEFT GEMINUS VOLAR DISTAL RADIUS GMN-LTN-3HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-LTN-3HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1790.0, "discounted_cash": 626.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE NARROW 5H 4.5MM COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71829455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE NARROW LFT ACULOC 2VDR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2432.5, "discounted_cash": 851.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE NARROW LOCK T 2.0 L 34 MM 2 X 5 HOLES 629770", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1684.0, "discounted_cash": 589.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE NARROW XTRA ARTICULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3442.0, "discounted_cash": 1204.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE NC RECON 28MM TL-28NC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TL-28NC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE NEUTRAL WRIST FUSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3379.26, "discounted_cash": 1182.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE NON-STERILE 7 HOLE LEFT 3.5MM PROX HUMERUS LOCK 140MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6870.0, "discounted_cash": 2404.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE NX 6 HOLE LEFT COLINK 2 MTP P42 ST238", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P42 ST238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5990.0, "discounted_cash": 2096.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE NX 6 HOLE RIGHT COLINK 2 MTP P42 ST138", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P42 ST138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5990.0, "discounted_cash": 2096.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OCLECRANON LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2240.0, "discounted_cash": 784.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OLECFANON 2.7MM 3.5MM 90MM 2 HOLE OLECFANON LFT SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.107.302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2724.0, "discounted_cash": 953.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OLECRANON 4 HOLE/LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2592.0, "discounted_cash": 907.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OLECRANON EXTENDED 5H LT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2229.5, "discounted_cash": 780.33, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OLECRENON PLATE 3 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2303.0, "discounted_cash": 806.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ONE-THIRD TUBULAR 2 HOLE 23MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626672S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 702.0, "discounted_cash": 245.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ONE-THIRD TUBULAR 6H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 756.0, "discounted_cash": 264.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ONE-THIRD TUBULAR 7H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 741.0, "discounted_cash": 259.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ORBITAL FLOOR ISOLATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-03003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2496.0, "discounted_cash": 873.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ORBITAL FLOOR MEDPOR 3D OFLEFT SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "81041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4893.0, "discounted_cash": 1712.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ORTHO 3.5MM X 52MM 3 HOLE HEAD 3 HOLE SHAFT T-PLATE LCP OBLIQUE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 881.0, "discounted_cash": 308.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ORTHO 3.5MM X 63MM 3 HOLE HEAD 4 HOLE SHAFT T-PLATE LCP OBLIQUE ANGLED RIG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 921.0, "discounted_cash": 322.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ORTHO 3.5MM X 96MM 3 HOLE HEAD 7 HOLE SHAFT T-PLATE LCP OBLIQUE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1045.0, "discounted_cash": 365.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OSTEO STRT 10 HOLE 2.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FRP-525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1122.0, "discounted_cash": 392.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE P-L VLP 3.5MM 1/3 LK TUB 5H 62MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7282-3005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 641.0, "discounted_cash": 224.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PERI-LOK CLAVICLE 8 HOLE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2905.0, "discounted_cash": 1016.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PERIARTICULAR 106MM 6 HOLE LEFT LOCKING DISTAL LATERAL FIBULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2357-018-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1220.0, "discounted_cash": 427.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PETITE 5 DEGREE X5DEGREE RIGHT MAXFORCE MTP AR-9944P-5R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9944P-5R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5871.0, "discounted_cash": 2054.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PETITE 5-5 LEFT MAXFORCE MTP AR-9944P-5L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9944P-5L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4455.0, "discounted_cash": 1559.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PETITE ARSENAL LAPIDUS RIGHT 300-83-002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-83-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5459.0, "discounted_cash": 1910.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PETITE MPJ RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-52-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PETITE MTP 300-82-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-82-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4260.0, "discounted_cash": 1491.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PINIT 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9A0P-2A12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1306.0, "discounted_cash": 457.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PINIT 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9A0P-2A08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1306.0, "discounted_cash": 457.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PLANTAR PYTHON LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SD11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3247.0, "discounted_cash": 1136.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PLANTAR PYTHON RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "sd12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3247.0, "discounted_cash": 1136.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE POLYAXIAL LOCKING MIDFOOT CROSS PLATE LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4570.0, "discounted_cash": 1599.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE POST MALE 2 HOLE DNE-2-MP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-2-MP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 398.0, "discounted_cash": 139.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE POSTERO 4 HANAT DIST FIBL LT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8963APLL-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3238.0, "discounted_cash": 1133.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE POSTERO 4H RT ANAT DIST FIB", "code_information": [{"code": "AR8963APLR-04", "type": "CDM"}], "standard_charges": [{"gross_charge": 3238.0, "discounted_cash": 1133.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE POSTERO 4H RT ANAT DIST FIB SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8963APLR-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3238.0, "discounted_cash": 1133.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE POSTEROLATERAL TIBIA SMALL LEFT MPPA401L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPPA401L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3131.0, "discounted_cash": 1095.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE POSTLATERAL DISTAL FIBULA LOCKING 7H 86MM LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7282-0807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1811.0, "discounted_cash": 633.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PROX HUMERUS SUTURE TI PHP-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PHP-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2280.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PROXIMA HUMERUS RIGHT SZ 1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "STDPS1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6489.0, "discounted_cash": 2271.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PROXIMAL 4H 99MM HUMERUS RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "627234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4677.0, "discounted_cash": 1636.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PROXIMAL HUMERUS 4 HOLE LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110030101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PROXIMAL LATERAL 4H 99MM HUMERUS LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "627204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4677.0, "discounted_cash": 1636.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PROXIMAL LATERAL 5H 112MM HUMERUS LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "627205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4677.0, "discounted_cash": 1636.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PROXIMAL ULNA 108MM LEFT APL-PUP-6HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "APL-PUP-6HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3125.0, "discounted_cash": 1093.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PROXIMAL ULNA 73MM LEFT APL-PUP-3HL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "APL-PUP-3HL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2662.0, "discounted_cash": 931.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE R STANDARD LAPIDUS 300-83-004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-83-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIAL STYLOID DIVERGENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3840.0, "discounted_cash": 1344.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS 2.4MM 3 HOLE HEAD X 3 HOLE SHAFT LCP DIST RADIUS POSITIVE 90 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 375.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS 2.4MM X 40MM 3 HOLE X 3 HOLE DISTL LCP DORSAL RIGHT ANGLED TI IMP L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.477", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1110.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS 2.4MM X 43MM 3 HOLE X 5 HOLE RIGHT VOLAR DIST LCP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2096.84, "discounted_cash": 733.89, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS 2.4MM X 45MM 3 HOLE X 5 HOLE LFT VOLAR DIST LCP JUXTA ARTICULAR TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.491", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1949.0, "discounted_cash": 682.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS 2.4MM X 48MM 5 HOLE DISTL LCP DORSAL STR TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.479", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1053.0, "discounted_cash": 368.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS 2.4MM X 57MM 6 HOLE DIST LCP STRAIGHT TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.49", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1067.0, "discounted_cash": 373.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS 2.4MM X 61MM 5 HOLE X 5 HOLE LFT VOLAR DIST LCP TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.492", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2064.0, "discounted_cash": 722.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS 2.4MM X 61MM 5 HOLE X 5 HOLE RIGHT VOLAR DIST LCP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS LNG VOLAR DIST LFT NARROW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2603.0, "discounted_cash": 911.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS TRIANGULAR DISTAL VOLAR 54MM 3HOLES RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PRRTN2203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1280.0, "discounted_cash": 448.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS VOLAR DIST LFT STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2785.0, "discounted_cash": 974.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS VOLAR DIST NARROW LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2209.0, "discounted_cash": 773.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS VOLAR DIST RIGHT NARROW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2571.0, "discounted_cash": 899.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS VOLAR DIST STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2839.0, "discounted_cash": 993.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RADIUS VOLAR DIST WIDE LFT ACU LOC 2 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5993.0, "discounted_cash": 2097.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RECON MTP 48MM STRAIGHT RIGHT TMP48-R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TMP48-R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3490.0, "discounted_cash": 1221.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RECON MTP LARGE 0D 53MM LEFT TMP53-0L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TMP53-0L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 1256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RECON MTP LARGE 5D 53MM LEFT TMP53-5L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TMP53-5L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1772.72, "discounted_cash": 620.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RECON MTP MEDIUM OD 45MM RIGHT TMP45-OR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TMP45-OR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3490.0, "discounted_cash": 1221.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RECONSTRUCTION 3.5 8 HOLE/ 94M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 739.0, "discounted_cash": 258.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RECONSTRUCTION 3.5MM X 113MM 8 HOLE LCP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "245.081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 692.0, "discounted_cash": 242.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RECONSTRUCTION 3.5MM X 140MM 10 HOLE LCP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "245.101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1411.0, "discounted_cash": 493.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RECONSTRUCTION 3.5MM X 168MM 12 HOLE LCP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "245.121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1534.0, "discounted_cash": 536.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RECONSTRUCTION 3.5MM X 70MM 5 HOLE LCP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "245.051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 375.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RECONSTRUCTION 3.5MM X 84MM 6 HOLE LCP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "245.061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.0, "discounted_cash": 412.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RECONSTRUCTION 3.5MM X 98MM 7 HOLE LCP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "245.071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 435.0, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE REVISION 62MM RIGHT RECON MTP TMP62-R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TMP62-R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4017.0, "discounted_cash": 1405.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RIGHT 1ST MPJ FUSION 300-80-004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-80-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RIGHT ARSENAL LARGE LAPIDUS 300-83-006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-83-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5459.0, "discounted_cash": 1910.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RIGHT NC 300-85-004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-85-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4620.0, "discounted_cash": 1617.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RIM 2.4MM 2 HOLE LCP RADIAL HEAD LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.681", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1534.0, "discounted_cash": 536.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RING 1/2 180MM TABBED EX FIX DNE-180-OV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-180-OV", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3570.0, "discounted_cash": 1249.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RSP GLENOID 30MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "508-32-104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2318.0, "discounted_cash": 811.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE RT CALC FX PERC STD ANTERIOR PROC POST TUBER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8954YR-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3224.0, "discounted_cash": 1128.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SB 6 HOLE STRAIGHT SB-UP-0006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB-UP-0006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5974.0, "discounted_cash": 2090.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SCREW 3.5 X 20MM LOCKING V35ST320", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V35ST320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SCREW LAPIDUS FIXATION SYSTEM P40 ST245", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P40 ST245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2794.0, "discounted_cash": 977.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SHORT DORSAL SPANNING GMN-DSP-160", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-DSP-160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3247.0, "discounted_cash": 1136.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SHORT LAPIDUS LEFT 300-83-009", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-83-009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4700.0, "discounted_cash": 1645.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SHORT LEFT MEDIAL COLUMN 300-87-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-87-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6777.0, "discounted_cash": 2371.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SHORT PLATE 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7150-5018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5265.0, "discounted_cash": 1842.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SMALL 0D 40MM LEFT RECON MTP TMP40-0L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TMP40-0L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3490.0, "discounted_cash": 1221.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SMALL CALC MESH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-10102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2130.0, "discounted_cash": 745.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SMALL FRAG LOCKING HIGH FLEX RIGHT 1312-17-100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-17-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 936.0, "discounted_cash": 327.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SMALL MPX GRIDLOCK 300-51-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-51-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SMALL RECON MTP 0D 40MM RIGHT TMP40-OR-MTP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TMP40-OR-MTP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5665.0, "discounted_cash": 1982.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SPEED LAPIPLASTY 18X17MM SK52", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK52", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6254.0, "discounted_cash": 2188.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SPINE TWO LEVEL 41MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5612-1741", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ST. 6H 2.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "324-1002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 868.0, "discounted_cash": 303.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STANDARD X 300-88-009", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-88-009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4330.0, "discounted_cash": 1515.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STD DVR CROSSLOCK LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1318-22-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1596.0, "discounted_cash": 558.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRAIGHT 2 HOLE 2.7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "336-2704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3296.0, "discounted_cash": 1153.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRAIGHT 6 HOLE 52020306", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52020306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1584.0, "discounted_cash": 554.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRAIGHT FIBULA 8 HOLE 300-91-003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-91-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5022.0, "discounted_cash": 1757.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRAIGHT HAND/ FOOT 8 HOLE 1.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF-408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1667.0, "discounted_cash": 583.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRAIGHT TUBULAR 10-HOLE ORTHOLOC 3DI PLATING SYS 58880110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58880110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1428.0, "discounted_cash": 499.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRAIGHT TUBULAR 7 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58880107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1052.0, "discounted_cash": 368.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRAIGHT UNIVERSAL 2 HOLE SP-2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2920.0, "discounted_cash": 1022.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRENGTH 6 HOLE EVOS 2.7MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72442766N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4790.0, "discounted_cash": 1676.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STROP PLANTAR REPAIR KIT 3.0MM X 8.0MM 1601-0002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1601-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1971.0, "discounted_cash": 689.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRUT 1.5MM 8 HOLE OBLIQUE ANGLED PREBENT PROFILE LFT DIRECTION SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "446.482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRUT 1.5MM X 1MM 8 HOLE EXTENDED H LFT DIRECTION OBLIQUE ANGLED TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "446.483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRUXXURE STANDARD 1 LEVEL 22MM 31-1-22", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "31-1-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE STRUXXURE STANDARD 4 LEVEL 68MM 31-4-68", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "31-4-68", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SUBCONDYLAR 2MM GOLD FPS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "324-1090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1157.0, "discounted_cash": 404.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SURG 2.7MM 3.5MM 116MM 4 HOLE LFT VA LCP OLECRANON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.107.304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2632.0, "discounted_cash": 921.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SYNAFORCE INSTRUMENT KIT 1500-4700", "code_information": [{"code": "1500-4700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1353.0, "discounted_cash": 473.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE SYNDESMOSIS 58884010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58884010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1012.0, "discounted_cash": 354.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 1.5MM X 44MM 3 HOLE HEAD X 8 HOLE SHAFT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "446.233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 191.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 1.5MM X 44MM 4 HOLE HEAD X 8 HOLE SHAFT MODULAR HND TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "446.234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 2 HOLE VLP MINI MOD 2.0MM HEAD 6 HOLE SHAFT 74442014", "code_information": [{"code": "74442014", "type": "CDM"}], "standard_charges": [{"gross_charge": 2780.0, "discounted_cash": 973.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 2.4MM 3 HOLE HEAD X 4 HOLE SHAFT LCP DIST RADIUS TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1159.0, "discounted_cash": 405.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 2MM X 53MM 2 HOLE X 8 HOLE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "447.232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 2MM X 53MM 3 HOLE X 8 HOLE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "447.233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 3.5MM 4 HOLE HEAD RIGHT ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.161", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1034.0, "discounted_cash": 361.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 3.5MM 74MM 3 HEAD HOLE X 5 SHAFT HOLE LCP OBLIQUE ANGLED DIRECTION LFT S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.951", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 965.0, "discounted_cash": 337.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 3.5MM X 52MM 3 HOLE X 3 HOLE LCP OBLIQUE LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.931", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 883.0, "discounted_cash": 309.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 3.5MM X 74MM 3 HOLE HEAD X 5 HOLE SHAFT LCP OBLIQUE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 961.0, "discounted_cash": 336.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 3.5MM X 87MM 3 HOLE HEAD X 7 HOLE SHAFT LCP RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1296.0, "discounted_cash": 453.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 3.5MM X 96MM 3 HOLE HEAD X 7 HOLE SHAFT LCP OBLIQUE LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1047.0, "discounted_cash": 366.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 37MM OBLIQUE LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-15071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1959.0, "discounted_cash": 685.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 54X6.3X1.25MM TI HL LOPRO PRECONTOUR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.914", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 683.0, "discounted_cash": 239.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 56MM 4 HOLE LCP RIGHT ANGLE SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.141", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 811.0, "discounted_cash": 283.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 63MM 3 HEAD HOLE X 4 SHAFT HOLE OBLIQUE ANGLED DIRECTION LFT SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.941", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 925.0, "discounted_cash": 323.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T 67MM 3 HOLE HEAD X 5 HOLE SHAFT RIGHT ANGLED SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "241.151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 887.0, "discounted_cash": 310.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T COMPRESSION 7H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFP 317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3712.0, "discounted_cash": 1299.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T HAND/ FOOT 6 HOLE 1.0MM RHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF-340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 884.0, "discounted_cash": 309.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T ROTATION CORRECTION 2.0MM5 HOLE AR-18720P-48", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-18720P-48", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 573.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T SAMLL FRAGMENT 2.5MM TRILOK RADIUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1883.0, "discounted_cash": 659.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T VLP MINI MOD 2.0 MM 3 X 6 HOLE 74442018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74442018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3980.0, "discounted_cash": 1393.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE T0.5 2.8 TRILOCK OLECRANON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4856.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1893.0, "discounted_cash": 662.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TACK 1.0 65MM THREADED TACPLT-1.0/065 T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TACPLT-1.0/065 T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 247.0, "discounted_cash": 86.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TACK 10MM LEOS 7624-2210", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7624-2210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 374.4, "discounted_cash": 131.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TACK 20MM 7624-2220", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7624-2220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 374.4, "discounted_cash": 131.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TEDDY BEAR SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P53-154-0001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4303.0, "discounted_cash": 1506.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE THORACIC 70MM PLATE 19-10-0070", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "19-10-0070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE THORACO-LUMBAR 80MM PLATE 20-10-0080-00", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-10-0080-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBIA 3.5MM 87MM 4 HOLE VAR ANGLE LCP PROXIMAL SM BEND LFT ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.127.211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3725.0, "discounted_cash": 1303.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBIA 3.5MM 87MM 4 HOLE VAR ANGLE LCP PROXIMAL SM BEND RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.127.210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3725.0, "discounted_cash": 1303.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBIA 3.5MM 89MM 3 HOLE MEDIAL DIST LFT PERI LOC VLP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72820603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4079.0, "discounted_cash": 1427.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBIA FIBULA STRAIGHT 3 HOLE NONE", "code_information": [{"code": "NONE", "type": "CDM"}], "standard_charges": [{"gross_charge": 2441.0, "discounted_cash": 854.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBIAL 4H 73MM LEFT PROXIMAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-0404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3863.0, "discounted_cash": 1352.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBIAL SZ6 LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71424006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8448.0, "discounted_cash": 2956.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBL 4.5MM X 82.0MM LCP PROXIMAL 4 HOLE LFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "240.037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2281.0, "discounted_cash": 798.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBL 82MM 4 HOLE RIGHT SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "240.036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3446.0, "discounted_cash": 1206.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBL 89MM DIST LATERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2707.0, "discounted_cash": 947.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBL SZ 4 LFT REV LEGION IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71424004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6211.0, "discounted_cash": 2173.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBL SZ 4 PRIMARY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5520-B-400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3801.0, "discounted_cash": 1330.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TIBULAR 4 HOLE L4 7MM ONE THIRD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626674S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 741.0, "discounted_cash": 259.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TN RECON TL-TNP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TL-TNP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TOTAL WRIST FUSION PLATE SMALL RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7231.0, "discounted_cash": 2530.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TOTAL WRIST FUSION STAND RT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70-0326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7737.0, "discounted_cash": 2707.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TRAUMA 853-012 12MM OD PLATE 853-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "853-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 979.0, "discounted_cash": 342.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TRIALS ANATOMIC DISTAL FIBULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FIS 653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TRIALS DISTAL RADIUS", "code_information": [{"code": "FDR-992", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TRIALS LESSER METATARSAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FIS 614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TRIALS STRAIGHT WITH SLOTS", "code_information": [{"code": "FIS 610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TRIALS TWOH", "code_information": [{"code": "FIS 612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TRIALS UTILITY", "code_information": [{"code": "FIS 608", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TRIATHLON TRITANIUM BASEPLATE 5536-B-100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5536-B-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 937.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TRILOCK 2.5 ADAPTIVE II 11H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3147.0, "discounted_cash": 1101.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TRILOCK CLAVICLE MIDSHAFT 2.8 6H RIGHT A-4851.22", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4851.22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2884.0, "discounted_cash": 1009.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TRILOCK FIBULA 2.8/3.5 A-4954.01", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4954.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4006.0, "discounted_cash": 1402.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TUBULAR 3.5MM X 86MM 7 HOLE ONE THIRD LOCKING IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72823007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 863.0, "discounted_cash": 302.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TUBULAR 8 HOLE 1/3IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "336-0008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1329.0, "discounted_cash": 465.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TUBULAR LK 1/3 7 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "427067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 469.0, "discounted_cash": 164.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TUBULAR NON LOCKING 10 HOLE 1/3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-9440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE TWO LEVEL 34MM AP234", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AP234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ULNAR OSTEOTOMY COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "UOCP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2719.0, "discounted_cash": 951.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ULTOS MTP SMALL RIGHT OS42260SR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS42260SR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4166.0, "discounted_cash": 1458.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE UTILITY 6 HOLE CROSS CHECK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CCP-UTN6", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3166.0, "discounted_cash": 1108.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VARIAX 5 HOLE 1/3 TUBULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626675S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 801.0, "discounted_cash": 280.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VARIAX 6H COMPRESSION NAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1083.0, "discounted_cash": 379.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VARIAX 8 HOLE 1/3 TUBULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 741.0, "discounted_cash": 259.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VARIAX 8H COMPRESSION NARROW STRT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1558.0, "discounted_cash": 545.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VARIAX 9H COMPRESSION NAR STRT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1361.0, "discounted_cash": 476.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VARIAX COMPRESSION NAR STRT 7H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629507S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1062.0, "discounted_cash": 371.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VARISYNC\u00c2\u00ae ALIF RECESSED -12MM X 8\u00c2\u00b0 860-08-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "860-08-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10000.0, "discounted_cash": 3500.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VLP FIBULA 4H LT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72821004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2833.0, "discounted_cash": 991.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR 10H LFT XSML VARIAX INTERMEDIATE STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25773", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2022.0, "discounted_cash": 707.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR 6H 2.4MM ANGLE LCO DISTAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-111-610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2119.0, "discounted_cash": 741.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR DISTAL RADIUS NARROW 3H LT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8916VNL-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 573.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR DISTAL RADIUS NARROW SZ 3 RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8916VNR-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2340.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR EXTRA SHORT NARROW 9-HOLE LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1983.0, "discounted_cash": 694.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR EXTRA SHORT NARROW 9-HOLE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25583", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2022.0, "discounted_cash": 707.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR INTERMEDIARE 3 HOLE 65 MM SHORT 54-25674", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1983.0, "discounted_cash": 694.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR INTERMEDIATE 10 HOLE 76MM LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2022.0, "discounted_cash": 707.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR INTERMEDIATE 14 HOLE 84MM LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25684", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1983.0, "discounted_cash": 694.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR INTERMEDIATE LFT 10HOLE 65MM SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25673", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2022.0, "discounted_cash": 707.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR NARROW LNG DIST RADIUS SMARTLOCK RIGHT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-25385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2603.0, "discounted_cash": 911.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE VOLAR R 13 HOLE, LONG, 2.5 ADAPTIVE II TRILOCK DISTRAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4170.0, "discounted_cash": 1459.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE WIRE MEDIUM 1.2MM K60-12M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K60-12M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE XLARGE DOG BONE PARALLEL RECON TDB-PXL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TDB-PXL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4635.0, "discounted_cash": 1622.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE Y 1.5MM X 46MM 3 HOLE X 8 HOLE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "446.612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 191.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE Y 16.1MM X 40.5MM HIGH FLEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-17-103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 936.0, "discounted_cash": 327.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE Y 2.0MM 629771", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1636.0, "discounted_cash": 572.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE Y 2/4 HOLE FIXATION IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4300.13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 983.0, "discounted_cash": 344.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE Y 2MM X 55MM 3 HOLE X 8 HOLE MODULAR HND TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "447.612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE Y 2MM X 55MM 3 HOLE X 8 HOLE STRAIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "447.032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE Z 2.3MM 13 HOLE 1.5MM PROFILE HEIGHT NRW OSTEOSYNTHESIS HND PLATING SYS PR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57-15379", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 347.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE-A TIBIAL DISTAL 5H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DAT 005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1332.0, "discounted_cash": 466.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE-A TRIALS DISTAL TIBIAL", "code_information": [{"code": "FIS 654", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE-L TRIALS ELONGATED", "code_information": [{"code": "FIS 602", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE-X COMPRESSION 1.7MM X 17MM LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFP 618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3657.0, "discounted_cash": 1279.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE-X TRIALS", "code_information": [{"code": "FIS 611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATEFIBULA VARIAX 8H 137MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1786.0, "discounted_cash": 625.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATEFIXATION 16H CURVED 1.2/1.5 GOLD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4300.05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1110.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATELET ANTIBODIES", "code_information": [{"code": "86022", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET DEPLETE OF HARVEST", "code_information": [{"code": "38213", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET SURVIVAL", "code_information": [{"code": "78191", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 447.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 703.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 703.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 703.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 241.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 258.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATES FOOT 205MM STRAIGHT ADULT DF-R300-205", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DF-R300-205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5902.0, "discounted_cash": 2065.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATFORM ACCESS SNGLINCISION W/ GELSEAL CAP ALEXIS WOUND PROTECTOR RETRACTOR 10", "code_information": [{"code": "CNGL2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1568.0, "discounted_cash": 548.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATING AIRLOCK SYSTEM KIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SUI02001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3245.0, "discounted_cash": 1135.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLCG2 GENE COMMON VARIANTS", "code_information": [{"code": "81320", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 742.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1168.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1168.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1168.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 419.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 419.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH CC", "code_information": [{"code": "187", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6283.13, "maximum": 10786.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6283.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8986.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9884.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10786.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH MCC", "code_information": [{"code": "186", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9390.94, "maximum": 16121.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9390.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13431.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14774.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16121.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITHOUT CC/MCC", "code_information": [{"code": "188", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4437.55, "maximum": 7618.17, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4437.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6346.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6981.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7618.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT ACCESS BIL TREE SM BWL", "code_information": [{"code": "47541", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47533", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47534", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROSTOMY CATHETER", "code_information": [{"code": "50432", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROURETERAL CATHETER", "code_information": [{"code": "50433", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT ADDL", "code_information": [{"code": "222T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT CERV", "code_information": [{"code": "219T", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT LUMB", "code_information": [{"code": "221T", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT THOR", "code_information": [{"code": "220T", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV 1ST", "code_information": [{"code": "10035", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV EA", "code_information": [{"code": "10036", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50693", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50694", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50695", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT XTN PROSTH EVASC RPR", "code_information": [{"code": "34709", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLNNING PT SPEC FENEST GRAFT", "code_information": [{"code": "34839", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLS AIMING GUIDES PLS-AIM-0910", "code_information": [{"code": "PLS-AIM-0910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG CATHETER DRAINAGE PROTECTOR 000076", "code_information": [{"code": "76", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG CEMENT SZ 8 CLEARCUT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "415-00-080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 51.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG CEMENTED SZ10 CLEARCUT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "415-00-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 51.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG MESH 1.9IN X 1.6IN LG SURG HERNIA REPAIR NON ABSORBL STRL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "112970", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG MESH LG 4.1CM X 4.8CM SURG", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "112770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG MESH LG 5CM ANCHOR 5CM RIM PARTIALLY ABSOBABLE ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UPPL2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG MESH MED 12 CM X 7.5 CM MED 4 CM HERNIA REPAIR ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UPPM2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 561.0, "discounted_cash": 196.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG MESH MEDIUM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "112760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG SURG GROIN HRN PLT EDG INNR PETAL MFL MRLX PRFX PP SM 1", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "112750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 102.0, "discounted_cash": 35.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUS DBM 3CC DBM W/ CANCELLOUS CHIP XEMPLIFI", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "8103.0203S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1180.0, "discounted_cash": 413.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PM DEVICE PROGR EVAL DUAL", "code_information": [{"code": "93280", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PM DEVICE PROGR EVAL MULTI", "code_information": [{"code": "93281", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PM PHONE R-STRIP DEVICE EVAL", "code_information": [{"code": "93293", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PML/RARALPHA 1 BREAKPOINT", "code_information": [{"code": "81316", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 319.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 528.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PML/RARALPHA COM BREAKPOINTS", "code_information": [{"code": "81315", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 319.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 528.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 831.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 298.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE DUP/DELET", "code_information": [{"code": "81324", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 947.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1933.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3041.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3041.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3041.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1092.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1092.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE FULL SEQUENCE", "code_information": [{"code": "81325", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 961.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1962.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3086.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3086.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3086.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1108.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1108.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE KNOWN FAM VARIANT", "code_information": [{"code": "81326", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 118.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 186.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 186.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 186.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 67.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 67.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMS2 GENE DUP/DELET VARIANTS", "code_information": [{"code": "81319", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 254.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 518.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 816.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 816.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 816.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 293.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 293.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMS2 GENE FULL SEQ ANALYSIS", "code_information": [{"code": "81317", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 883.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1725.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2712.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2712.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2712.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 974.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 974.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMS2 KNOWN FAMILIAL VARIANTS", "code_information": [{"code": "81318", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 413.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 844.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1327.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1327.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1327.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 476.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 476.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMS2 MRNA SEQ ALYS", "code_information": [{"code": "161U", "type": "CPT"}], "standard_charges": [{"minimum": 407.35, "maximum": 2712.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1725.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2712.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2712.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2712.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNE FLU HEPB COV HOME ADMIN", "code_information": [{"code": "M0201", "type": "HCPCS"}], "standard_charges": [{"minimum": 156.56, "maximum": 246.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 156.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 246.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 246.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 246.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNE NOT GIVEN NORSN", "code_information": [{"code": "G9280", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNE SCRN DONE DOC NOT IND", "code_information": [{"code": "G9281", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNE SCRN DONE DOC VAC DONE", "code_information": [{"code": "G9279", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUM VAX ADMIN 19+", "code_information": [{"code": "M1305", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOCOCCAL VACCINE ADMIN", "code_information": [{"code": "G8864", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOCYSTIS CARINII AG IF", "code_information": [{"code": "87281", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX TRAY", "code_information": [{"code": "8888567032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 261.0, "discounted_cash": 91.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITH CC", "code_information": [{"code": "200", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6548.35, "maximum": 11241.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6548.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9365.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10302.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11241.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITH MCC", "code_information": [{"code": "199", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10888.57, "maximum": 18692.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10888.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15573.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17130.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18692.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITHOUT CC/MCC", "code_information": [{"code": "201", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4316.5, "maximum": 7410.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4316.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6173.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6790.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7410.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PNXR ASPIR ABSC HMTMA BULLA", "code_information": [{"code": "10160", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PODIATRY SS", "code_information": [{"code": "G4028", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [{"code": "917", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8993.72, "maximum": 15439.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8993.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12862.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14149.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15439.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC", "code_information": [{"code": "918", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4815.3, "maximum": 8266.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4815.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6886.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7575.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8266.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLIOVIRUS IPV SC/IM", "code_information": [{"code": "90713", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLLICIZATION OF A DIGIT 26550", "code_information": [{"code": "26550", "type": "CPT"}, {"code": "44768019", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 3836.0, "discounted_cash": 1342.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1856.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLY SZ 2 8MM 33652208", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "33652208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4087.0, "discounted_cash": 1430.45, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYMYXIN B SULF 500MU VIAL", "code_information": [{"code": "MED0174", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYMYXIN B SULFATE 500,000 UNITS VIAL", "code_information": [{"code": "MED0175", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYPECTOMY NASAL-EXTENSIVE 30115", "code_information": [{"code": "30115", "type": "CPT"}, {"code": "1481621", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYPECTOMY NASAL-SIMPLE 30110", "code_information": [{"code": "30110", "type": "CPT"}, {"code": "1481622", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 789.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSCREW 3.5X12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FAAA35012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1391.0, "discounted_cash": 486.85, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYSOM 6/> YRS 4/> PARAM", "code_information": [{"code": "95810", "type": "CPT"}], "standard_charges": [{"minimum": 2209.15, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2209.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3471.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3471.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3471.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSOM 6/>YRS CPAP 4/> PARM", "code_information": [{"code": "95811", "type": "CPT"}], "standard_charges": [{"minimum": 2322.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2322.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3648.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3648.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3648.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSOM <6 YRS 4/> PARAMTRS", "code_information": [{"code": "95782", "type": "CPT"}], "standard_charges": [{"minimum": 3507.63, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3507.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5511.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5511.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5511.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSOM <6 YRS CPAP/BILVL", "code_information": [{"code": "95783", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3720.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5846.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5846.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5846.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSOM ANY AGE 1-3> PARAM", "code_information": [{"code": "95808", "type": "CPT"}], "standard_charges": [{"minimum": 2616.01, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2616.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4110.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4110.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4110.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYTIP CANNULA 25G/38G 2MM 3255", "code_information": [{"code": "3255", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 163.0, "discounted_cash": 57.05, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYVALENT MULT ORG EA AG IA", "code_information": [{"code": "87451", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POOLING BLOOD PLATELETS", "code_information": [{"code": "86965", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PORT A CATH II PAC LOW PROFILE DELTEC", "code_information": [{"code": "21-4482-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1222.1, "discounted_cash": 427.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PORT IMPLANTABLE 8FRINSUFFLATED CATH OPEN END LIGHTWEIGHT POWERPORT ISP INTERMEDIATE MRI PLUS", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "1808050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PORT IMPLANTABLE 8FRINSUFFLATED CATH OPEN END LIGHTWEIGHT POWERPORT MRI PLUS", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "1808000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 503.0, "discounted_cash": 176.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PORT TROCAR SHRT 5.5 SECONDARY", "code_information": [{"code": "24055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "POS AIRWAY PRESS PRESCRIBED", "code_information": [{"code": "G8845", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POS AIRWAY PRESSURE CPAP", "code_information": [{"code": "94660", "type": "CPT"}], "standard_charges": [{"minimum": 811.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 811.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POS CLIN DEPRES SCRN F/U DOC", "code_information": [{"code": "G8431", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSISEP C", "code_information": [{"code": "9210764", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONAL CHANGE OF FINGER", "code_information": [{"code": "26555", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSITIONAL NYSTAGMUS TEST", "code_information": [{"code": "92532", "type": "CPT"}], "standard_charges": [{"minimum": 63.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 99.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSITIONAL NYSTAGMUS TEST", "code_information": [{"code": "92542", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSITIONER ARTHROSCOPIC WHT KNEE HOLDER WITHOUT COVER LF", "code_information": [{"code": "NON081446", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER BERKETTE BEACH CHAIR LIMB POSITIONER STERILE 711200", "code_information": [{"code": "711200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER CRADLE HEAD FOAM", "code_information": [{"code": "FP-HEADCR", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER FOAM KNEE ARTHROSCOPIC FP-ARTKNEE", "code_information": [{"code": "FP-ARTKNEE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.2, "discounted_cash": 11.97, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER HD 6IN X 10.75IN X 9.75IN RASPBERRY FRM REST FOAM LATEX WITHOUT COVER", "code_information": [{"code": "NON081146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER HEAD 8 X 9 X 1/4 CRADLE LF ADLT", "code_information": [{"code": "8815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER HEAD 9IN X 2IN RING CUSHION FOAM", "code_information": [{"code": "NON081141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER HEAD FOAM ADULT 9 X 8 X 4.5IN", "code_information": [{"code": "NON081144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER HEAD UNIVERSAL FOR LIFT ASSIST BEACH CHAIR POSITIONING DISP", "code_information": [{"code": "AR-1627-06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER HEADREST FOAM SOFTOUCH", "code_information": [{"code": "FP-HEADSF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 30.52, "discounted_cash": 10.68, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER SHOULDER LG SUPPORT ARM", "code_information": [{"code": "12-401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.52, "discounted_cash": 45.68, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONING DEVICE GASTRISAIL 36FR GASTRIC BARIATRIC", "code_information": [{"code": "GPS36", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1279.0, "discounted_cash": 447.65, "setting": "both", "billing_class": "facility"}]}, {"description": "POST D/C H VST NEW PT 20 M", "code_information": [{"code": "G2001", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST DRILL 1.6MM", "code_information": [{"code": "510-16-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 232.75, "setting": "both", "billing_class": "facility"}]}, {"description": "POST FXTN 2 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-11610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 351.0, "discounted_cash": 122.85, "setting": "both", "billing_class": "facility"}]}, {"description": "POST FXTN ONE HOLE RING FXTN SYS TRUELOK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-11600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POST OP SERVICE LVRS MIN 6", "code_information": [{"code": "G0305", "type": "HCPCS"}], "standard_charges": [{"minimum": 2141.54, "maximum": 3365.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST TAPER 12MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "U110-0218-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1362.0, "discounted_cash": 476.7, "setting": "both", "billing_class": "facility"}]}, {"description": "POST TAPER 7.0MM HEMICAP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9070-0013-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 933.0, "discounted_cash": 326.55, "setting": "both", "billing_class": "facility"}]}, {"description": "POST TAPER 9.5MM ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9095-0018-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POST VERT ARTHRPLST 1 LUMBAR", "code_information": [{"code": "202T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-COITAL MUCOUS EXAM", "code_information": [{"code": "Q0115", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 100.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 100.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C CARE PLAN OVERS 30M", "code_information": [{"code": "G2014", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C CARE PLAN OVERS 60M", "code_information": [{"code": "G2015", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 20 M", "code_information": [{"code": "G2006", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 30 M", "code_information": [{"code": "G2007", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 45 M", "code_information": [{"code": "G2008", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 60 M", "code_information": [{"code": "G2009", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 75 M", "code_information": [{"code": "G2013", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 30 M", "code_information": [{"code": "G2002", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 45 M", "code_information": [{"code": "G2003", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 60 M", "code_information": [{"code": "G2004", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 75 M", "code_information": [{"code": "G2005", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR COLPORRHAPHY REPAIR OF RECTOCELE 57250", "code_information": [{"code": "57250", "type": "CPT"}, {"code": "1481626", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR NON SEGMENTAL INSTRUMENTATION 22840", "code_information": [{"code": "22840", "type": "CPT"}, {"code": "1653279", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2808.0, "discounted_cash": 982.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1359.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR SEGMENTAL INSTRUMENTATION 22842", "code_information": [{"code": "22842", "type": "CPT"}, {"code": "1653280", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3772.0, "discounted_cash": 1320.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1825.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR TIBIALIS TENDON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "443016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POSTOP FOLLOW-UP VISIT", "code_information": [{"code": "99024", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTOP REN FAIL", "code_information": [{"code": "G8575", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC", "code_information": [{"code": "862", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11537.63, "maximum": 19807.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11537.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16501.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18151.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19807.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC", "code_information": [{"code": "863", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6152.35, "maximum": 10562.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6152.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8799.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9679.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10562.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "857", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12788.9, "maximum": 21955.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12788.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18290.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20119.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21955.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "856", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28370.5, "maximum": 48705.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28370.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 40575.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 44633.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48705.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "858", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8270.45, "maximum": 14198.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8270.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11828.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13011.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14198.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES", "code_information": [{"code": "769", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9839.86, "maximum": 16892.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9839.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14073.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15480.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16892.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES", "code_information": [{"code": "776", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4711.28, "maximum": 8088.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4711.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6738.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7411.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8088.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POTASSIUM HYDROXIDE PREPS", "code_information": [{"code": "Q0112", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 23.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POUCH ENDOCATCH GOLD 10MM SPECIMEN 1TIME 173050G", "code_information": [{"code": "173050G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.0, "discounted_cash": 214.9, "setting": "both", "billing_class": "facility"}]}, {"description": "POUCH RETRIEVAL 5IN X 8IN SPECIMEN ENDOBAG", "code_information": [{"code": "25040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "billing_class": "facility"}]}, {"description": "POUCH SELF SEAL 10\" x 15\"", "code_information": [{"code": "886115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "POUCH SELF SEAL 4IN x 9IN", "code_information": [{"code": "886049", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "POUCH SURG 7IN X 11ININSTR DRP PLASTIC STERI DRP LF STRL", "code_information": [{"code": "1018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "POVIDONE IODINE (BETADINE) TOP 10% SOL 120 ML", "code_information": [{"code": "MED0027", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "POVIDONE IODINE (BETADINE) TOPICAL 10% OINT 1 GM", "code_information": [{"code": "MED0025", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "POVIDONE IODINE 30 GRAMS OINTMENT (BETADINE)10%", "code_information": [{"code": "MED0176", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "POVIDONE IODINE 5% OPHTH 30ML (BETADINE)", "code_information": [{"code": "MED0177", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "POVIDONE IODINE 5% OPHTHALMIC SOLUTION 30ML BOTTLE", "code_information": [{"code": "MED0026", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "POWDER HEMOSTATIC SURGICEL ABSORBABLE", "code_information": [{"code": "3013SP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 473.27, "discounted_cash": 165.64, "setting": "both", "billing_class": "facility"}]}, {"description": "POWDER MAVIX-C 05 CC TOPICAL COLLAGEN XOB05C", "code_information": [{"code": "A6010", "type": "HCPCS"}, {"code": "XOB05C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4951.0, "discounted_cash": 1732.85, "setting": "both", "billing_class": "facility"}]}, {"description": "POWDER SURGIFOAM PORCINE STRL 1978", "code_information": [{"code": "1978", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "POWER BOX NSK", "code_information": [{"code": "5770POWER", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 968.4, "discounted_cash": 338.94, "setting": "both", "billing_class": "facility"}]}, {"description": "PP EVAL/EDU NOT PERF", "code_information": [{"code": "G9358", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PP EVAL/EDU PERF", "code_information": [{"code": "G9357", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PPP2R2B GEN DETC ABNOR ALLEL", "code_information": [{"code": "81343", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PPSV23 VACC 2 YRS+ SUBQ/IM", "code_information": [{"code": "90732", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRCRD DRG 0-5YR OR W/ANOMLY", "code_information": [{"code": "33018", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRCRD DRG 6YR+ W/O CGEN CAR", "code_information": [{"code": "33017", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-HTN OR HTN DOC, F/U INDC", "code_information": [{"code": "G8950", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-HTN OR HTN DOC, F/U INDC", "code_information": [{"code": "M1278", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-HTN/HTN, NO F/U, NOT GVN", "code_information": [{"code": "G8952", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-HTN/HTN, NO F/U, NOT GVN", "code_information": [{"code": "M1279", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS 1-9 DOS", "code_information": [{"code": "G0304", "type": "HCPCS"}], "standard_charges": [{"minimum": 2141.54, "maximum": 3365.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS 10-15DOS", "code_information": [{"code": "G0303", "type": "HCPCS"}], "standard_charges": [{"minimum": 610.12, "maximum": 958.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS COMPLETE", "code_information": [{"code": "G0302", "type": "HCPCS"}], "standard_charges": [{"minimum": 2141.54, "maximum": 3365.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-PLAN 3D MODEL W/CCTA", "code_information": [{"code": "C9793", "type": "HCPCS"}], "standard_charges": [{"minimum": 4353.31, "maximum": 6843.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4353.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6843.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-SHAPED ACHILLES TENDON 0.9 X 27.0/CBL = 2.5CM PS289FF", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PS289FF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6788.0, "discounted_cash": 2375.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PRECISION NOVIL PULSE GENERATOR KIT WITH RELATED COMPONENTS", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1042C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40685.0, "discounted_cash": 14239.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRED<=5 MG RA GLU <6M", "code_information": [{"code": "G2112", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRED>5 MG >6M, NO CHG DA", "code_information": [{"code": "G2113", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREDNISOLONE ACETATE OPHTH SUSP 1% 5ML", "code_information": [{"code": "MED0490", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PREG DRNG ADJV TRTMT", "code_information": [{"code": "G2205", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREMARIN VAGINAL CREAM 0.625 MG/G 30G (NO CHARGE)", "code_information": [{"code": "MED0233", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 740.0, "discounted_cash": 259.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [{"code": "791", "type": "MS-DRG"}], "standard_charges": [{"minimum": 988.0, "maximum": 988.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [{"code": "792", "type": "MS-DRG"}], "standard_charges": [{"minimum": 988.0, "maximum": 988.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PREMIUM FOUR-PANEL ABDOMINAL BINDER", "code_information": [{"code": "ORT213101XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE-BREAST 19290", "code_information": [{"code": "1481627", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PREP & CANNULJ CDVR DON LUNG", "code_information": [{"code": "494T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP CADAVER RENAL ALLOGRAFT", "code_information": [{"code": "50323", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP CHLORAPREP 26ML ORANGE STERILE 930815", "code_information": [{"code": "930815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/ARTERY", "code_information": [{"code": "44721", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/VENOUS", "code_information": [{"code": "44720", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER 3-SEGMENT", "code_information": [{"code": "47144", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER LOBE SPLIT", "code_information": [{"code": "47145", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER WHOLE", "code_information": [{"code": "47143", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/ARTERIAL", "code_information": [{"code": "47147", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/VENOUS", "code_information": [{"code": "47146", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS", "code_information": [{"code": "48551", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/ARTERIAL", "code_information": [{"code": "50328", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/URETERAL", "code_information": [{"code": "50329", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/VENOUS", "code_information": [{"code": "50327", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP TUM CAV IORT PRIM CRNOT", "code_information": [{"code": "735T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARATION FOR BLADDER XRAY", "code_information": [{"code": "51605", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARATION OF REPORT", "code_information": [{"code": "90889", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARATION PALATE MOLD", "code_information": [{"code": "42280", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART", "code_information": [{"code": "33944", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART/LUNG", "code_information": [{"code": "33933", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR INTESTINE", "code_information": [{"code": "44715", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG DOUBLE", "code_information": [{"code": "32856", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG SINGLE", "code_information": [{"code": "32855", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE EMBRYO FOR TRANSFER", "code_information": [{"code": "89255", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21077", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21079", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21080", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21081", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21082", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21083", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21084", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21085", "type": "CPT"}], "standard_charges": [{"minimum": 1508.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21086", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21087", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21088", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FECAL MICROBIOTA", "code_information": [{"code": "44705", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE HEART-AORTA CONDUIT", "code_information": [{"code": "33404", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE PENIS STUDY", "code_information": [{"code": "54230", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE SPERM DUCT X-RAY", "code_information": [{"code": "55300", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPJ TUM CAV IORT PRTL MAST", "code_information": [{"code": "19294", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRES ANTIBX ON/WITHIN 3 DAY", "code_information": [{"code": "G8711", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRES DIG COG BEHAV THERA FDA", "code_information": [{"code": "A9291", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRES DIG VISUAL THERAPY FDA", "code_information": [{"code": "A9292", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRESC ANTICO MED IN PP", "code_information": [{"code": "M1056", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRESSURE TREATMENT ESOPHAGUS", "code_information": [{"code": "43460", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 15", "code_information": [{"code": "99401", "type": "CPT"}], "standard_charges": [{"minimum": 111.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 30", "code_information": [{"code": "99402", "type": "CPT"}], "standard_charges": [{"minimum": 225.7, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 225.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 354.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 354.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 354.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 45", "code_information": [{"code": "99403", "type": "CPT"}], "standard_charges": [{"minimum": 336.92, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 336.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 529.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 529.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 529.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 60", "code_information": [{"code": "99404", "type": "CPT"}], "standard_charges": [{"minimum": 446.6, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 446.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 701.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 701.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 701.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV TRT INF D/O HIV/HEP MVP", "code_information": [{"code": "M1368", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 1-4", "code_information": [{"code": "99392", "type": "CPT"}], "standard_charges": [{"minimum": 344.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 344.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 12-17", "code_information": [{"code": "99394", "type": "CPT"}], "standard_charges": [{"minimum": 390.99, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 390.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 614.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 614.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 614.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 18-39", "code_information": [{"code": "99395", "type": "CPT"}], "standard_charges": [{"minimum": 402.1, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 402.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 631.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 631.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 631.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 40-64", "code_information": [{"code": "99396", "type": "CPT"}], "standard_charges": [{"minimum": 435.49, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 435.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 684.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 684.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 684.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 5-11", "code_information": [{"code": "99393", "type": "CPT"}], "standard_charges": [{"minimum": 344.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 344.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 12-17", "code_information": [{"code": "99384", "type": "CPT"}], "standard_charges": [{"minimum": 457.71, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 457.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 719.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 719.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 719.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 18-39", "code_information": [{"code": "99385", "type": "CPT"}], "standard_charges": [{"minimum": 438.66, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 438.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 689.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 689.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 689.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 40-64", "code_information": [{"code": "99386", "type": "CPT"}], "standard_charges": [{"minimum": 534.01, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 534.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 839.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 839.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 839.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 5-11", "code_information": [{"code": "99383", "type": "CPT"}], "standard_charges": [{"minimum": 390.99, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 390.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 614.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 614.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 614.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREVENTIVE COUNSELING GROUP", "code_information": [{"code": "99411", "type": "CPT"}], "standard_charges": [{"minimum": 34.97, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREVENTIVE COUNSELING GROUP", "code_information": [{"code": "99412", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREVENTIVE MEDICINE SS", "code_information": [{"code": "G4029", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL ICDS SS IP", "code_information": [{"code": "575T", "type": "CPT"}], "standard_charges": [{"minimum": 92.44, "maximum": 145.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL IIMS IP", "code_information": [{"code": "528T", "type": "CPT"}], "standard_charges": [{"minimum": 92.44, "maximum": 145.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL ISDSS IP", "code_information": [{"code": "683T", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 251.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL PM/LDLS PM", "code_information": [{"code": "93279", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL SCRMS IP", "code_information": [{"code": "93285", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL SCRMS REMOTE", "code_information": [{"code": "650T", "type": "CPT"}], "standard_charges": [{"minimum": 94.73, "maximum": 148.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 94.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 148.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 148.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 148.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL WCS IP", "code_information": [{"code": "522T", "type": "CPT"}], "standard_charges": [{"minimum": 92.44, "maximum": 145.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "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": 159.86, "maximum": 251.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93282", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93283", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93284", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVL LDLS PM 1CHMBR IP", "code_information": [{"code": "826T", "type": "CPT"}], "standard_charges": [{"minimum": 91.62, "maximum": 144.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 91.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 144.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 144.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 144.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVL LDLS PM 2CHMBR IP", "code_information": [{"code": "804T", "type": "CPT"}], "standard_charges": [{"minimum": 89.25, "maximum": 140.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG IO RTA ELTRD RA", "code_information": [{"code": "472T", "type": "CPT"}], "standard_charges": [{"minimum": 690.82, "maximum": 1086.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 690.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1086.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1086.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1086.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC 1ST VSL", "code_information": [{"code": "37184", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC SBSQ VSL", "code_information": [{"code": "37185", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMARY REPAIR TENDON/MUSCLE EXTENSOR FOREARM/WRIST-SINGLE-EACH TENDON 25270", "code_information": [{"code": "25270", "type": "CPT"}, {"code": "1481628", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMARY REPAIR TENDON/MUSCLE FLEXOR FOREARM/WRIST-SINGLE EACH TENDON 25260", "code_information": [{"code": "25260", "type": "CPT"}, {"code": "1481629", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMARY REVERSE SHOULDER - AEQRVS II CAP1013", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP1013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10177.0, "discounted_cash": 3561.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIMARY REVERSE SHOULDER - ASCEND FLEX CAPFLEXREV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAPFLEXREV", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24720.0, "discounted_cash": 8652.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIMARY TRITANIUM HEMI CLUSTER HOLE CUP 52MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "502-03-52D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4076.0, "discounted_cash": 1426.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIMARY TRITANIUM HEMI CLUSTER HOLE CUP 56MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "502-03-56E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 980.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT PHYS 1ST 30", "code_information": [{"code": "99424", "type": "CPT"}], "standard_charges": [{"minimum": 346.49, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 346.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 544.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 544.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 544.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT PHYS EA ADDL", "code_information": [{"code": "99425", "type": "CPT"}], "standard_charges": [{"minimum": 241.58, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 241.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT STAFF 1ST 30", "code_information": [{"code": "99426", "type": "CPT"}], "standard_charges": [{"minimum": 232.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 364.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 364.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 364.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT STAFF EA ADDL", "code_information": [{"code": "99427", "type": "CPT"}], "standard_charges": [{"minimum": 163.7, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 163.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIOR DX/ACTIVE CLIN ASCVD", "code_information": [{"code": "G9662", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIOR HISTORY OF KNOWN CVD", "code_information": [{"code": "M1256", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIOR THYROID DISE DX", "code_information": [{"code": "G9553", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRO3 F AMNIOTIC INJECTABLE FLUID 2.00ML", "code_information": [{"code": "P01-AMF-0200", "type": "CDM"}], "standard_charges": [{"gross_charge": 10506.0, "discounted_cash": 3677.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PRO3-P AMNIOTIC PLACENTA MEMBRANE 4 X 8 CM", "code_information": [{"code": "P01-AMP-0408", "type": "CDM"}], "standard_charges": [{"gross_charge": 7807.0, "discounted_cash": 2732.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE 27GA LASER ANGLED CURVED", "code_information": [{"code": "PD727.22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ABLATOR 3MM 90DEG ASPIRATING COOLCUT", "code_information": [{"code": "AR-9803A-90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE APOLLO RF 50 DEG ASPIRATING ABLATOR", "code_information": [{"code": "AR-9815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE APOLLO RF 90 DEG MULTIPORT", "code_information": [{"code": "AR-9811", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BALL TIP NERVE STIM LAT 11IN", "code_information": [{"code": "2701-90257", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.77, "discounted_cash": 51.02, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BIPOLAR MICRO FORK 45MM STRAIGHT 5140-522-610", "code_information": [{"code": "5140-522-610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE CADWELL BALL TIP", "code_information": [{"code": "302430-000-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 798.93, "discounted_cash": 279.63, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE COVER 4 X54 VPC0454", "code_information": [{"code": "VPC0454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE DIATHERMY 27G 339.31", "code_information": [{"code": "339.31", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.64, "discounted_cash": 55.17, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE DISCOGRAPHY DISCMONITORINTERVENTIONAL SPINE DISCMONITOR", "code_information": [{"code": "407-290-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1037.94, "discounted_cash": 363.28, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE DISPOSABLE 6360-001", "code_information": [{"code": "6360-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 871.56, "discounted_cash": 305.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE DISPOSABLE INTECH SET LB-132", "code_information": [{"code": "LB-132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1576.8, "discounted_cash": 551.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ECKARDT 23G MUTLI-FIBER", "code_information": [{"code": "3269.MF06", "type": "CDM"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ENDO TOTAL VIEW 23G", "code_information": [{"code": "3.27E+09", "type": "CDM"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ENDODIATHERMY 27G POINTED TIP", "code_information": [{"code": "1120.04", "type": "CDM"}], "standard_charges": [{"gross_charge": 1726.0, "discounted_cash": 604.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ENDOILLUMINATION 25G", "code_information": [{"code": "3269.D05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 53.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE FIBER 25-30G", "code_information": [{"code": "14120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 205.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE HEMOSTASIS 350 CM OUTER DIA 7FR BIPLR SNGL PLUG SIVER HYDROPHILLIC TIP COA", "code_information": [{"code": "CD-B420LA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 162.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE HOOK 30 DEGREEINTEGRATED CABLE DYONICS RFINSTR", "code_information": [{"code": "72202145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE INCREMENTING 8225825E", "code_information": [{"code": "8225825E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 181.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE KIT FOR RFA", "code_information": [{"code": "MCK2-17-75-4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1050.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE KIT OPTABLATE CURVE 20MM SINGLE 9700-120-000", "code_information": [{"code": "9700-120-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10963.23, "discounted_cash": 3837.13, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER 23-27G 45 ANGLED STL", "code_information": [{"code": "14545", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER 23G STEPPED", "code_information": [{"code": "7511.ALC", "type": "CDM"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 152.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER 23G STEPPED ILLUM", "code_information": [{"code": "7510.ALC", "type": "CDM"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 152.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER 25G STEPPED", "code_information": [{"code": "7525.ALC", "type": "CDM"}], "standard_charges": [{"gross_charge": 429.0, "discounted_cash": 150.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER 25GA ILLUMINATED FLEXIBLE CURVED 8065751593", "code_information": [{"code": "8065751593", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER ILLUMINATED PIK 25GA W/RFID 8065751572", "code_information": [{"code": "8065751572", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 347.0, "discounted_cash": 121.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER OPTH 25G 20DEG BRIGHTLIGHT STEPPED ANGLED", "code_information": [{"code": "14560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE NANOSCOPE AR-10100N", "code_information": [{"code": "AR-10100N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 451.97, "discounted_cash": 158.19, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE NDL TIP SPATULA W/ ADAPTER AND CABLEINSTR", "code_information": [{"code": "250-070-441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 458.4, "discounted_cash": 160.44, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE NEUROMONITORING SPINAL GUIDE WIRE AVS ARIA", "code_information": [{"code": "48755006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE NL DUCT W/BALLOON", "code_information": [{"code": "68816", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBE PICK LIGHT 23GA OPHTHALMOLOGY STRAIGHT", "code_information": [{"code": "PD123.03A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE PTEYE FIBER OPTIC ASSEMBLY PTEYE-1", "code_information": [{"code": "PTEYE-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE RADIO FREQUENCE DFT-32", "code_information": [{"code": "DFT-32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1237.35, "discounted_cash": 433.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE RADIO FREQUENCY DFT-31/32", "code_information": [{"code": "DFT-31/32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1237.35, "discounted_cash": 433.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE RADIOFREQUENCY BLACK ABLTR HIP ELECTROSURGERY W/INTEGRATED CABLE DYONICS E", "code_information": [{"code": "72200683", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1550.0, "discounted_cash": 542.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE RADIOFREQUENCY LUMBARCOOL", "code_information": [{"code": "LUP-17-100-4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1342.0, "discounted_cash": 469.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE RF FG 0043", "code_information": [{"code": "FG 0043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9105.0, "discounted_cash": 3186.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE RF INTRACEPT RLV0015", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "RLV0015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8840.0, "discounted_cash": 3094.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE RHYZOTOMY 17GA X 75MM X 4MM COLD THERAPY", "code_information": [{"code": "SIP-17-75-4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1342.0, "discounted_cash": 469.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE SPATULA ELECTROCAUTERY SHEATHINSTR", "code_information": [{"code": "250-070-460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.68, "discounted_cash": 48.54, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE STIMULATING SIDE-BY-SIDE BIPOLAR ENT", "code_information": [{"code": "8225401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 438.0, "discounted_cash": 153.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE STIMULATOR I62-48-01", "code_information": [{"code": "I62-48-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 423.0, "discounted_cash": 148.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE STMLTR .5MM TIP MONOPOLAR STANDARD PRASS FLUSH TIP FOR LOCATING AND MAPPIN", "code_information": [{"code": "8225101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 136.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE SUCTION 5MM IRRIGATION CORSON", "code_information": [{"code": "5200-902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 46.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE TIP NIM SURGEON CONTROL PRASS 8225825X", "code_information": [{"code": "8225825X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 517.0, "discounted_cash": 180.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE TRUVIEW SYSTEM XL DISPOSABLE BTP255-2.3-1B", "code_information": [{"code": "BTP255-2.3-1B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1624.0, "discounted_cash": 568.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE VITRECTOMY 25GA STANDALONE CUTTER 8065830026", "code_information": [{"code": "8065830026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 707.0, "discounted_cash": 247.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE VITRECTOMY ANTERIOR CENTURION 23GA", "code_information": [{"code": "8065752134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE VITRECTOMY HYPERVIT 8065830077", "code_information": [{"code": "8065830077", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1495.38, "discounted_cash": 523.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBEINCREMENT STANDARD PRASS TIP", "code_information": [{"code": "8225825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 517.0, "discounted_cash": 180.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBING OF LACRIMAL CANALICULI WITH OR WITHOUT IRRIGATION 68840", "code_information": [{"code": "68840", "type": "CPT"}, {"code": "1481630", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 287.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBING OF NASOLACRIMAL DUCT 68810", "code_information": [{"code": "68810", "type": "CPT"}, {"code": "1481631", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 789.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBING OF NASOLACRIMAL DUCT REQUIRING GENERAL ANESTHESIA 68811", "code_information": [{"code": "68811", "type": "CPT"}, {"code": "1481632", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBING OF NASOLACRIMAL DUCT WITH INSERTION OF TUBE OR STENT 68815", "code_information": [{"code": "68815", "type": "CPT"}, {"code": "1481634", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCALCITONIN (PCT)", "code_information": [{"code": "84145", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 109.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 109.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 109.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCEDURE KIN HYSTEROLUX 72205015", "code_information": [{"code": "72205015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 694.0, "discounted_cash": 242.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCEDURE KIT HYSTER. 7209827", "code_information": [{"code": "7209827", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 697.0, "discounted_cash": 243.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCEDURE MASK INSTAGARD PEDIATRIC", "code_information": [{"code": "AT771212", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCEDURE SET GENESYS HTA", "code_information": [{"code": "58021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3496.0, "discounted_cash": 1223.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCHONDRIX CR 1.0MM THICK 17MM 17MM", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "3102-2717CR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCLAIM DRG", "code_information": [{"code": "7883", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCLAIM DRG IMPLANTABLE PULSE GENERATOR", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3664 ST JUDE MEDICAL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37580.0, "discounted_cash": 13153.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCLAIM PLUS 5 IMPLANTABLE PULSE GENERATOR 3670", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3670", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34000.0, "discounted_cash": 11900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCTOPLASTY FOR PROLAPSE OF MUCOUS MEMBRANE 45505", "code_information": [{"code": "45505", "type": "CPT"}, {"code": "1481641", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOPLASTY FOR STENOSIS 45500", "code_information": [{"code": "45500", "type": "CPT"}, {"code": "1481642", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY BLEED", "code_information": [{"code": "45317", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY DILATE", "code_information": [{"code": "45303", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY FB", "code_information": [{"code": "45307", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY RIGID W/ABLATION OF TUMOR/LESION BY HOT BX BIPOLAR CAUTERY 45320", "code_information": [{"code": "45320", "type": "CPT"}, {"code": "36235648", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.92, "maximum": 8450.0, "gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY VOLVUL", "code_information": [{"code": "45321", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/ REM'L MULTIPLE TUMORS/POLYPS/LESIONS 45315", "code_information": [{"code": "45315", "type": "CPT"}, {"code": "1481623", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/ REM'L SINGLE LESION BY HOT BIOPSY FORCEP/BIPOLAR CAUTERY 45308", "code_information": [{"code": "45308", "type": "CPT"}, {"code": "1481625", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/ REM'L SINGLE TUMOR/POLYP/LESION BY SNARE 45309", "code_information": [{"code": "45309", "type": "CPT"}, {"code": "1481624", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/STENT", "code_information": [{"code": "45327", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY-RIGID W/BIOPSY 45305", "code_information": [{"code": "45305", "type": "CPT"}, {"code": "1482109", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY-RIGID; DIAGNOSTIC 45300", "code_information": [{"code": "45300", "type": "CPT"}, {"code": "1482108", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRODIGY MRI CONTROL SYSTEM", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37904.0, "discounted_cash": 13266.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PRODISC C VIVO MEDIUM 5MM PDVM5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PDVM5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12400.0, "discounted_cash": 4340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRODISC C VIVO MEDIUM DEEP 5MM PDVMDS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PDVMDS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12400.0, "discounted_cash": 4340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROFILE COSTAL CARTILAGE SHEET LARGE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "258225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1306.0, "discounted_cash": 457.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRAMABLE INGEST CAPSULE", "code_information": [{"code": "A9269", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.37, "maximum": 6.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGRAMMER CONTROLLER PATIENT INTELLIS 97745NT", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "97745NT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1147.0, "discounted_cash": 401.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRAMMER MRI COMPATIBILITY SMART TH90P01", "code_information": [{"code": "TH90P01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3741.0, "discounted_cash": 1309.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRAMMER ORALLY INGEST CAP", "code_information": [{"code": "A9268", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.37, "maximum": 6.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGRAMMER PATIENT EXTERNAL SPINAL CORD STIMULATION MYSTIM", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "97740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2549.0, "discounted_cash": 892.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRAMMER PT FOR USE W/INTERSTIM ORINTERSTIM II NEUROSTIMULATORS NEUROSTIMULATO", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "3037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PROL INTUBATION REQ", "code_information": [{"code": "G8569", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG CLIN STAFF SVC 1ST HR", "code_information": [{"code": "99415", "type": "CPT"}], "standard_charges": [{"minimum": 44.5, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG CLIN STAFF SVC EA ADD", "code_information": [{"code": "99416", "type": "CPT"}], "standard_charges": [{"minimum": 19.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG IP/OBS E/M EA 15 MIN", "code_information": [{"code": "99418", "type": "CPT"}], "standard_charges": [{"minimum": 184.38, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 184.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 289.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 289.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 289.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 147.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG HOME EVAL ADD 15M", "code_information": [{"code": "G0318", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.84, "maximum": 219.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 139.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG INPT EVAL ADD15 M", "code_information": [{"code": "G0316", "type": "HCPCS"}], "standard_charges": [{"minimum": 143.06, "maximum": 224.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 143.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG NURSIN FAC EVAL 15M", "code_information": [{"code": "G0317", "type": "HCPCS"}], "standard_charges": [{"minimum": 143.06, "maximum": 224.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 143.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG OUTPT/OFFICE VIS", "code_information": [{"code": "G2212", "type": "HCPCS"}], "standard_charges": [{"minimum": 147.82, "maximum": 232.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG PREV SVCS, ADDL 30M", "code_information": [{"code": "G0514", "type": "HCPCS"}], "standard_charges": [{"minimum": 274.96, "maximum": 432.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 274.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG PREV SVCS, FIRST 30M", "code_information": [{"code": "G0513", "type": "HCPCS"}], "standard_charges": [{"minimum": 274.96, "maximum": 432.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 274.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 432.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG SERV W/O CONTACT ADD", "code_information": [{"code": "99359", "type": "CPT"}], "standard_charges": [{"minimum": 241.58, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 241.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG SERVICE W/O CONTACT", "code_information": [{"code": "99358", "type": "CPT"}], "standard_charges": [{"minimum": 500.62, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 500.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 786.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 786.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 786.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE 50 MG/ML INJ SOLN", "code_information": [{"code": "MED0774", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PRONG GRASPER 3 CAPTURE G30361", "code_information": [{"code": "G30361", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 694.93, "discounted_cash": 243.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPARACAINE 0.5% OPHTH 15ML", "code_information": [{"code": "MED0222", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPHYLACTIC TREATMENT CLAVICLE NAILING/PINNING/PLATING/WIRING 23490", "code_information": [{"code": "23490", "type": "CPT"}, {"code": "1481644", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPHYLACTIC TREATMENT HUMERAL SHAFT NAILING/PINNING/PLATING/WIRING 24498", "code_information": [{"code": "24498", "type": "CPT"}, {"code": "1481646", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPHYLAXIS OF RETINAL DETACHMENT W/O DRAINAGE CRYOTHERAPY DIATHERMY 67141", "code_information": [{"code": "67141", "type": "CPT"}, {"code": "1481647", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1451.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPHYLAXIS OF RETINAL DETACHMENT W/O DRAINAGE PHOTOCOAGULATION 67145", "code_information": [{"code": "67145", "type": "CPT"}, {"code": "2650537", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 539.17, "maximum": 8450.0, "gross_charge": 1114.0, "discounted_cash": 389.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 539.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPOFOL 10MG/ML IV EMUL 100ML (MEDID)", "code_information": [{"code": "MED0504", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPOFOL 200MG/20ML VIAL", "code_information": [{"code": "MED0436", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTATE CA SCREENING; DRE", "code_information": [{"code": "G0102", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.73, "maximum": 62.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATE LASER ENUCLEATION", "code_information": [{"code": "52649", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATE SATURATION SAMPLING", "code_information": [{"code": "55706", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY PERINEAL RADICAL 55810", "code_information": [{"code": "55810", "type": "CPT"}, {"code": "1481648", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY PERINEAL RADICAL WITH LYMPH NODE BIOPSY 55812", "code_information": [{"code": "55812", "type": "CPT"}, {"code": "1481649", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY PERINEAL RADICAL-WITH BILATERAL LYMPHADENECTOMY 55815", "code_information": [{"code": "55815", "type": "CPT"}, {"code": "1481650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY PERINEAL SUBTOTAL 55801", "code_information": [{"code": "55801", "type": "CPT"}, {"code": "1481651", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY RETROPUBIC RADICAL 55840", "code_information": [{"code": "55840", "type": "CPT"}, {"code": "1481652", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY RETROPUBIC RADICAL WITH BILATERAL PELVIC LYMPHADENECTOMY 55845", "code_information": [{"code": "55845", "type": "CPT"}, {"code": "1481653", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY RETROPUBIC RADICAL WITH LYMPH NODE BIOPSY 55842", "code_information": [{"code": "55842", "type": "CPT"}, {"code": "1481654", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH CC", "code_information": [{"code": "666", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10582.6, "maximum": 18167.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10582.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15135.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16648.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18167.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH MCC", "code_information": [{"code": "665", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18502.66, "maximum": 31764.47, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18502.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26462.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29109.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31764.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "667", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6067.79, "maximum": 10416.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6067.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8678.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9546.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10416.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY-RETROPUBIC SUBTOTAL 55831", "code_information": [{"code": "55831", "type": "CPT"}, {"code": "1481655", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY-SUPRAPUBIC SUBTOTAL 55821", "code_information": [{"code": "55821", "type": "CPT"}, {"code": "1481656", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATOTOMY COMPLICATED 55725", "code_information": [{"code": "55725", "type": "CPT"}, {"code": "1481657", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATOTOMY SIMPLE 55720", "code_information": [{"code": "55720", "type": "CPT"}, {"code": "1481658", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTH RETINA RECEIVE&GEN", "code_information": [{"code": "100T", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTHESIS 10MM CONSTRAINED POSTERIOR STABILIZED SURFACE 42-5226-004-10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5226-004-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8102.0, "discounted_cash": 2835.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS ATTUNE KNEE SYSTEM FEMORAL CRUCIATE RETAINING NARROW SZ 5N LT CEMENTED 1504-00-125", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1504-00-125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 1155.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS BASEPLATE AND TAPER KIT 6.5MM NEUTRAL 508-65-000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "508-65-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS CAP TOTAL HIP 98-0005-003-28", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "98-0005-003-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11312.0, "discounted_cash": 3959.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS CASCADIA INTERBODY SYSTEM LATERAL SIZE 18X50X08 MM 8DEG 6101-2185008LL8-G2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2185008LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 2800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS CASCADIA INTERBODY SYSTEM LATRTAL SIZE 18 X 45 X 08MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2184508LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 2800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS CUP LATERALIZED GLENOSPHERE 42 MM X 3 MM DWP4423", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP4423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS FEMORIAL OXINIUM JOURNEY II UNI 9RM/LL 74026039", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74026039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS FINGER JOINT MCP PYROCARBON SIZE 05", "code_information": [{"code": "L8631", "type": "HCPCS"}, {"code": "SMCP-500-05-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 980.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS FINGER JOINT SIZE 0 ASCENSION PYROCARBON SILICONE PROXIMAL INTERPHALANGEAL", "code_information": [{"code": "L8659", "type": "HCPCS"}, {"code": "SPIP-520-0-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS FINGER JOINT SIZE 30 26.6 X 18.3 X 14.2MM ASCENSION SILICONE METACARPOPHALANGEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "SMCP-500-30-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2978.78, "discounted_cash": 1042.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS FRACTURE HUMERAL HEAD COUPLER; CENTERED PFX00001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PFX00001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 225.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS FRACTURE STEM PFX08130S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PFX08130S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 5250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS GLENOID SZ 48 PEGGED SHOULDER AFFINITI IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "20062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6386.0, "discounted_cash": 2235.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS HUMERAL HEAD COCR 41MM 15MM DWN4115", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWN4115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS HUMERAL HEAL 41 X 15 MM 7122869", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7122869", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS HUMERAL PERFORM SYSTEM VE REVERSED INSERT SIZE 3 DWS2426", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS2426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS HUMERAL STEM STD X-LONG SIZE 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX2SX", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16383.0, "discounted_cash": 5734.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS HUMERAL SYS VE REVERSED INSERT SIZE 1/2 39MM DWS1390", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS1390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS IMPLANT HEAD 43/16 ARTHREX ECLIPSE TI HUMERAL AR-9343-16T", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9343-16T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 58.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS IMPLANT REVERSE INSERT SIZE 3/439MM +0 PERFORM DWP2390", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP2390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS INTEGRA LMP IMPLANT SIZE 40 LMP-40T", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "LMP-40T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3970.0, "discounted_cash": 1389.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS INTERBODY SIZE 18X40X10 MM 8 DEG 6101-2184010LL8-G2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2184010LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 5600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS INTERBODY SYSTEM CACADIA 10X55X18MM 8DEG 6101-2185510LL8-G2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2185510LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8755.0, "discounted_cash": 3064.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS INTERBODY SYSTEM CASCADIA 10MMX50MMX22MM 8D 6101-2225010LL8-G2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6101-2225010LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8000.0, "discounted_cash": 2800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS JOINT GREAT TOE SIZE 2 LPT REGULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "487S002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2841.0, "discounted_cash": 994.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS JOURNEY II BCS CONSTRAINED ARTICULAR INSERT SZ 7-8 RIGHT 74029272", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74029272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 0.02, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS JOURNEY II UNI OXINIUM FEMORAL COMPONENT 8 LM/RL 74026028", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74026028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 0.02, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS JOURNEY II UNI OXINIUM FEMORAL COMPONENT 8 RM/LL 74026038", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74026038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 0.02, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS K-WIRE BLUNT SHARP TIP 1.7MM OVER K-WIRE 86264", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "86264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS LEGION PS OXIN FEM SZ5 RT KNEE 71421205", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8055.0, "discounted_cash": 2819.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS MCP JOINT SILICONE SZ10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "SMCP-500-10-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2978.78, "discounted_cash": 1042.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS MCP JOINT SILICONE SZ20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "SMCP-500-20-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2978.78, "discounted_cash": 1042.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PATELLA POROUS ROUND SZ 29MM 74025463", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74025463", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PATELLA SZ 26MM POROUS ROUND 74025462", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74025462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PATELLA SZ 32MM ROUND PORAUS 74025464", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74025464", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PATELLAR 7.5MM X 32MM RESURFACING GENESIS II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71932636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PENILE 15 CM PRECONNECTED W/ MS PUMP CX", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "72404231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16924.0, "discounted_cash": 5923.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PENILE 15 CM PRECONNECTED W/ MS PUMP LGX PS", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "72404251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22166.0, "discounted_cash": 7758.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PENILE 18 CM PRECONNECTED W/ MS PUMP CX", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "72404232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16924.0, "discounted_cash": 5923.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PENILE 18 CM PRECONNECTED W/ MS PUMP LGX", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "72404252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16760.0, "discounted_cash": 5866.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PERFORM HUMERAL SYSTEM VE REVERSE INSERT SIZE 1/2 DWS1366", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWS1366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS POROUS ROUND PATELLA SZ 38MM 74025466", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74025466", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 0.02, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS POROUS TIBIA BASEPLATE W/JRNY LOCK SZ 1 LEFT 71425321", "code_information": [{"code": "71425321", "type": "CDM"}], "standard_charges": [{"gross_charge": 0.02, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PRESTOGE (R) LP CERVICAL DISC 6972250", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6972250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7000.0, "discounted_cash": 2450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PRODISC C VIVO 5MM HEIGHT LARGE-DEEP PDVLD5", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "PDVLD5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12400.0, "discounted_cash": 4340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS PRODISC C VIVO MEDIUM DEEP 5MM", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "PDVMD5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12400.0, "discounted_cash": 4340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS RADIAL HEAD W/025MM HD 07.5MM STM 11MM HD HT 09.405.570S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9.405.570S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8755.0, "discounted_cash": 3064.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS REDAPT 190MM SLEEVELESS REVISION STEM SIZE 15 71354464", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71354464", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20910.0, "discounted_cash": 7318.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS RTS 1 METATARSOPHALANGEAL LESSER IMPLANT TOE JOINT 7-10MM", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "M40 SE010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4894.0, "discounted_cash": 1712.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS SI JOIN T5 TI 25-16-5T VG-SJ-T5-16-25-5T", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "VG-SJ-T5-16-25-5T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 5600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS SPINE JACK EXPANSION KIT 4.2MM 0909-200-042", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909-200-042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2703.0, "discounted_cash": 946.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS STEM HIP NECK ANGLE CEMENTLESS SZ 1 101-0001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "101-0001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 196.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS TESTICULAR LG SALINE FILLED IMP", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "450-1329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3749.0, "discounted_cash": 1312.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS TOE JOINT COBALT CHROME PC MD 20MM 10413", "code_information": [{"code": "L8630", "type": "HCPCS"}, {"code": "10413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS TOE JOINT TITANIUM PC LG 23MM 17038", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "17038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5900.0, "discounted_cash": 2065.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS TOE JOINT TITANIUM PC M/L 21.5MM 17037", "code_information": [{"code": "L8630", "type": "HCPCS"}, {"code": "17037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS TORNIER PERFORM\u00e2\u201e\u00a2 HUMERAL SYSTEM DWX912", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX912", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3176.0, "discounted_cash": 1111.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS TORNIER SIMPLICITI HUM HEADSIZE 5 8X18 7122872", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7122872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS TOTAL CERVICAL DISC REPLACEMENT SYSTEM: MOBI-C CERVICAL DISC MB3575", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "MB3575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6386.0, "discounted_cash": 2235.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS TRIATHLON END CAP 5560-S-016-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5560-S-016-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS URINARY W/INHIBIZONE 800 CONT PUMP AMS 800", "code_information": [{"code": "C1815", "type": "HCPCS"}, {"code": "72404127", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12135.0, "discounted_cash": 4247.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS VE RERENTIVE REVERSED DWS3363", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS3363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHESIS VE REVERSED INSERT SIZE 3/4 DWS2423", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWS2423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTHETIC TRAING 1ST ENC", "code_information": [{"code": "97761", "type": "CPT"}], "standard_charges": [{"minimum": 184.38, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 184.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 289.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 289.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 289.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTIM 10CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "86SR0410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10885.0, "discounted_cash": 3809.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTACK 5MM TITANIUM 1X USE 174006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "174006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 776.0, "discounted_cash": 271.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTECTOR EYE ADULT STERILE 9-0210-00", "code_information": [{"code": "9-0210-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.62, "discounted_cash": 12.82, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTECTOR NERVE 10MM X 4 CM NEURAWRAP", "code_information": [{"code": "C9361", "type": "HCPCS"}, {"code": "NW1040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5714.0, "discounted_cash": 1999.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTECTOR WOUND EXTRA SM 2 CM TO 4 CM RETRACTOR ALEXIS", "code_information": [{"code": "C8312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTECTOR WOUND EXTRA-SMALL WPXSM24", "code_information": [{"code": "WPXSM24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTEIN ANALYSIS W/PROBE", "code_information": [{"code": "88372", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 35.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 105.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 105.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 105.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 37.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 37.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN E-PHORESIS/URINE/CSF", "code_information": [{"code": "84166", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 71.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 71.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN WESTERN BLOT TEST", "code_information": [{"code": "84182", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 36.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN WESTERN BLOT TISSUE", "code_information": [{"code": "88371", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 34.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 32.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 32.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEXIS LATEX CLASSIC; STERILE LATEX POWDER-FREE SURGICAL GLOVES WITH NITRILE COATING, SIZE 6", "code_information": [{"code": "2D72N60X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTEXIS LATEX CLASSIC; STERILE LATEX POWDER-FREE SURGICAL GLOVES WITH NITRILE COATING, SIZE 9", "code_information": [{"code": "2D72N90X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTEXIS LATEX; STERILE LATEX POWDER-FREE SURGICAL GLOVES WITH NITRILE COATING, SIZE 5.5", "code_information": [{"code": "2D72NS55X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTHROMBIN TEST", "code_information": [{"code": "85611", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTON TREATMENT COMPLEX", "code_information": [{"code": "77525", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8565.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1843.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5448.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8565.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8565.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8565.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT INTERMEDIATE", "code_information": [{"code": "77523", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8565.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1843.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5448.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8565.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8565.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8565.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT SIMPLE W/COMP", "code_information": [{"code": "77522", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8565.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1843.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5448.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8565.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8565.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8565.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT SIMPLE W/O COMP", "code_information": [{"code": "77520", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 914.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2354.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3701.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3701.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3701.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTOZOA ANTIBODY NOS", "code_information": [{"code": "86753", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROVIDE INR TEST MATER/EQUIP", "code_information": [{"code": "G0249", "type": "HCPCS"}], "standard_charges": [{"minimum": 511.25, "maximum": 803.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROVISC (SODIUM HYALURONATE) 10MG/ML 0.55ML", "code_information": [{"code": "MED0246", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PROXIMAL BODY ANATOMIC 135 DEG SZ 6/8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110020000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2373.0, "discounted_cash": 830.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PROXIMAL LATERAL TIBLA LEFT 121MM 4 HOLES", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "627304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4477.0, "discounted_cash": 1566.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PRPERTL PEL PACK HEMRRG TRMA", "code_information": [{"code": "49013", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRT UXTR SEP ACS", "code_information": [{"code": "36837", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRTJ UXTR 1 ACS", "code_information": [{"code": "36836", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD ANGIO/ATHRECT 1 ART", "code_information": [{"code": "92924", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD ANGIO/ATHRECT ADDL", "code_information": [{"code": "92925", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC CHRONIC 1VSL", "code_information": [{"code": "92943", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC CHRONIC ADDL", "code_information": [{"code": "92944", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC MI 1 VSL", "code_information": [{"code": "92941", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT W/ANGIO 1 VSL", "code_information": [{"code": "92928", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT W/ANGIO ADDL", "code_information": [{"code": "92929", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT/ATH/ANGIO", "code_information": [{"code": "92933", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT/ATH/ANGIO", "code_information": [{"code": "92934", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIO ADDL ART", "code_information": [{"code": "92921", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIOPLAST 1 ART", "code_information": [{"code": "92920", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CORONARY MECH THROMBECT", "code_information": [{"code": "92973", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ ELC NRV STIM CN WO IMPLT", "code_information": [{"code": "720T", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 2989.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ NJX BIOD OSTEO MATRL FEM", "code_information": [{"code": "814T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT 1 VSL", "code_information": [{"code": "92937", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT ADDL", "code_information": [{"code": "92938", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ TCAT THRM ABLT NRV P-ART", "code_information": [{"code": "793T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRTL EXC BONE RADIAL H/N", "code_information": [{"code": "24145", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRTL EXCHANGE TRANSFUSE NB", "code_information": [{"code": "36456", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA SCREENING", "code_information": [{"code": "G0103", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 77.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 77.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 77.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 77.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSEUDOANEURYSM INJECTION TRT", "code_information": [{"code": "36002", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSOR AS DOC NO SPC BM", "code_information": [{"code": "G9651", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSOR AS DOC SPC BM", "code_information": [{"code": "G9649", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PST VRT JT RPLCMT LMBR 1 SGM", "code_information": [{"code": "719T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 7663.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSY DEP ANX AP AND ICD ASSE", "code_information": [{"code": "G2121", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSY EVALUATION OF RECORDS", "code_information": [{"code": "90885", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSY/DEP/ANX/APANDICD NOASSE", "code_information": [{"code": "G2122", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC ANXIETY DO MRNA 15 BMRK", "code_information": [{"code": "437U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 14 GENES", "code_information": [{"code": "173U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 671.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 671.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 671.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 15 GENES", "code_information": [{"code": "175U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1923.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GENOM ALYS PNL 15 GEN", "code_information": [{"code": "345U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1923.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GENOM ALYS PNL 15 GEN", "code_information": [{"code": "411U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1923.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GENOMIC ALYS PNL 26 GEN", "code_information": [{"code": "423U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC MOOD DO MRNA 144 GENES", "code_information": [{"code": "291U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 2527.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2527.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2527.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC STRS DO MRNA 72 GENES", "code_information": [{"code": "292U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 2527.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2527.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2527.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC SUICIDAL IDEA MRNA 54", "code_information": [{"code": "293U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1094.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCH DIAG EVAL W/MED SRVCS", "code_information": [{"code": "90792", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCH DIAGNOSTIC EVALUATION", "code_information": [{"code": "90791", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCHOANALYSIS", "code_information": [{"code": "90845", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCHOPHYSIOLOGICAL THERAPY", "code_information": [{"code": "90875", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCHOPHYSIOLOGICAL THERAPY", "code_information": [{"code": "90876", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCL TST EVAL PHYS/QHP 1ST", "code_information": [{"code": "96130", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCL TST EVAL PHYS/QHP EA", "code_information": [{"code": "96131", "type": "CPT"}], "standard_charges": [{"minimum": 375.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 375.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 589.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 589.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 589.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TECH 1ST", "code_information": [{"code": "96138", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST AUTO RESULT", "code_information": [{"code": "96146", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST PHY/QHP 1ST", "code_information": [{"code": "96136", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST PHY/QHP EA", "code_information": [{"code": "96137", "type": "CPT"}], "standard_charges": [{"minimum": 87.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 137.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST TECH EA", "code_information": [{"code": "96139", "type": "CPT"}], "standard_charges": [{"minimum": 171.64, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 269.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX COMPLEX INTERACTIVE", "code_information": [{"code": "90785", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX CRISIS EA ADDL 30 MIN", "code_information": [{"code": "90840", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX CRISIS INITIAL 60 MIN", "code_information": [{"code": "90839", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT 30 MINUTES", "code_information": [{"code": "90832", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT 45 MINUTES", "code_information": [{"code": "90834", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT 60 MINUTES", "code_information": [{"code": "90837", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT W E/M 30 MIN", "code_information": [{"code": "90833", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT W E/M 45 MIN", "code_information": [{"code": "90836", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT W E/M 60 MIN", "code_information": [{"code": "90838", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT", "code_information": [{"code": "85610", "type": "CPT"}, {"code": "633793", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 87.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT + HCV ABY +VIR W/ RX 3 MO", "code_information": [{"code": "M1228", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 1 TDAP BETW 10-13 YRS", "code_information": [{"code": "G9416", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 1ST BIOLOG ANTIRHEUM", "code_information": [{"code": "G2182", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 45-85 W/ SCOPE", "code_information": [{"code": "G2204", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 50 YRS W/CLIN IND HD", "code_information": [{"code": "G2188", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAIL INPT ADV ILL", "code_information": [{"code": "M1292", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND ADV ILL", "code_information": [{"code": "G2091", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND ADV ILL", "code_information": [{"code": "G2099", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND ADV ILL", "code_information": [{"code": "G2101", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND ADV ILL", "code_information": [{"code": "G2107", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND MED DEM", "code_information": [{"code": "G2090", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND MED DEM", "code_information": [{"code": "G2098", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND MED DEM", "code_information": [{"code": "G2100", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND MED DEM", "code_information": [{"code": "G2106", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND MED DEM", "code_information": [{"code": "M1291", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G2081", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G2105", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G9898", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G9901", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G9910", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G9938", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "M1284", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66-80 FRAILTY AND ADV ILL", "code_information": [{"code": "G2116", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66-80 FRAILTY AND ADV ILL", "code_information": [{"code": "G2126", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66-80 FRAILTY AND MED DEM", "code_information": [{"code": "G2115", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 66-80 FRAILTY AND MED DEM", "code_information": [{"code": "G2127", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 81+ FRAILTY", "code_information": [{"code": "G2118", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT 81+ FRAILTY", "code_information": [{"code": "G2125", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT >2 RSK FAC POST-OP VOMIT", "code_information": [{"code": "G9954", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT >= 86  W/ HI RISK", "code_information": [{"code": "G9661", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT AC STAT KID TRNSPLT WTLST", "code_information": [{"code": "M1268", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT ALIVE", "code_information": [{"code": "G9787", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT ALIVE 3 MOS POST PROC", "code_information": [{"code": "G9540", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT ANPHX DUE TO DTP BEF 13", "code_information": [{"code": "M1161", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT ANPHX DUE TO HPV BEF 13", "code_information": [{"code": "M1163", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT ANPHX DUE TO MENGB BEF 13", "code_information": [{"code": "M1160", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT ANPHX DUE TO PNEUM", "code_information": [{"code": "M1306", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT BL SRG 30 DAY PST SRG", "code_information": [{"code": "G9625", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT BSLN PAM, 2ND SCR 6-12 MO", "code_information": [{"code": "M1345", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT BWLI SRG 30 DAY PST SRG", "code_information": [{"code": "G9628", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT Body Position Current Status G-8981 -> CM At least 80% but less than 100% impaired", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "16165083", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Body Position Goal Status G-8982 -> CJ At least 20% but less than 40% impaired", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "16165100", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CAT AND THCK ON REPORT", "code_information": [{"code": "G9294", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT CMPLT SUICD SAF PLN 120DY", "code_information": [{"code": "M1351", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT COMORB DX 12M OF EPI", "code_information": [{"code": "G2175", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT COPD SYMPTOMS", "code_information": [{"code": "M1218", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT CR FT INF LM OR PT ID SL", "code_information": [{"code": "M1041", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT CURRENTLY ON STATIN", "code_information": [{"code": "G9797", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CH 0% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165123", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CI At least 1% but less than 20% impaired", "code_information": [{"code": "16165122", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CJ At least 20% but less than 40% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165121", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CK At least 40% but less than 60% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165120", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CL At least 60% but less than 80% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165119", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CM At least 80% but less than 100% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165118", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CN 100% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165117", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Complexity -> High", "code_information": [{"code": "97163", "type": "CPT"}, {"code": "44642247", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 107.7, "maximum": 8450.0, "gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 119.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 119.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 146.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 107.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 381.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT Complexity -> Low", "code_information": [{"code": "97161", "type": "CPT"}, {"code": "44642246", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 107.7, "maximum": 8450.0, "gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 119.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 119.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 146.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 107.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 381.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT Complexity -> Moderate", "code_information": [{"code": "97162", "type": "CPT"}, {"code": "44642245", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 107.7, "maximum": 8450.0, "gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 119.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 119.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 146.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 107.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 381.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 599.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DIED DUR MEAS PD", "code_information": [{"code": "M1356", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DIED DUR MEAS PD", "code_information": [{"code": "M1362", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DIED DURING INPT/30D AFT", "code_information": [{"code": "G9812", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DIED FROM CANCER", "code_information": [{"code": "G9846", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DIED FROM CANCER", "code_information": [{"code": "G9859", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DIED IN PP", "code_information": [{"code": "M1060", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DISCH HOME DAY #2 CEA", "code_information": [{"code": "G8834", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DISCH HOME DAY #2 EVAR", "code_information": [{"code": "G8826", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DOC", "code_information": [{"code": "G9531", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DOC NO BURN PRIOR TO D/C", "code_information": [{"code": "G8909", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DOC NO EVENTS ON DISCHARG", "code_information": [{"code": "G8907", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DOC NO FALL IN ASC", "code_information": [{"code": "G8911", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DOC NO WRONG EVENT", "code_information": [{"code": "G8913", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DOC TO HAVE FALL IN ASC", "code_information": [{"code": "G8910", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DOC W BURN PRIOR TO D/C", "code_information": [{"code": "G8908", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DOC WITH WRONG EVENT", "code_information": [{"code": "G8912", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DX HST CR PT SK LG CR SCR", "code_information": [{"code": "M1018", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DX LUM IDI OR CONG SCOL", "code_information": [{"code": "M1040", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DX LUM SP REG CACR", "code_information": [{"code": "M1037", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DX LUM SP REG FRACT", "code_information": [{"code": "M1038", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DX LUM SP REG INF", "code_information": [{"code": "M1039", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DX MEOP OR SUR STERI", "code_information": [{"code": "M1016", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT ED POS 23", "code_information": [{"code": "G0035", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT ENCEPH DUE TO DTP BEF 13", "code_information": [{"code": "M1162", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT ENROLL HOSPICE", "code_information": [{"code": "G9858", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT F/U 30-180 DYS NO + IMPRV", "code_information": [{"code": "M1338", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HAD >= 2-3 HPV VACCINES", "code_information": [{"code": "G9762", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HCV RCTV ABY F/U NEG", "code_information": [{"code": "M1234", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HCV RCTV ABY NO F/U TST", "code_information": [{"code": "M1230", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HCV TST NO REACTIVE RES", "code_information": [{"code": "M1231", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HCV TST REACTIVE RESULT", "code_information": [{"code": "M1232", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HEMO < 3MO", "code_information": [{"code": "G1027", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HEMO > 3MO", "code_information": [{"code": "G1026", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HOSP DUR MSMT PERIOD", "code_information": [{"code": "G9691", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HOSPICE MNTH", "code_information": [{"code": "G0051", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HX ACT DRAIN PREV 90 DAYS", "code_information": [{"code": "G8560", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HX TOT COL OR COLON CA", "code_information": [{"code": "G9711", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT HX TOT COL OR COLON CA", "code_information": [{"code": "M1295", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT IMM CKPT INHIB THERAPY", "code_information": [{"code": "M1180", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT IN HOS", "code_information": [{"code": "G9690", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT IN HOS", "code_information": [{"code": "G9758", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT INELIG FOOTWEAR EVALUATIO", "code_information": [{"code": "G8416", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT INELIG FOR REF OTO EVAL", "code_information": [{"code": "G8561", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT INELIG REF OTO EVAL", "code_information": [{"code": "G8566", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT INITIATED ANTI-TNF AGENT", "code_information": [{"code": "G9914", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT IS W/HOSP DURING MSMT PER", "code_information": [{"code": "G9700", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT IS W/HOSP DURING MSMT PER", "code_information": [{"code": "G9714", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT KID TRANSPLT WTLST LV DON", "code_information": [{"code": "M1259", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT LESS 3D HOSPICE", "code_information": [{"code": "G9860", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT MBHT HD CT ORD EC PROV", "code_information": [{"code": "G9530", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT MBHT HD CT ORD EC PROV", "code_information": [{"code": "G9594", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT MECH PROS HT VALV", "code_information": [{"code": "G0043", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT MET DIS AT DX", "code_information": [{"code": "G9838", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT MET DIS AT DX", "code_information": [{"code": "G9842", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT MITRAL STENOSIS", "code_information": [{"code": "G0044", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT MNTH 1 MCP PROV", "code_information": [{"code": "G1025", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT MORE THAN 3D HOSPICE", "code_information": [{"code": "G9861", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO ABD IMG NO DOC RSN", "code_information": [{"code": "G9457", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO ACT KID TRANSPLT WTLST", "code_information": [{"code": "M1267", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO ANTIEMET PRE/INTRAOP", "code_information": [{"code": "G9777", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO BL SRG 30 DAY PST SRG", "code_information": [{"code": "G9627", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO BWLI SRG 30 DAY SRG", "code_information": [{"code": "G9630", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO CHEMO LAST 14D LIFE", "code_information": [{"code": "G9848", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO DAILY ASA/ANTIPLAT", "code_information": [{"code": "G9795", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO DOC HEAR LOSS", "code_information": [{"code": "G8567", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO F/U 30-180 DYS", "code_information": [{"code": "M1341", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO HCV ABY OR RESULT", "code_information": [{"code": "M1233", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO HX ACT DRAIN 90 D", "code_information": [{"code": "G8562", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO KD TRNSPLT WTLST LV DO", "code_information": [{"code": "M1260", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO PAM 3 PTS 6-12 MO", "code_information": [{"code": "M1349", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO PRM NURS HM RES IN PP", "code_information": [{"code": "M1059", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO REC TD/TDAP 9YRS PRIOR", "code_information": [{"code": "M1173", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO RECD ANTI-EGFR THER", "code_information": [{"code": "G9844", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO RECD CERV CYTO/HPV", "code_information": [{"code": "G9807", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO REF OTO REAS NO SPEC", "code_information": [{"code": "G8563", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO REF OTOLO NO SPEC", "code_information": [{"code": "G8568", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO REF, RN SPEC", "code_information": [{"code": "G0039", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO RESP BEST INT", "code_information": [{"code": "M1240", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO RESP HEARD", "code_information": [{"code": "M1239", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO RESP IMPRT TO ME", "code_information": [{"code": "M1242", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO RESP SEEN AS PERSON", "code_information": [{"code": "M1241", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO SCRN SDOH", "code_information": [{"code": "M1208", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NO SUICD SAF PLN 120DY", "code_information": [{"code": "M1354", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT 1 TDAP BETW 10-13 YRS", "code_information": [{"code": "G9417", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT ABLE TO PARTICIPATE", "code_information": [{"code": "G0037", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT AMBUL/IMMOB/WC", "code_information": [{"code": "G9719", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT AMBUL/IMMOB/WC", "code_information": [{"code": "G9721", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT AMBULATORY", "code_information": [{"code": "M1068", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT CURRENTLY ON STATIN", "code_information": [{"code": "G9796", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT DIED W/IN 30D OF PROC", "code_information": [{"code": "G9813", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT DISCH HOME DAY#2 EVAR", "code_information": [{"code": "G8833", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT ELI D/T ACT DIG HTN", "code_information": [{"code": "G9744", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT ELI D/T ACT DIG HTN", "code_information": [{"code": "M1290", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT ELIG LOW NEURO EX", "code_information": [{"code": "G2178", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT ELIGIBLE ACE/ARB", "code_information": [{"code": "G8936", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT HAVE 2-3 HPV VACCINES", "code_information": [{"code": "G9763", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT SCRN FUT FALL NO RSN", "code_information": [{"code": "M1070", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT SCRN OR NO COUNSELING", "code_information": [{"code": "G9624", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NOT TRANS TO HOSP AT D/C", "code_information": [{"code": "G8915", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NT PRSC ADR DEP THRPY RNG", "code_information": [{"code": "G9897", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT ON DAILY ASA/ANTIPLAT", "code_information": [{"code": "G9793", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT OTHR THN TRUE BEST INT", "code_information": [{"code": "M1244", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT OTHR THN TRUE HEARD", "code_information": [{"code": "M1243", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT OTHR THN TRUE IMPRT TO ME", "code_information": [{"code": "M1246", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT OTHR THN TRUE PERSON", "code_information": [{"code": "M1245", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT PAM INCR 3 PT 6-12 MO", "code_information": [{"code": "M1347", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT PAM INCR 6 PT 6-12 MO", "code_information": [{"code": "M1348", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT PAM LVL 4 BASE OR SRT LIN", "code_information": [{"code": "M1343", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT PERI DIALYSIS DUR MO", "code_information": [{"code": "G0052", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT PHYS/OCC THERAPY", "code_information": [{"code": "G0040", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT PRES ANTIBIOTIC", "code_information": [{"code": "G8710", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT PRM NURS HM RES IN PP", "code_information": [{"code": "M1058", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT PROV HOSP SRV MSMT PER", "code_information": [{"code": "G9710", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RCV HEDIA OUTPT DYLS FAC", "code_information": [{"code": "G8956", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT REASON FOR NO BETA", "code_information": [{"code": "G9191", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT REC'G RRT", "code_information": [{"code": "M1199", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RECD 1 TD/TDAP 9YRS PRIOR", "code_information": [{"code": "M1171", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RECD ANTI-EGFR THER", "code_information": [{"code": "G9845", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RECD CERV CYTO/HPV", "code_information": [{"code": "G9806", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RECD CHEMO LAST 14D LIFE", "code_information": [{"code": "G9847", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RECD FLU VAX 7/1-6/30", "code_information": [{"code": "M1168", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RECD PCV ON/AFT 60", "code_information": [{"code": "M1177", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RECV >=1 WELL-CHLD VISIT", "code_information": [{"code": "G9964", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RECV TBCO CESS INTERV", "code_information": [{"code": "G9906", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RECV TBCO CESS INTERV", "code_information": [{"code": "M1301", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT REF APP RSRCS", "code_information": [{"code": "G2186", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT REF DOC OTO EVAL", "code_information": [{"code": "G8559", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT REF OTO EVAL", "code_information": [{"code": "G8564", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT REFRD 2 PVDR/SPCLST IN PP", "code_information": [{"code": "G9968", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RESP TRUE BEST INT", "code_information": [{"code": "M1247", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RESP TRUE HEARD", "code_information": [{"code": "M1250", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RESP TRUE IMPRT TO ME", "code_information": [{"code": "M1249", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RESP TRUE SEEN AS PERSON", "code_information": [{"code": "M1248", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RSN NO ACE ARN ARNI", "code_information": [{"code": "G2094", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RSN NO ACE-I/ARB RX", "code_information": [{"code": "M1202", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RSN NO SCRN", "code_information": [{"code": "M1237", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SCR FT FALL RSK", "code_information": [{"code": "M1069", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SCR TOB & CESS INT", "code_information": [{"code": "G0030", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SCR TOB & CESS INT", "code_information": [{"code": "M1310", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SCRN SDOH", "code_information": [{"code": "M1207", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SCRN TBCO AND ID AS USER", "code_information": [{"code": "G9902", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SCRN TBCO AND ID AS USER", "code_information": [{"code": "M1283", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SCRN TBCO ID AS NON USER", "code_information": [{"code": "G9903", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SCRN TBCO ID AS NON USER", "code_information": [{"code": "M1282", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SELF DSCHG", "code_information": [{"code": "M1148", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SFTY POS EXP W ANETH MVP", "code_information": [{"code": "G0059", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SPEC ALG RX-ONC TX OPTION", "code_information": [{"code": "794T", "type": "CPT"}], "standard_charges": [{"minimum": 253.49, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 253.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 398.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 398.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 398.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SURV IMPROV BSLINE TX", "code_information": [{"code": "G9603", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SURV RESULTS NOT AVAIL", "code_information": [{"code": "G9604", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT TRANS FROM ANEST TO PACU", "code_information": [{"code": "G9656", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT TRANS TO HOSP POST D/C", "code_information": [{"code": "G8914", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT TREATD W/ORAL SYST OR BIO", "code_information": [{"code": "G9764", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT UC IN PP", "code_information": [{"code": "M1021", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT UC IN PP", "code_information": [{"code": "M1054", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT UNABLE CMPLT LEPF PROM", "code_information": [{"code": "G9727", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT UNBL CMPLT EWH FS PROM", "code_information": [{"code": "G9737", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT UNBL CMPLT LB FS PROM", "code_information": [{"code": "G9733", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT UNBL CMPLT LEPF PROM", "code_information": [{"code": "G9729", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT UNBL CMPLT LEPF PROM", "code_information": [{"code": "G9731", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT UNBL CMPLT SHLD FS PROM", "code_information": [{"code": "G9735", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT USE HOSP DURING MSMT PER", "code_information": [{"code": "G9693", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT USE HOSP DURING MSMT PER", "code_information": [{"code": "G9702", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT USE HOSP DURING MSMT PER", "code_information": [{"code": "G9713", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT USE HSPC DUR MEAS PD", "code_information": [{"code": "M1165", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W 2 HZV ON/AFT 50", "code_information": [{"code": "M1174", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W IV AB GIVEN ON TIME", "code_information": [{"code": "G8916", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W IV AB NOT GIVEN ON TIME", "code_information": [{"code": "G8917", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ +HCV +VIR REF WIN 1 MO", "code_information": [{"code": "M1229", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ CKD STG 5", "code_information": [{"code": "M1188", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ DEMENTIA ANY TIME", "code_information": [{"code": "M1164", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ DX OSTEO DOE", "code_information": [{"code": "M1153", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ DX SQ CELL CA OF ESOPH", "code_information": [{"code": "M1192", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ ESRD", "code_information": [{"code": "M1187", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ HX TRNSPLT OR LVAD", "code_information": [{"code": "M1151", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ HX TRNSPLT OR LVAD", "code_information": [{"code": "M1152", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ LMTED LIFE EXPEC", "code_information": [{"code": "G0050", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ RX FOR HSPC/PLLTV CARE", "code_information": [{"code": "M1186", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ SUIC SAF PLN INIT REV", "code_information": [{"code": "M1350", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/90D MRS 0-2", "code_information": [{"code": "G9646", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/90D MRS >2", "code_information": [{"code": "G9648", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ABN LVEF B-BLOC NO RX", "code_information": [{"code": "G8452", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/ABN LVEF INELIG B-BLOC", "code_information": [{"code": "G8451", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/CANCER SCOLIOSIS", "code_information": [{"code": "G9945", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/CANCER SCOLIOSIS", "code_information": [{"code": "M1051", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/CLIN ASCVD DX", "code_information": [{"code": "G9674", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/DOC USE ANTICOAG MST YR", "code_information": [{"code": "G9724", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/DXA NO RESULTS DOC", "code_information": [{"code": "G8400", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/DXA RESULTS DOCUMENT", "code_information": [{"code": "G8399", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/FAST/DIR LAB LDL-C >190", "code_information": [{"code": "G9675", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9688", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9741", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9761", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9768", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9805", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9819", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/O FLU VAX 7/1-6/30", "code_information": [{"code": "M1170", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/O HZV ON/AFT AGE 50", "code_information": [{"code": "M1176", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/O PREOP ORDER IV AB PRO", "code_information": [{"code": "G8918", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT W/RED SUIC IDEA 120 DAYS", "code_information": [{"code": "M1357", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT, PN, HIST GRADE DOC", "code_information": [{"code": "G8721", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT, PN, HIST GRADE NOT DOC", "code_information": [{"code": "G8724", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT-FOCUSED HLTH RISK ASSMT", "code_information": [{"code": "96160", "type": "CPT"}], "standard_charges": [{"minimum": 14.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT. CHARGER", "code_information": [{"code": "42-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4455.0, "discounted_cash": 1559.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PT/CAREGIVER TRAING HOME INR", "code_information": [{"code": "93792", "type": "CPT"}], "standard_charges": [{"minimum": 235.23, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 235.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 369.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 369.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 369.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT/PTN DECLN ASSESS", "code_information": [{"code": "G0036", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT/PTN DECLN REFERRAL", "code_information": [{"code": "G0041", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTCA W/ PLCMT BRACHYTX DEV", "code_information": [{"code": "C7533", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTEN FULL GENE ANALYSIS", "code_information": [{"code": "235U", "type": "CPT"}], "standard_charges": [{"minimum": 765.0, "maximum": 1203.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1203.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1203.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1203.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTEN GENE DUP/DELET VARIANT", "code_information": [{"code": "81323", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1203.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1203.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1203.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTEN GENE FULL SEQUENCE", "code_information": [{"code": "81321", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2406.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTEN GENE KNOWN FAM VARIANT", "code_information": [{"code": "81322", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 66.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 118.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 186.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 186.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 186.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 67.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 67.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTERYGOMAXILLARY FOSSA SURGERY 31040", "code_information": [{"code": "31040", "type": "CPT"}, {"code": "31939569", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1164.5, "maximum": 8450.0, "gross_charge": 2406.0, "discounted_cash": 842.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1164.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS 7WK INJ, SCRN IOP =<25", "code_information": [{"code": "M1322", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS 7WK INJ, SCRN IOP >25", "code_information": [{"code": "M1323", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS ACT PVD 2 WKS 2 WKS", "code_information": [{"code": "M1334", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS ACT PVD 2 WKS 8 WKS", "code_information": [{"code": "M1329", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS ADMIT SNF", "code_information": [{"code": "M1266", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS BREASTFEEDING", "code_information": [{"code": "G9779", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS COUNSL CPT OPT OUT", "code_information": [{"code": "M1317", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS CSP DOC CONTACT", "code_information": [{"code": "M1319", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS DECEASED PRIOR HU SURV", "code_information": [{"code": "M1254", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS DEM ANY TIME/DUR MO", "code_information": [{"code": "M1271", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS DIED PERF PER", "code_information": [{"code": "M1342", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS DX ACUTE VITREOUS HEM", "code_information": [{"code": "M1328", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS DX HYPOTONY", "code_information": [{"code": "M1326", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS DX W/RHABDOMYOLYSIS", "code_information": [{"code": "G9780", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS EVAL INI XM 2 WKS", "code_information": [{"code": "M1336", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS EVAL INI XM 8 WKS", "code_information": [{"code": "M1331", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS F/U 30-180 DYS + IMPROV", "code_information": [{"code": "M1339", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS HOSP DIALYSIS DT", "code_information": [{"code": "M1263", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS HOSP EXL", "code_information": [{"code": "M1275", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS HU SURV NO AMB PLLTV", "code_information": [{"code": "M1253", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS INTRAVITREAL/PCI", "code_information": [{"code": "M1324", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS KID TRANSPLT WTLST", "code_information": [{"code": "M1272", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS NO 7WK INJ,NO IOP,IOP>25", "code_information": [{"code": "M1321", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS NO <SUICD IDEA 120 DYS", "code_information": [{"code": "M1358", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS NO BSLN OR 2ND PAM SCORE", "code_information": [{"code": "M1344", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS NO CMPLT HU SURVEY", "code_information": [{"code": "M1252", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS NO CMPLT SUICD SAF PLN", "code_information": [{"code": "M1353", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS NO CSP DOC CONTACT", "code_information": [{"code": "M1318", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS NO EVAL INI XM NO 2 WKS", "code_information": [{"code": "M1332", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS NO EVAL INI XM NO 8 WKS", "code_information": [{"code": "M1327", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS NO F/U 120 DYS", "code_information": [{"code": "M1363", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS NO KID TRANSPLT WTLST", "code_information": [{"code": "M1270", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS NO PAM 6 PTS 6-12 MO", "code_information": [{"code": "M1346", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS ON WTLIST BEF DIALYSIS", "code_information": [{"code": "M1261", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS PROXY CMPLT HU SURV", "code_information": [{"code": "M1251", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS SCRN + HRSN", "code_information": [{"code": "M1320", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS SNF 1 YR DIALYSIS", "code_information": [{"code": "M1273", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS SNF EXL MO", "code_information": [{"code": "M1274", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS TRANSPLT BEF DIALYSIS", "code_information": [{"code": "M1262", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTS W/ OTHR RSN VST,+PRG TST", "code_information": [{"code": "M1255", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTT", "code_information": [{"code": "85730", "type": "CPT"}, {"code": "633794", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 87.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92997", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92998", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULLER ZIPLOOP TOGGLELOCK DISP", "code_information": [{"code": "904794", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 67.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PULM DS IPF MRNA 190 GEN ALG", "code_information": [{"code": "81554", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 22055.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14025.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22055.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22055.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22055.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7920.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7920.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM FUNCT TST PLETHYSMOGRAP", "code_information": [{"code": "94726", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM FUNCTION TEST BY GAS", "code_information": [{"code": "94727", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM TISS VNTJ ALYS PREV CT", "code_information": [{"code": "807T", "type": "CPT"}], "standard_charges": [{"minimum": 635.53, "maximum": 999.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 635.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 999.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 999.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 999.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULM TISS VNTJ ALYS W/CT", "code_information": [{"code": "808T", "type": "CPT"}], "standard_charges": [{"minimum": 1223.86, "maximum": 1924.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1223.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1924.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1924.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1924.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [{"code": "189", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7458.37, "maximum": 12804.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7458.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10667.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11733.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12804.16, "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": 9404.32, "maximum": 16144.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9404.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13450.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14795.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16144.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [{"code": "176", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5400.49, "maximum": 9271.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5400.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7723.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8496.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9271.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY STRESS TESTING", "code_information": [{"code": "94618", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULMONOLOGY SS", "code_information": [{"code": "G4030", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE GENERATOR 32400", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "32400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43500.0, "discounted_cash": 15225.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP PAIN 2-14 ML/HR 400 ML BLACK VAR RATE W/ SELECT A FLOW ONQ C BLOC", "code_information": [{"code": "CB004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP SYNCHROMEDIII INFUSION EMAN 8667-40", "code_information": [{"code": "C1772", "type": "HCPCS"}, {"code": "8667-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23582.0, "discounted_cash": 8253.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP SYSTEM SINGLE ACTION", "code_information": [{"code": "M006720100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 53.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH 4.75/5.5MM ARGO KNOTLESS TIM SMOOTH K4755DSP", "code_information": [{"code": "K4755DSP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH 8.25MM BARRON VACUUM", "code_information": [{"code": "K20-2109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BARRON VACUMME 8.0MM", "code_information": [{"code": "K20-2108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BIOPSY OF SKIN SINGLE LESION 11104", "code_information": [{"code": "11104", "type": "CPT"}, {"code": "45432300", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 586.12, "maximum": 8450.0, "gross_charge": 1211.0, "discounted_cash": 423.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 586.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCH BONE 3.5MM", "code_information": [{"code": "2000-03-035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 632.0, "discounted_cash": 221.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BONE 3.5MM ST", "code_information": [{"code": "2000-01-035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 822.0, "discounted_cash": 287.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BROACHING KNOTLESS K4755DBP", "code_information": [{"code": "K4755DBP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN EA SEP/ADDL", "code_information": [{"code": "11105", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCH CORNEAL 7.0MM DONOR VACUUM BARRON", "code_information": [{"code": "K20-2104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH CORNEAL 7.25MM DONOR VACUUM", "code_information": [{"code": "K20-2105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH CORNEAL 7.5MM DONOR VACUUM BARRON", "code_information": [{"code": "K20-2106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH CORNEAL 7.75MM DONOR VACUUM BARRON", "code_information": [{"code": "K20-2107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 271.15, "discounted_cash": 94.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH CORNEAL 8.5MM DONOR VACUUM BARRON", "code_information": [{"code": "K20-2110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH CORNEAL 8.75MM DONOR VACUUM BARRON", "code_information": [{"code": "K20-2111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH CORNEAL 9.0MM DONOR VACUUM BARRON", "code_information": [{"code": "K20-2112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH CORNEAL 9.5MM DONOR VACUUM BARRON", "code_information": [{"code": "K20-2114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH PACK FOR 4.75MM SUTURE ANCHOR THN00241", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "THN00241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 850.0, "discounted_cash": 297.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TAP 5.5MM FULLY THREADED CORKSCREW SWIVELOCK STRL DISP", "code_information": [{"code": "AR-1927PBS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 127.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TOE HEMI LARGE GREAT", "code_information": [{"code": "375-0007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1387.0, "discounted_cash": 485.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TREPHINE VACUUM 7.00 MM 17202D700", "code_information": [{"code": "17202D700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 334.95, "discounted_cash": 117.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TREPHINE VACUUM 7.25 MM 17202D725", "code_information": [{"code": "17202D725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 334.95, "discounted_cash": 117.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TREPHINE VACUUM 7.50 MM 17202D750", "code_information": [{"code": "17202D750", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 334.95, "discounted_cash": 117.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TREPHINE VACUUM 7.75 MM 17202D775", "code_information": [{"code": "17202D775", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 334.95, "discounted_cash": 117.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TREPHINE VACUUM 8.00 MM 17202D800", "code_information": [{"code": "17202D800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 334.95, "discounted_cash": 117.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TREPHINE VACUUM 8.25 MM 17202D825", "code_information": [{"code": "17202D825", "type": "CDM"}], "standard_charges": [{"gross_charge": 334.95, "discounted_cash": 117.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TREPHINE VACUUM 8.50 MM 17202D850", "code_information": [{"code": "17202D850", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 334.95, "discounted_cash": 117.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TREPHINE VACUUM 8.75 MM 17202D875", "code_information": [{"code": "17202D875", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 334.95, "discounted_cash": 117.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH TREPHINE VACUUM 9.00 MM 17202D900", "code_information": [{"code": "17202D900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 398.75, "discounted_cash": 139.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH VACUUM 7.00 MM 17200D700", "code_information": [{"code": "17200D700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH VACUUM 7.25 MM 17200D725", "code_information": [{"code": "17200D725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH VACUUM 7.50 MM 17200D750", "code_information": [{"code": "17200D750", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH VACUUM 7.75 MM 17200D775", "code_information": [{"code": "17200D775", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH VACUUM 8.00 MM 17200D800", "code_information": [{"code": "17200D800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH VACUUM 8.25MM 17200D825", "code_information": [{"code": "17200D825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 398.75, "discounted_cash": 139.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH VACUUM 8.50 MM 17200D850", "code_information": [{"code": "17200D850", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 398.75, "discounted_cash": 139.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH VACUUM 8.75 MM 17200D875", "code_information": [{"code": "17200D875", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 398.75, "discounted_cash": 139.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH VACUUM 9.00 MM 17200D900", "code_information": [{"code": "17200D900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 398.75, "discounted_cash": 139.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIR CYST BRST EA", "code_information": [{"code": "19001", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCTURE/CLEAR WINDPIPE", "code_information": [{"code": "31612", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAFORCE 8CM X 4CM 550-004", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "550-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PURE TONE AUDIOMETRY AIR", "code_information": [{"code": "92552", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURE TONE HEARING TEST AIR", "code_information": [{"code": "92551", "type": "CPT"}], "standard_charges": [{"minimum": 52.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUSHER KNOT CUTTER SLOTTED CANNULA STRAIGHT FAST-FIX 360", "code_information": [{"code": "72202674", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 453.3, "discounted_cash": 158.66, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY 10CC CRUSHED MIX", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "PHG-10C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5696.0, "discounted_cash": 1993.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY 10CC H GENIN", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "PHG-10P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6845.0, "discounted_cash": 2395.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY 10CC REFICIO DBM 27800518", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "27800518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4160.0, "discounted_cash": 1456.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY 5.0ML NANOBONE 200052", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3660.0, "discounted_cash": 1281.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY 5CC MONTAGE OS-MON-1001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS-MON-1001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 1256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY ALLOMATRIX DBM 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "860C0500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1902.0, "discounted_cash": 665.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY ALLOMATRIX DR BONE 3CC 86DR0300", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "86DR0300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.94, "discounted_cash": 472.83, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY BONE 2.5CC DEMENERLIZED BONE MATRIX STIMUBLAST JRF", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "80038002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1296.0, "discounted_cash": 453.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY BONE 2.5CC DEMERNERLIZED GLYCEROL FIBERS OSTEOBIOLOGICS", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "TPUT02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY BONE 5CC DBM COMPOSITION TENSIX IMP", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "PHG-05P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3631.0, "discounted_cash": 1270.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY BONE 5CC DEMENERLIZED BONE MATRIX STIMUBLAST JRF", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ABS-2001-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY BONE 5CC DEMERNERLIZED GLYCEROL FIBERS OSTEOBIOLOGICS", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "TPUT05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY BONE GRAFT OSTEOFLO NANO 5CC ONP-T-500", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "ONP-T-500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 10.0CC AT680FD", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "AT680FD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 100 1 CC 4104-K5010DP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4104-K5010DP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 356.9, "discounted_cash": 124.92, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 100 5 CC 4104-K5050DP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4104-K5050DP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1189.66, "discounted_cash": 416.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 10CC ALLOGRAFT OSTEO AMP", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "14100501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5383.0, "discounted_cash": 1884.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 10CC FIBER ACTISTIM MDBM1100", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "MDBM1100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 10CC HERO", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "1001-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 1CC FIBER ACTISTIM MDBM1010", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "MDBM1010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 1CC PAA-001", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PAA-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1329.0, "discounted_cash": 465.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 2.5CC FIBER ACTISTIM MDBM1025", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "MDBM1025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 2.5CC MATRIX CELLECT 100", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "452025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 2.5CC PAA-025", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PAA-025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1446.68, "discounted_cash": 506.34, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 5.0CC MATRIX CELLECT 100", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "452050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 5CC BEAST", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "P01-DBM-1005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4219.0, "discounted_cash": 1476.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM 5CC FIBER ACTISTIM MDBM1050", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "MDBM1050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1607.0, "discounted_cash": 562.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM T43102 1CC GRAFTON PUTTY T43102", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "T43102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM T43103 2.5CC GRAFTON PUTTY T43103", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "T43103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 853.0, "discounted_cash": 298.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM T43105 5CC GRAFTON PUTTY T43105", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "T43105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1242.0, "discounted_cash": 434.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DEMINERALIZD BONE MATRIX W/CHIPS 10CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3963.0, "discounted_cash": 1387.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DEMINERALIZED BONE MATRIX 10CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "HG-10P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3963.0, "discounted_cash": 1387.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DEMINERALIZED BONE MATRIX 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "HG-05P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3471.0, "discounted_cash": 1214.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DEMINERALIZED BONE MATRIX CRUNCH 10CC", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "HG-10C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3963.0, "discounted_cash": 1387.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY H-GENIN 10CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "JHG-10P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3963.0, "discounted_cash": 1387.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY H-GENIN 1CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "JHG-01P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY H-GENIN 2.5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "JHG-02P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1069.0, "discounted_cash": 374.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY H-GENIN 2.5CC PHG-02P", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "PHG-02P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1681.0, "discounted_cash": 588.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY MIX CRUSH IN SYRINGE 1CC THB1340177", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "THB1340177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY OSTEOFUSE BIOACTIVE BONE GRAFT 15.0G", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "SGF-150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6060.0, "discounted_cash": 2121.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY OSTEOFUSE BIOACTIVE BONE GRAFT 3.75G", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "SGF-037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2008.0, "discounted_cash": 702.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY OSTEOFUSE BIOACTIVE BONE GRAFT 7.50G", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "SGF-075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY SBX NANOBONE 2.5ML 200051", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2290.0, "discounted_cash": 801.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY SERV FEE BIO DBM 10CC 7775010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7775010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY SMALL 3.75G SYNTHETIC BONE MSBG0375", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "MSBG0375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PVB THORACIC 2ND+ INJ SITE", "code_information": [{"code": "64462", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC SINGLE INJ SITE", "code_information": [{"code": "64461", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PVDR RFRD PT NO RPRT RCVD", "code_information": [{"code": "G9970", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PVDR RFRD PT RPRT RCVD", "code_information": [{"code": "G9969", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYELOPLASTY LAPAROSCOPIC 50544", "code_information": [{"code": "50544", "type": "CPT"}, {"code": "1481661", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY COMPLICATED", "code_information": [{"code": "50135", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/DRG PYELOSTOMY", "code_information": [{"code": "50125", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/EXPLORATION", "code_information": [{"code": "50120", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/REMOVAL CALCULUS", "code_information": [{"code": "50130", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Partial craniectomy, channel creation, and tunneling of electrode for sub-scalp implantation of an electrode array, receiver, and telemetry unit for continuous bilateral electroencephalography monitoring system, including imaging guidance", "code_information": [{"code": "956T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 6045.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Pathology IPX Each Antibody 88342", "code_information": [{"code": "88342", "type": "CPT"}, {"code": "21549786", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 205.0, "discounted_cash": 71.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 130.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Pathology Special Stains Group II 88313", "code_information": [{"code": "88313", "type": "CPT"}, {"code": "21549787", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 54.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 109.63, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 116.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Pathology consultation during surgery; 88329", "code_information": [{"code": "88329", "type": "CPT"}, {"code": "25237651", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 302.0, "discounted_cash": 105.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 112.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Pathology consultation during surgery; cytologic examination 88333", "code_information": [{"code": "88333", "type": "CPT"}, {"code": "22802327", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 54.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 48.84, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 52.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Pathology consultation during surgery; each additional tissue block with frozen section(s) 88332", "code_information": [{"code": "88332", "type": "CPT"}, {"code": "21812137", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 54.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 88.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 88.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 88.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 38.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 41.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 35.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 35.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen", "code_information": [{"code": "88331", "type": "CPT"}, {"code": "21631946", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 302.0, "discounted_cash": 105.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 112.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 63.39, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 67.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patient Office Consultation, Typically 15 Minutes", "code_information": [{"code": "99241", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patient encounter during the performance period with place of service code 11", "code_information": [{"code": "M1382", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and", "code_information": [{"code": "G0535", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.41, "maximum": 244.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 155.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 244.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patient received hospice services any time during the performance period", "code_information": [{"code": "M1416", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients on a therapeutic clinical trial", "code_information": [{"code": "M1396", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients on a therapeutic clinical trial", "code_information": [{"code": "M1404", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group", "code_information": [{"code": "M1395", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group", "code_information": [{"code": "M1402", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who are not up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination", "code_information": [{"code": "M1419", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who are not up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination because of a medical contraindication documented by clinician", "code_information": [{"code": "M1418", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who are up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination", "code_information": [{"code": "M1417", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who did not have a positive PD-L1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy", "code_information": [{"code": "M1415", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who did not have germline testing for BRCA1 and BRCA2 or genetic counseling completed within 6 months of diagnosis", "code_information": [{"code": "M1410", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who died during the follow-up period", "code_information": [{"code": "M1400", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who died during the follow-up period", "code_information": [{"code": "M1407", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who died during the performance period", "code_information": [{"code": "M1384", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who died during the performance period", "code_information": [{"code": "M1387", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who do not have a documented exam performed for recurrence of melanoma or no documentation within the performance period", "code_information": [{"code": "M1390", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who had a positive PD-L1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy", "code_information": [{"code": "M1413", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who have germline BRCA testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer", "code_information": [{"code": "M1408", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who leave the practice during the follow-up period", "code_information": [{"code": "M1399", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who leave the practice during the follow-up period", "code_information": [{"code": "M1406", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who received germline testing for BRCA1 and BRCA2 or genetic counseling completed within 6 months of diagnosis", "code_information": [{"code": "M1409", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients who were not diagnosed with recurrent melanoma during the current performance period", "code_information": [{"code": "M1393", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients with an excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial ajcc staging of 0, i, or ii at the start of the performance period", "code_information": [{"code": "M1386", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients with baseline and follow-up PROMIS surveys documented in the medical record", "code_information": [{"code": "M1403", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients with baseline and follow-up promis surveys documented in the medical record", "code_information": [{"code": "M1398", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients with documentation of an exam performed for recurrence of melanoma", "code_information": [{"code": "M1388", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients with metastatic NSCLC with epidermal growth factor receptor (EGFR) mutations, ALK genomic tumor aberrations, or other targetable genomic abnormalities with approved first-line targeted therapy, such as NSCLC with ROS1 rearrangement, BRAF V600E mu", "code_information": [{"code": "M1412", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients with recurrence/disease progression", "code_information": [{"code": "M1397", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients with recurrence/disease progression", "code_information": [{"code": "M1405", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Patients with secondary stroke (e.g., a subsequent stroke that may occur with vasospasm in the setting of subarachnoid hemorrhage) within 5 days of the initial procedure", "code_information": [{"code": "M1381", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or inspiration to meet oud treatment and recovery goals; conducting a person-centered int", "code_information": [{"code": "G0536", "type": "HCPCS"}], "standard_charges": [{"minimum": 374.54, "maximum": 588.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 374.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 588.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With MCC Or 4+ Arteries Or Stents", "code_information": [{"code": "246", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19005.12, "maximum": 32627.06, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19005.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27181.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29899.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32627.06, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without MCC", "code_information": [{"code": "247", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12002.98, "maximum": 20606.13, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12002.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17166.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18883.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20606.13, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With MCC Or 4+ Arteries Or Stents", "code_information": [{"code": "248", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19235.66, "maximum": 33022.85, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19235.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27511.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30262.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33022.85, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without MCC", "code_information": [{"code": "249", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11397.72, "maximum": 19567.05, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11397.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16301.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17931.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19567.05, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Percutaneous transcatheter therapeutic drug delivery by intracoronary drug-delivery balloon (eg, drug-coated, drug-eluting) performed on a separate target lesion from the target lesion treated with balloon angioplasty, coronary stent placement or coronary", "code_information": [{"code": "914T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Percutaneous transcatheter therapeutic drug delivery by intracoronary drug-delivery balloon (eg, drug-coated, drug-eluting), including mechanical dilation by nondrug-delivery balloon angioplasty, endoluminal imaging using intravascular ultrasound (IVUS) o", "code_information": [{"code": "913T", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance with intravascular ultrasound (noncoronary vessel(s)) during diagnostic evaluation and/or therapeutic i", "code_information": [{"code": "C7564", "type": "HCPCS"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Perfluoroalkyl substances (PFAS) (eg, perfluorooctanoic acid, perfluorooctane sulfonic acid), 9 PFAS compounds by LC-MS/MS, plasma or serum, quantitative", "code_information": [{"code": "457U", "type": "CPT"}], "standard_charges": [{"minimum": 61.43, "maximum": 96.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Perfluoroalkyl substances (PFAS) (eg, perfluorooctanoic acid, perfluorooctane sulfonic acid), by liquid chromatography with tandem mass spectrometry (LC-MS/MS), plasma or serum, quantitative", "code_information": [{"code": "535U", "type": "CPT"}], "standard_charges": [{"minimum": 61.43, "maximum": 96.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Personalized target development for accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation derived from a structural and resting-state functional MRI, including data preparation and transmission, generation of the tar", "code_information": [{"code": "889T", "type": "CPT"}], "standard_charges": [{"minimum": 4191.71, "maximum": 6586.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4191.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6586.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6586.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6586.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Pharmacy supplying fee for HIV pre-exposure prophylaxis FDA approved prescription", "code_information": [{"code": "Q0521", "type": "HCPCS"}], "standard_charges": [{"minimum": 114.66, "maximum": 180.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 180.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 180.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 180.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Phenytoin Level Total", "code_information": [{"code": "80185", "type": "CPT"}, {"code": "633801", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 27.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Phosphorus Level", "code_information": [{"code": "84100", "type": "CPT"}, {"code": "633803", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Physical Therapy Group Rate", "code_information": [{"code": "423", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 277.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 238.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Physical Therapy Hourly Charge", "code_information": [{"code": "422", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 277.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 238.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Physical Therapy Visit Charge", "code_information": [{"code": "421", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 277.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 238.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Physical Therapy, Evaluation Or Reevaluation", "code_information": [{"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 277.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 238.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Physical Therapy, General", "code_information": [{"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 277.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 238.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Physical Therapy, Other", "code_information": [{"code": "429", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 60.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 403.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 235.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 277.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 238.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Physician Supervision Of Patient Care At Home Or Assisted Living Facility, 15-29 Minutes In One Month", "code_information": [{"code": "99339", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Physician Supervision Of Patient Care At Home Or Assisted Living Facility, 30 Minutes Or More In One Month", "code_information": [{"code": "99340", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Placement Of Mesh To Repair Incisional Or Abdominal Hernia, Open Procedure", "code_information": [{"code": "49568", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Placement Of Scalp Electrodes For Assessment And Recording Of Responses From Several Areas Of The Nerve-Brain Hearing System", "code_information": [{"code": "92585", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Placement Of Scalp Electrodes For Assessment And Recording Of Responses From Several Areas Of The Nerve-Brain Hearing System, Infant", "code_information": [{"code": "92586", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Placement of bone marrow sampling port, including imaging guidance when performed", "code_information": [{"code": "901T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Plastic Surgery To Reconstruct Breast With Other Technique", "code_information": [{"code": "19366", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Platelets, each unit P9019", "code_information": [{"code": "P9019", "type": "HCPCS"}, {"code": "36202793", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "Platelets, pheresis, pathogen-reduced, each unit P9073", "code_information": [{"code": "P9073", "type": "HCPCS"}, {"code": "45845022", "type": "CDM"}, {"code": "384", "type": "RC"}], "standard_charges": [{"minimum": 1560.63, "maximum": 2454.16, "gross_charge": 2538.0, "discounted_cash": 888.3, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1560.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2454.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2454.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2454.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Pneumococcal conjugate vaccine, 21 valent (PCV21), for intramuscular use", "code_information": [{"code": "90684", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Post discharge telephonic follow-up contacts performed in conjunction with a discharge from the emergency department for behavioral health or other crisis encounter, 4 calls per calendar month", "code_information": [{"code": "G0544", "type": "HCPCS"}], "standard_charges": [{"minimum": 407.93, "maximum": 641.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 407.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 641.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 641.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 641.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Post-operative follow-up visit complexity inherent to evaluation and management services addressing surgical procedure(s), provided by a physician or qualified health care professional who is not the practitioner who performed the procedure (or in the sam", "code_information": [{"code": "G0559", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.35, "maximum": 63.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 63.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 63.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Potassium Level", "code_information": [{"code": "84132", "type": "CPT"}, {"code": "633616", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 111.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Prealbumin", "code_information": [{"code": "84134", "type": "CPT"}, {"code": "1969162", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 28.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 58.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 58.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Preparation of skin cell suspension autograft, requiring enzymatic processing, manual mechanical disaggregation of skin cells, and filtration; each additional 25 sq cm of harvested skin or part thereof (List separately in addition to code for primary proc", "code_information": [{"code": "15014", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Preparation of skin cell suspension autograft, requiring enzymatic processing, manual mechanical disaggregation of skin cells, and filtration; first 25 sq cm or less of harvested skin", "code_information": [{"code": "15013", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, implantable cardiac contractility m", "code_information": [{"code": "926T", "type": "CPT"}], "standard_charges": [{"minimum": 95.09, "maximum": 149.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 95.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 149.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Programming of subcutaneously implanted peritoneal ascites pump system by physician or other qualified health care professional", "code_information": [{"code": "875T", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 251.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Prolonged Inpatient Or Observation Hospital Service Each 30 Minutes Beyond First Hour", "code_information": [{"code": "99357", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Prolonged Inpatient Or Observation Hospital Service First Hour", "code_information": [{"code": "99356", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Prolonged Office Or Other Outpatient Service Each 30 Minutes Beyond First Hour", "code_information": [{"code": "99355", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Prolonged Office Or Other Outpatient Service First Hour", "code_information": [{"code": "99354", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Prostate Specific Antigen", "code_information": [{"code": "84153", "type": "CPT"}, {"code": "633810", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 102.0, "discounted_cash": 35.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 28.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Protein Body Fluid", "code_information": [{"code": "85303", "type": "CPT"}, {"code": "633812", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Protein Electrophoresis", "code_information": [{"code": "84165", "type": "CPT"}, {"code": "633816", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 2053.0, "discounted_cash": 718.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 762.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Pulmonology care MIPS value pathway", "code_information": [{"code": "M1424", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Q FEVER ANTIBODY", "code_information": [{"code": "86638", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QMRCP W/DX MRI SAME ANATOMY", "code_information": [{"code": "724T", "type": "CPT"}], "standard_charges": [{"minimum": 604.59, "maximum": 950.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 604.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QMRCP W/O DX MRI SM ANAT SES", "code_information": [{"code": "723T", "type": "CPT"}], "standard_charges": [{"minimum": 4153.69, "maximum": 6529.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4153.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6529.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6529.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6529.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QNHP OL DIG ASSMT&MGMT 11-20", "code_information": [{"code": "98971", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QNHP OL DIG ASSMT&MGMT 21+", "code_information": [{"code": "98972", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QNHP OL DIG ASSMT&MGMT 5-10", "code_information": [{"code": "98970", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QTc interval derived by augmentative algorithmic analysis of input from an external, patient-activated mobile ECG device", "code_information": [{"code": "902T", "type": "CPT"}], "standard_charges": [{"minimum": 328.7, "maximum": 516.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 328.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 516.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 516.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 516.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUADPRO HARVESTER 10MM AR-2386-10", "code_information": [{"code": "AR-2386-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1239.28, "discounted_cash": 433.75, "setting": "both", "billing_class": "facility"}]}, {"description": "QUADRICEPS TENDON WITH BONE QDT-002", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "QDT-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4540.0, "discounted_cash": 1589.0, "setting": "both", "billing_class": "facility"}]}, {"description": "QUAL CARE ENT DISORDER MVP", "code_information": [{"code": "M1367", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUALCARE MENTAL HLTH/SUD MVP", "code_information": [{"code": "M1369", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN CT TISS CHARAC W/CT", "code_information": [{"code": "722T", "type": "CPT"}], "standard_charges": [{"minimum": 604.59, "maximum": 950.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 604.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN CT TISS CHARAC W/O CT", "code_information": [{"code": "721T", "type": "CPT"}], "standard_charges": [{"minimum": 2842.69, "maximum": 4468.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2842.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4468.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4468.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4468.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN MR TIS WO MRI 1ORGN", "code_information": [{"code": "648T", "type": "CPT"}], "standard_charges": [{"minimum": 1005.67, "maximum": 1580.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1005.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN MR TIS WO MRI MLT ORGN", "code_information": [{"code": "697T", "type": "CPT"}], "standard_charges": [{"minimum": 1026.95, "maximum": 1614.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1026.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1614.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1614.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1614.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN MR TISS W/MRI 1ORGN", "code_information": [{"code": "649T", "type": "CPT"}], "standard_charges": [{"minimum": 1005.67, "maximum": 1580.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1005.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN MR TISS W/MRI MLT ORGN", "code_information": [{"code": "698T", "type": "CPT"}], "standard_charges": [{"minimum": 1005.67, "maximum": 1580.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1005.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1580.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN MRI ALYS BRN W/DX MRI", "code_information": [{"code": "866T", "type": "CPT"}], "standard_charges": [{"minimum": 1020.26, "maximum": 1603.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1020.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1603.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1603.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1603.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN MRI ALYS BRN W/O DX MRI", "code_information": [{"code": "865T", "type": "CPT"}], "standard_charges": [{"minimum": 1020.26, "maximum": 1603.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1020.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1603.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1603.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1603.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN PUPLMTRY PHY/QHP UNI/BI", "code_information": [{"code": "95919", "type": "CPT"}], "standard_charges": [{"minimum": 296.08, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 296.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN US TIS CHARAC W/DX US", "code_information": [{"code": "690T", "type": "CPT"}], "standard_charges": [{"minimum": 604.59, "maximum": 950.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 604.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN US TIS CHARAC W/O DX US", "code_information": [{"code": "689T", "type": "CPT"}], "standard_charges": [{"minimum": 361.01, "maximum": 567.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 361.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 567.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 567.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 567.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUANTA OF 200UM PERFORMANCE SU 137903", "code_information": [{"code": "137903", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "QUANTITATIVE ASSAY DRUG", "code_information": [{"code": "80299", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Quantitative software measurements of cardiac volume, cardiac chambers volumes and left ventricular wall mass derived from CT scan(s) data of the chest/heart (with or without contrast)", "code_information": [{"code": "G0183", "type": "HCPCS"}], "standard_charges": [{"minimum": 384.78, "maximum": 604.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 384.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 604.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 604.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 604.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7521", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7522", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT ART/GRFT ANG HRT FLOW", "code_information": [{"code": "C7552", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT ART/GRFT ANGIO", "code_information": [{"code": "93457", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93594", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93593", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT CORONARY ARTERY ANGIO", "code_information": [{"code": "93456", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&I HRT ART/VENT ANG DRG AD", "code_information": [{"code": "C7553", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7527", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7528", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT ART/VENTRICLE ANGIO", "code_information": [{"code": "93460", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT ART/VENTRICLE ANGIO", "code_information": [{"code": "93461", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93597", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93596", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH W/VENTRICLGRPHY", "code_information": [{"code": "93453", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT GFT ANG W/FLOW RESRV", "code_information": [{"code": "C7529", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R-T PRS SENSING EDRL GDN SYS", "code_information": [{"code": "777T", "type": "CPT"}], "standard_charges": [{"minimum": 326.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 326.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R-T SPCTRL ALYS PRST8 TISS", "code_information": [{"code": "443T", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R3 20 DEG XLPE LNR 44MM ID X 62 OD 71331107", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71331107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5758.0, "discounted_cash": 2015.3, "setting": "both", "billing_class": "facility"}]}, {"description": "R3 3 HOLE ACET SHELL 64MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 1256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "R3CON LOCKING PLATE SCREW 2.7 X 15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-2715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RA TRACER ID OF SENTINL NODE", "code_information": [{"code": "38792", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HEAT TREATED", "code_information": [{"code": "90376", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT&SOL HUMAN IM/SC", "code_information": [{"code": "90377", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG IM/SC", "code_information": [{"code": "90375", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE ID", "code_information": [{"code": "90676", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE IM", "code_information": [{"code": "90675", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD EXPOS IND/EXP TM DOC", "code_information": [{"code": "G9500", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD EXPOS IND/EXP TM NO DOC", "code_information": [{"code": "G9501", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E 5 CM+", "code_information": [{"code": "24079", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESECT ABD TUMOR 5 CM/>", "code_information": [{"code": "22905", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESECTION TUM RADIAL H/N", "code_information": [{"code": "24152", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD ROD TI HEX 5.5MM X 80MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 197.4, "setting": "both", "billing_class": "facility"}]}, {"description": "RADIAL KERATOTOMY", "code_information": [{"code": "65771", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIAL STYLOIDECTOMY 25230", "code_information": [{"code": "25230", "type": "CPT"}, {"code": "1481666", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION HANDLING", "code_information": [{"code": "77790", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 67.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 106.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 106.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 106.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION ONCOLOGY SS", "code_information": [{"code": "G4031", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77336", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 219.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 355.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 559.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 559.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 559.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77370", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 219.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 554.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 871.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 871.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 871.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY DOSE PLAN", "code_information": [{"code": "77300", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 219.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 151.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 237.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 237.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 237.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 82.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 88.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY MANAGEMENT", "code_information": [{"code": "77431", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 466.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 732.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 732.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 732.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77261", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 319.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 502.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 502.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 502.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77262", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 481.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 757.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 757.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 757.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77263", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 752.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1183.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1183.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1183.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77332", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 219.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 127.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 200.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 200.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 200.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 41.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 43.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77333", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 219.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 311.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 490.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 490.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 490.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 233.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 248.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77334", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 565.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 302.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 475.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 475.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 475.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 159.17, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 169.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77401", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77402", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 615.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 968.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 968.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 968.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77407", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1118.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1757.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1757.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1757.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77412", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 384.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1061.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1668.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1668.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1668.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6003", "type": "HCPCS"}], "standard_charges": [{"minimum": 870.94, "maximum": 1369.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 870.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1369.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1369.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1369.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6004", "type": "HCPCS"}], "standard_charges": [{"minimum": 637.85, "maximum": 1002.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 637.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1002.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1002.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1002.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6005", "type": "HCPCS"}], "standard_charges": [{"minimum": 637.85, "maximum": 1002.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 637.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1002.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1002.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1002.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6006", "type": "HCPCS"}], "standard_charges": [{"minimum": 636.27, "maximum": 1000.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 636.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1000.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1000.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1000.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6007", "type": "HCPCS"}], "standard_charges": [{"minimum": 1206.38, "maximum": 1896.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1206.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1896.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1896.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1896.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6008", "type": "HCPCS"}], "standard_charges": [{"minimum": 880.38, "maximum": 1384.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 880.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1384.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1384.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1384.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6009", "type": "HCPCS"}], "standard_charges": [{"minimum": 875.66, "maximum": 1376.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 875.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1376.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1376.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1376.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6010", "type": "HCPCS"}], "standard_charges": [{"minimum": 875.66, "maximum": 1376.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 875.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1376.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1376.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1376.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6011", "type": "HCPCS"}], "standard_charges": [{"minimum": 1190.65, "maximum": 1871.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1190.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6012", "type": "HCPCS"}], "standard_charges": [{"minimum": 1167.01, "maximum": 1834.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1167.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1834.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1834.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1834.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6013", "type": "HCPCS"}], "standard_charges": [{"minimum": 1168.58, "maximum": 1837.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1168.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1837.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1837.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1837.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6014", "type": "HCPCS"}], "standard_charges": [{"minimum": 1168.58, "maximum": 1837.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1168.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1837.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1837.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1837.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TX DELIVERY IMRT", "code_information": [{"code": "G6015", "type": "HCPCS"}], "standard_charges": [{"minimum": 1584.34, "maximum": 2490.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1584.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2490.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2490.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2490.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TX MANAGEMENT X5", "code_information": [{"code": "77427", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 845.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1329.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1329.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1329.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADICAL ABDOMINAL HYSTERECTOMY W/ TOTAL PELVIC LYMPHADENECTOMY 58210", "code_information": [{"code": "58210", "type": "CPT"}, {"code": "1481667", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL EXCISION OF BURSA/SYNOVIA FLEXORS WRIST/FOREARM 25115", "code_information": [{"code": "25115", "type": "CPT"}, {"code": "1481669", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL EXCISON OF BURSA-EXTENSORS WRIST/FOREARM 25116", "code_information": [{"code": "25116", "type": "CPT"}, {"code": "1481670", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECT ABD TUMOR<5CM", "code_information": [{"code": "22904", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION OF CAPSULE ELBOW W/CONTRACTURE RELEASE 24149", "code_information": [{"code": "24149", "type": "CPT"}, {"code": "1481673", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION OF TUMOR FEMUR OR KNEE 27365", "code_information": [{"code": "27365", "type": "CPT"}, {"code": "6313482", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 9405.0, "discounted_cash": 3291.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4552.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 3103.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION OF TUMOR PELVIS/HIP LESS THAN 5CM 27049", "code_information": [{"code": "27049", "type": "CPT"}, {"code": "1481674", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION TUMOR BACK 5CM OR LESS 21935", "code_information": [{"code": "21935", "type": "CPT"}, {"code": "1481676", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION TUMOR FACE/SCALP LESS THAN 2CM 21015", "code_information": [{"code": "21015", "type": "CPT"}, {"code": "1481678", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION TUMOR FACE/SCALP MORE THAN 2CM 21016", "code_information": [{"code": "21016", "type": "CPT"}, {"code": "1481679", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION TUMOR FINGER PROXIMAL/MIDDLE 26260", "code_information": [{"code": "26260", "type": "CPT"}, {"code": "1481680", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION TUMOR SOFT TISSUE ARM/ELBOW LESS THAN 5CM 24077", "code_information": [{"code": "24077", "type": "CPT"}, {"code": "1481681", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION TUMOR SOFT TISSUE HAND 3CM OR LESS 26117", "code_information": [{"code": "26117", "type": "CPT"}, {"code": "1481682", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION TUMOR SOFT TISSUE HAND 3CM OR MORE 26118", "code_information": [{"code": "26118", "type": "CPT"}, {"code": "1481683", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION TUMOR SOFT TISSUE SHOULDER LESS THAN 5CM 23077", "code_information": [{"code": "23077", "type": "CPT"}, {"code": "1481684", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION TUMOR-SHAFT-OR DISTAL HUMERUS 24150", "code_information": [{"code": "24150", "type": "CPT"}, {"code": "1482036", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL TRACHELECTOMY W/BILATERAL PELVIC LYMPHADENECTOMY 57531", "code_information": [{"code": "57531", "type": "CPT"}, {"code": "1481687", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIOFREQUENCY ABLATION NERVES INNERVATING SACROILIAC JT W/IMAGING 64625", "code_information": [{"code": "64625", "type": "CPT"}, {"code": "45577567", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIOLOGY PORT IMAGES(S)", "code_information": [{"code": "77417", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 79.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 79.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 79.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIOTHERAPY", "code_information": [{"code": "849", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15168.57, "maximum": 26040.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15168.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 21694.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23863.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26040.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIOTHERAPY DOSE PLAN IMRT", "code_information": [{"code": "77301", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 10678.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2076.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6792.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10678.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10678.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10678.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 3446.09, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 3670.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFS CRS EWH NO SCOR NO SURV", "code_information": [{"code": "G8670", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFS CRS HI NO SCOR NO SURV", "code_information": [{"code": "G8654", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFS CRS KI NO SCOR NO RSN", "code_information": [{"code": "G8650", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFS CRS LBI NO SCOR NO SURV", "code_information": [{"code": "G8662", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFS CRS SI NO SCOR NO SURV", "code_information": [{"code": "G8666", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS EWH SCOR < 0", "code_information": [{"code": "G8668", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS EWH SCOR >= 0", "code_information": [{"code": "G8667", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS HI SCOR < 0", "code_information": [{"code": "G8652", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS HI SCOR >=0", "code_information": [{"code": "G8651", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS KI SCOR < 0", "code_information": [{"code": "G8648", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS KI SCOR >= 0", "code_information": [{"code": "G8647", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LBI NO SCOR", "code_information": [{"code": "G8661", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LBI SCOR < 0", "code_information": [{"code": "G8660", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LBI SCOR >= 0", "code_information": [{"code": "G8659", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LLFAI NO SCOR + SURV", "code_information": [{"code": "G8658", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LLFAI SCOR < 0", "code_information": [{"code": "G8656", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LLFAI SCOR >= 0", "code_information": [{"code": "G8655", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS SI SCOR < 0", "code_information": [{"code": "G8664", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAFSCRS SI SCOR >= 0", "code_information": [{"code": "G8663", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAIL MICRO 90MM GOLD M500-090", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "M500-090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7406.0, "discounted_cash": 2592.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RAIL MINI 100MM BLACK M600-100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "M600-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7406.0, "discounted_cash": 2592.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RAIN BAG URINE METER 350CC 153204", "code_information": [{"code": "153204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RAMPART-O 30MM X 10MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "380-3010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RANGE OF MOTION MEASUREMENTS", "code_information": [{"code": "95851", "type": "CPT"}], "standard_charges": [{"minimum": 34.97, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RANGE OF MOTION MEASUREMENTS", "code_information": [{"code": "95852", "type": "CPT"}], "standard_charges": [{"minimum": 27.03, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 42.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 42.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 42.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAP-PAC B 1.2MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202797", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 257.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RAPID DESENSITIZATION", "code_information": [{"code": "95180", "type": "CPT"}], "standard_charges": [{"minimum": 1603.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1603.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAR DO WHL GN&MTCDRL DNA ALS", "code_information": [{"code": "265U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 7885.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7885.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7885.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DO ID OPT GEN MAPG&SEQ", "code_information": [{"code": "267U", "type": "CPT"}], "standard_charges": [{"minimum": 9704.64, "maximum": 20175.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12829.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20175.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9704.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9704.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS GEN DNA ALYS EA COMP", "code_information": [{"code": "213U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 3902.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3902.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3902.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS GEN DNA ALYS PROBAND", "code_information": [{"code": "212U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 7884.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7884.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7884.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS ID OPT GENOME MAPG", "code_information": [{"code": "260U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1819.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1819.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1819.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS ID OPT GENOME MAPG", "code_information": [{"code": "264U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 1819.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1819.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1819.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS WHL GEN SEQ BLD/SLV", "code_information": [{"code": "336U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 3707.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3707.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3707.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS WHL GEN SEQ FETA", "code_information": [{"code": "335U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 7523.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7523.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7523.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS XOM DNA ALYS EA COMP", "code_information": [{"code": "215U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 3707.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3707.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3707.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS XOM DNA ALYS PROBAND", "code_information": [{"code": "214U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 7523.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7523.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7523.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RASP 12 MM LONG", "code_information": [{"code": "120-04012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP 13.0 X 6.9MM TEAR RASP LG TEAR CROSS CUT KM-83", "code_information": [{"code": "KM-83", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP RHEAD CONTERSINK DISP", "code_information": [{"code": "17-0974", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1137.0, "discounted_cash": 397.95, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP SURG 14MM X 7MM CROSS CUT LG TEAR REPROCESSINSTR", "code_information": [{"code": "510037114R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 215.0, "discounted_cash": 75.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP SURG 6.5MM LG MICRO CROSS CUT RECIPROCATING HALL", "code_information": [{"code": "5053-083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 32.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP SURG LG 13.9MM X 7.0MM TEAR CROSS CUT TSP", "code_information": [{"code": "5100-37-114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RBC ANTIBODY ELUTION", "code_information": [{"code": "86860", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC ANTIBODY IDENTIFICATION", "code_information": [{"code": "86870", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DEPLETION OF HARVEST", "code_information": [{"code": "38212", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNOTYP 10 BLD GROUPS", "code_information": [{"code": "84U", "type": "CPT"}], "standard_charges": [{"minimum": 1036.8, "maximum": 2887.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1836.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1036.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1036.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNOTYP 16 BLD GROUPS", "code_information": [{"code": "246U", "type": "CPT"}], "standard_charges": [{"minimum": 1036.8, "maximum": 2887.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1836.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1036.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1036.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNTYP 12 BLD GRP GEN", "code_information": [{"code": "282U", "type": "CPT"}], "standard_charges": [{"minimum": 1036.8, "maximum": 2887.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1836.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1036.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1036.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DNA HEA 35 AG 11 BLD GRP", "code_information": [{"code": "1U", "type": "CPT"}], "standard_charges": [{"minimum": 1036.8, "maximum": 2887.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1836.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2887.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1036.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1036.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC MECHANICAL FRAGILITY", "code_information": [{"code": "85547", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC OSMOTIC FRAGILITY", "code_information": [{"code": "85555", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC OSMOTIC FRAGILITY", "code_information": [{"code": "85557", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC PRETREATMENT SERUM", "code_information": [{"code": "86978", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC PRETX INCUBATJ W/CHEMICL", "code_information": [{"code": "86970", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 83.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC PRETX INCUBATJ W/DENSITY", "code_information": [{"code": "86972", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC PRETX INCUBATJ W/ENZYMES", "code_information": [{"code": "86971", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX ID DILUTION", "code_information": [{"code": "86976", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX INCUBJ DRUGS", "code_information": [{"code": "86975", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 546.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 546.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX INCUBJ/INHIB", "code_information": [{"code": "86977", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC SICKLE CELL TEST", "code_information": [{"code": "85660", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96931", "type": "CPT"}], "standard_charges": [{"minimum": 764.47, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 764.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1201.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1201.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1201.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96932", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 119.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 119.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 119.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96933", "type": "CPT"}], "standard_charges": [{"minimum": 209.78, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 209.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 329.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 329.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 329.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96934", "type": "CPT"}], "standard_charges": [{"minimum": 435.49, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 435.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 684.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 684.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 684.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96935", "type": "CPT"}], "standard_charges": [{"minimum": 200.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 200.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96936", "type": "CPT"}], "standard_charges": [{"minimum": 200.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 200.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 314.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RE-EXPLORATION OF CHEST", "code_information": [{"code": "32120", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RE-EXPLORE PARATHYROIDS", "code_information": [{"code": "60502", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RE-LOAD STAPLER ENDO GIA W/REINFORCEMENT 45MM PURPLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EGIATRS45AMT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1087.0, "discounted_cash": 380.45, "setting": "both", "billing_class": "facility"}]}, {"description": "RE-LOAD STAPLER ENDO GIA W/REINFORCEMENT 60MM BLACK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EGIATRS60AXT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 375.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RE-LOAD STAPLER ENDO GIA W/REINFORCEMENT 60MM PURPLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EGIATRS60AMT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1238.0, "discounted_cash": 433.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REAL INTELLIGENCE TUBING SET ROB10031", "code_information": [{"code": "ROB10031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REALIGNMENT OF EXTENSOR TENDON HAND 26437", "code_information": [{"code": "26437", "type": "CPT"}, {"code": "1481688", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF HAND", "code_information": [{"code": "25335", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF KNEE", "code_information": [{"code": "27457", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF THIGH BONE", "code_information": [{"code": "27454", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REAMER 10.0MM CUTTING HEAD P31-955-0100", "code_information": [{"code": "P31-955-0100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 11.5MM CUTTING HEAD P31-955-0115", "code_information": [{"code": "P31-955-0115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 12MM DORSAL 120-02012", "code_information": [{"code": "120-02012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2 IN 1 DIAM 1.6 LG 10MM AO", "code_information": [{"code": "G0200011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2.0MM", "code_information": [{"code": "XDR20S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 718.0, "discounted_cash": 251.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2.0MM DRILL BIT", "code_information": [{"code": "XDR-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2.1 3MM P06 N0441", "code_information": [{"code": "P06 N0441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2.4 ALLOAID PIP", "code_information": [{"code": "C015001A02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2.55", "code_information": [{"code": "45303155", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 473.0, "discounted_cash": 165.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2.5MM", "code_information": [{"code": "CCP-RM25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 649.0, "discounted_cash": 227.15, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2.7MM DEPTH", "code_information": [{"code": "XDR-27S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 723.0, "discounted_cash": 253.05, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2.8 ALLOAID PIP", "code_information": [{"code": "C015001A05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 21MM COLINK CONE P04 N0033", "code_information": [{"code": "P04 N0033", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 672.5, "discounted_cash": 235.38, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 21MM COLINK CUP P04 N0023", "code_information": [{"code": "P04 N0023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 672.5, "discounted_cash": 235.38, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 22MM CONVEX 311-02-022", "code_information": [{"code": "311-02-022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2256.0, "discounted_cash": 789.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 23MM CUP AND CONE COLINK PLATING SYSTEM P04 N0034", "code_information": [{"code": "P04 N0034", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 23MM CUP COLINK PLATING SYSTEM P04 N0024", "code_information": [{"code": "P04 N0024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2MM", "code_information": [{"code": "CCP-RM20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 649.0, "discounted_cash": 227.15, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 3.2 CANNULATED 8528-1-S", "code_information": [{"code": "8528-1-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 605.52, "discounted_cash": 211.93, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 5.1MM CANNULATED WITH STOP", "code_information": [{"code": "AR-2374", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 812.0, "discounted_cash": 284.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 8MM CONCAVE", "code_information": [{"code": "220-08-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 8MM CONVEX", "code_information": [{"code": "220-08-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 232.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER ARROW-LOK DISPOSABLE INSTR", "code_information": [{"code": "95-3000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.45, "discounted_cash": 61.41, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE 10MM CANNULATED KNEE FOR TRANSTIBIAL ACL RECONSTRUCTIONINSTR", "code_information": [{"code": "AR-1410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE 10MM LOW PROFILE STRLINSTR", "code_information": [{"code": "AR-1410LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE 6 TO 11MM LOW PROFILEINSTR", "code_information": [{"code": "AR-1411LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE 7.5MM PILOTED HEADEDINSTR", "code_information": [{"code": "AR-1453", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE 8.58MM PILOTED HEADEDINSTR", "code_information": [{"code": "AR-1455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE 8MM LOW PROFILE KNEEINSTR DISP", "code_information": [{"code": "AR-1408LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE 9.5MM LOW PROFILE KNEE STRLINSTR DISP", "code_information": [{"code": "AR-1408LP-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE 9.5MM LOW PROFILE KNEEINSTR DISP", "code_information": [{"code": "AR-1409LP-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE 9MM CANNULATED KNEE FOR TRANSTIBIAL ACL RECONSTRUCTIONINSTR", "code_information": [{"code": "AR-1409", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE 9MM DIA LOW PROFILE STRLINSTR", "code_information": [{"code": "AR-1409LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE ANCHORAGE 2 CP", "code_information": [{"code": "705172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1489.0, "discounted_cash": 521.15, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CALIBRATED 2.7MM", "code_information": [{"code": "XDR27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1068.0, "discounted_cash": 373.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CANNULATED 2.7MM", "code_information": [{"code": "117066", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2199.0, "discounted_cash": 769.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CANNULATED 5MM", "code_information": [{"code": "IN0111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 781.0, "discounted_cash": 273.35, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE 10MM", "code_information": [{"code": "220-10-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE 12MM", "code_information": [{"code": "220-12-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE 22MM", "code_information": [{"code": "311-01-022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2256.0, "discounted_cash": 789.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE 24MM", "code_information": [{"code": "311-01-024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2256.0, "discounted_cash": 789.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE SURF DIAM 20MM", "code_information": [{"code": "XFR004120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1415.0, "discounted_cash": 495.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONE MTP 20MM", "code_information": [{"code": "58890220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 679.0, "discounted_cash": 237.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONVEX 10MM", "code_information": [{"code": "220-10-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONVEX 12MM", "code_information": [{"code": "220-12-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CORING 10MM CANNULATED", "code_information": [{"code": "AR-8902CR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CORING 10MM CANNULATED COLLARED PIN SET", "code_information": [{"code": "AR-1224S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CORING 11MM CANNULATED W/ COLLARED PIN STRLINSTR", "code_information": [{"code": "AR-1226S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CORING 13MM W/ COLLARED PIN STRL", "code_information": [{"code": "AR-1229S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CORING 14MM CANNULATED W/ COLLARED PIN STRL", "code_information": [{"code": "AR-1231S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CORING 7MM CANNULATED COLLARED PIN STRLINSTR", "code_information": [{"code": "AR-1220S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CORING CANN 9MM", "code_information": [{"code": "AR-1223S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CUP MTP 20MM", "code_information": [{"code": "58890120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 679.0, "discounted_cash": 237.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER DORSAL 4.5MM 9M59-1045", "code_information": [{"code": "9M59-1045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1579.0, "discounted_cash": 552.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER ENTRYINSTR", "code_information": [{"code": "14-440052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 154.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER FEMALE 19MM DISP", "code_information": [{"code": "P01-900-1902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1173.0, "discounted_cash": 410.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER FEMALE 21MM DISP", "code_information": [{"code": "P01-900-2102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1173.0, "discounted_cash": 410.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER FEMALE PROTECTOR SLEEVE 21MM", "code_information": [{"code": "P01-911-1902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER HEADLESS 3.0 PROXIMAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CD-FX-2030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1463.0, "discounted_cash": 512.05, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER HINDFOOT 8.0MM P31-955-0080", "code_information": [{"code": "P31-955-0080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER HINDFOOT 9.0MM P31-955-0090", "code_information": [{"code": "P31-955-0090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER HOLLOW COMPLETE FOR 6.5 MM AND 7 MM SCREW", "code_information": [{"code": "309.065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1281.0, "discounted_cash": 448.35, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER HPI HEMI PHALANGEAL IMPLANT", "code_information": [{"code": "HPI-1005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1455.0, "discounted_cash": 509.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER HPI HEMI PHALANGEAL IMPLANT ST", "code_information": [{"code": "HP1-1005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1462.0, "discounted_cash": 511.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER INBONE TALAR 10 MM 200432010", "code_information": [{"code": "200432010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER LOW PROFILE 7MM", "code_information": [{"code": "906570", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER LOW PROFILE 9MM REPROCESS", "code_information": [{"code": "AR-1409LPR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER MALE 19MM DISP", "code_information": [{"code": "P01-900-1903", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1173.0, "discounted_cash": 410.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER MALE PROTECTOR SLEEVE 19MM", "code_information": [{"code": "P01-911-1901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER MALE PROTECTOR SLEEVE 21MM", "code_information": [{"code": "P01-911-2101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER MEDSHAPE 5.0MM", "code_information": [{"code": "1500-01-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 266.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER METHEAD QC 16MM/1.6MM P672-16-16", "code_information": [{"code": "P672-16-16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 963.02, "discounted_cash": 337.06, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER METHEAD QC 18MM/1.6MM", "code_information": [{"code": "P672-18-16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 963.02, "discounted_cash": 337.06, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PATELLA 35MM", "code_information": [{"code": "5979-95-35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PATELLA 38MM", "code_information": [{"code": "5979-95-38", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PATELLA W/ PILOT HOLE 46MM", "code_information": [{"code": "5979-95-46", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PHALANX QC 16MM/1.6MM P682-16-16", "code_information": [{"code": "P682-16-16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 963.02, "discounted_cash": 337.06, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PHALANX QC 18MM/1.6MM", "code_information": [{"code": "P682-18-16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 963.02, "discounted_cash": 337.06, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PROXIMAL CANNULATED", "code_information": [{"code": "CD-FX-2040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1602.0, "discounted_cash": 560.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER STEPPED CAN 8.0 TO 13.0MM P99-110-0813", "code_information": [{"code": "P99-110-0813", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1246.0, "discounted_cash": 436.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURFACING 18MM CONCAVE", "code_information": [{"code": "XFR004118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1265.82, "discounted_cash": 443.04, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURFACING 18MM CONVEX", "code_information": [{"code": "XFR004218", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1265.82, "discounted_cash": 443.04, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURFACING 22MM CONVEXINSTR", "code_information": [{"code": "XFR004222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1875.0, "discounted_cash": 656.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 10MM RIGID", "code_information": [{"code": "1806-2010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2312.0, "discounted_cash": 809.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 18MM ENCOMPASS", "code_information": [{"code": "386-1218", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1962.0, "discounted_cash": 686.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 22MM CONCAVE", "code_information": [{"code": "XFR004122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1415.0, "discounted_cash": 495.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 4.8MM CANNULATEDINSTR", "code_information": [{"code": "110069", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2857.95, "discounted_cash": 1000.28, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG CONVEXINSTR 20MM", "code_information": [{"code": "XFR004220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1415.0, "discounted_cash": 495.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMERS DYNAFORCE MPJ CUP/CONE 20MM", "code_information": [{"code": "70CC-0020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1353.0, "discounted_cash": 473.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REAS NO ADHERE THERAPY", "code_information": [{"code": "G8854", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REC INST NO SMOKE DAY SURG", "code_information": [{"code": "G9497", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REC'D ESRD MCP LST DAY OF MO", "code_information": [{"code": "M1269", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECD 2 ANTI-EMET PRE/INTRAOP", "code_information": [{"code": "G9775", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECD SCRN HCV INFEC", "code_information": [{"code": "G9383", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35301", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35302", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35303", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35304", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35305", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35306", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35311", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35321", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35331", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35341", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35351", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35355", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35361", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35363", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35371", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35372", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHARGER BELT LARGE FP9000L", "code_information": [{"code": "FP9000L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.75, "discounted_cash": 29.66, "setting": "both", "billing_class": "facility"}]}, {"description": "RECON, CTA FOR SURG PLAN", "code_information": [{"code": "G0288", "type": "HCPCS"}], "standard_charges": [{"minimum": 159.07, "maximum": 250.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECON. EYELID FULL THICKNESS-TRANSFER OF TARSOCONJUNCTIVAL FLAP-OPPOSING EYELID 67971", "code_information": [{"code": "67971", "type": "CPT"}, {"code": "1481690", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECON. PENIS-1 STAGE-PROXIMAL PENILE W/ EXTENSIVE DISSECTION TO CORRECT CHORDEE 54332", "code_information": [{"code": "54332", "type": "CPT"}, {"code": "1481691", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/GRAFT", "code_information": [{"code": "21194", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/O FIXATION", "code_information": [{"code": "21195", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/O GRAFT", "code_information": [{"code": "21193", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW SEGMENT", "code_information": [{"code": "21198", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW W/ADVANCE", "code_information": [{"code": "21199", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT BRONCHUS", "code_information": [{"code": "31775", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT FOOT", "code_information": [{"code": "28360", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42200", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42205", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42210", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42215", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42220", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42225", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21182", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21183", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21184", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24361", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24362", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21179", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21180", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT EXTRA FINGER", "code_information": [{"code": "26587", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT INJURED CHEST", "code_information": [{"code": "32820", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LARYNX & PHARYNX", "code_information": [{"code": "31395", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40525", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40527", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21247", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21255", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21172", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21175", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT VENA CAVA", "code_information": [{"code": "34502", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31780", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31781", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION ANGULAR DEFORMITY OF TOE/ SOFT TISSUE 28313", "code_information": [{"code": "28313", "type": "CPT"}, {"code": "2858375", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION BREAST WITH IMPLANT 19325", "code_information": [{"code": "19325", "type": "CPT"}, {"code": "1481695", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9735.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION COLLATERAL LIGAMENT METACARPOPHALANGEAL JOINT SINGLE W/ GRAFT 26541", "code_information": [{"code": "26541", "type": "CPT"}, {"code": "1481700", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION COLLATERAL LIGAMENT MP JOINT W/ LOCAL TISSUE 26542", "code_information": [{"code": "26542", "type": "CPT"}, {"code": "1481702", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION COLLATERAL LIGAMENT-IP JOINT W/ GRAFT 26545", "code_information": [{"code": "26545", "type": "CPT"}, {"code": "1481701", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION COMPLETE SHOULDER (ROTATOR) CUFF AVULSION-CHRONIC 23420", "code_information": [{"code": "23420", "type": "CPT"}, {"code": "1481985", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION FINGER VOLAR PLATE-IP JOINT 26548", "code_information": [{"code": "26548", "type": "CPT"}, {"code": "1481697", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION HAND/FINGER TENDON PULLEY W/GRAFT 26502", "code_information": [{"code": "26502", "type": "CPT"}, {"code": "1481734", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION HAND/FINGER TENDON PULLEY-EACH TENDON W/ LOCAL TISSUES 26500", "code_information": [{"code": "26500", "type": "CPT"}, {"code": "1481733", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION LATERAL COLLATERAL LIGAMENT ELBOW 24343", "code_information": [{"code": "24343", "type": "CPT"}, {"code": "1481698", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION LATERAL COLLATERAL LIGAMENT ELBOW W/ TENDON GRAFT 24344", "code_information": [{"code": "24344", "type": "CPT"}, {"code": "1481699", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION MANDIBULAR RAMI W/ INTERNAL FIXATION 21196", "code_information": [{"code": "21196", "type": "CPT"}, {"code": "1481703", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION MANDIBULAR WITH ALLOGRAFT COMPLETE 21249", "code_information": [{"code": "21249", "type": "CPT"}, {"code": "1481704", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT ELBOW W/ TENDON GRAFT 24346", "code_information": [{"code": "24346", "type": "CPT"}, {"code": "1481708", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION NAIL BED 11760", "code_information": [{"code": "11760", "type": "CPT"}, {"code": "1481709", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION NIPPLE/AREOLA 19350", "code_information": [{"code": "19350", "type": "CPT"}, {"code": "1481710", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ANUS", "code_information": [{"code": "46753", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF BILE DUCTS", "code_information": [{"code": "47800", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21123", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF DISLOCATING PATELLA 27420", "code_information": [{"code": "27420", "type": "CPT"}, {"code": "1481711", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF DISLOCATING PATELLA W/ EXTENSOR REALIGNMENT 27422", "code_information": [{"code": "27422", "type": "CPT"}, {"code": "1481713", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF DISLOCATING PATELLA W/ PATELLECTOMY 27424", "code_information": [{"code": "27424", "type": "CPT"}, {"code": "1481712", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EXTERNAL AUDITORY CANAL FOR CONGENITAL ATRESIA SINGLE STAGE 69320", "code_information": [{"code": "69320", "type": "CPT"}, {"code": "1481715", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EXTERNAL AUDITORY CANAL FOR STENOSIS 69310", "code_information": [{"code": "69310", "type": "CPT"}, {"code": "1481714", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID SECOND STAGE 67975", "code_information": [{"code": "67975", "type": "CPT"}, {"code": "1481716", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID TOTAL EYELID LOWER 1 STAGE OR FIRST STAGE 67973", "code_information": [{"code": "67973", "type": "CPT"}, {"code": "1481717", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID TOTAL EYELID UPPER 1 STAGE OR FIRST STAGE 67974", "code_information": [{"code": "67974", "type": "CPT"}, {"code": "1481718", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HIP SOCKET", "code_information": [{"code": "27120", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14250.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14250.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HIP SOCKET", "code_information": [{"code": "27122", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21245", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21246", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21242", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF LOWER JAW", "code_information": [{"code": "21244", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MANDIBLE OR MAXILLA PARTIAL 21248", "code_information": [{"code": "21248", "type": "CPT"}, {"code": "1481705", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MIDFACE", "code_information": [{"code": "21188", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40840", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40842", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40843", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40844", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40845", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NAIL BED", "code_information": [{"code": "11762", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ORBIT", "code_information": [{"code": "21256", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF PYLORUS", "code_information": [{"code": "43800", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF STERNUM", "code_information": [{"code": "21740", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF THROAT", "code_information": [{"code": "42950", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF WINDPIPE", "code_information": [{"code": "31766", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION ORBITAL FLOOR PERIORBITAL APPROACH 21386", "code_information": [{"code": "21386", "type": "CPT"}, {"code": "1481722", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION ORBITAL FLOOR PERIORBITAL APPROACH W/ IMPLANT 21390", "code_information": [{"code": "21390", "type": "CPT"}, {"code": "1481724", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION PENIS EXTENSIVE 1 STAGE PERINEAL HYPOSPADIAS REPAIR W/ GRAFT 54336", "code_information": [{"code": "54336", "type": "CPT"}, {"code": "1481725", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION PENIS FOR HYPOSPADIAS W/ EXTENSIVE DISSECTION TO CORRECT CHORDEE 54328", "code_information": [{"code": "54328", "type": "CPT"}, {"code": "1481727", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION PENIS TO CORRECT ANGULATION 54360", "code_information": [{"code": "54360", "type": "CPT"}, {"code": "1481726", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION POST. TIBIAL TENDON W/ EXCISION OF TARSAL NAVICULAR BONE 28238", "code_information": [{"code": "28238", "type": "CPT"}, {"code": "1481728", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION STABALIZATION DISTAL ULNA OR RADIOULNA JOINT 25337", "code_information": [{"code": "25337", "type": "CPT"}, {"code": "1481729", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION TO MACRODACTYLY REQUIRING BONE RESECTION 28341", "code_information": [{"code": "28341", "type": "CPT"}, {"code": "25618650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION TOE MACRODACTYL SOFT TISSUE RESECTION 28340", "code_information": [{"code": "28340", "type": "CPT"}, {"code": "23574050", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION-TOE-SYNDACTYLY W/ OR W/O SKIN GRAFTS-EACH WEB 28345", "code_information": [{"code": "28345", "type": "CPT"}, {"code": "1481732", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECORD BP IP, ER, URG/SELF", "code_information": [{"code": "G9789", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECOTHROM THROMBIN TOPICAL SPRAY 20,000 IU", "code_information": [{"code": "MED0202", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 196.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH CC", "code_information": [{"code": "333", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13025.53, "maximum": 22361.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13025.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18629.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20492.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22361.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH MCC", "code_information": [{"code": "332", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25314.4, "maximum": 43458.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25314.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 36205.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39825.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 43458.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITHOUT CC/MCC", "code_information": [{"code": "334", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9785.11, "maximum": 16798.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9785.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13994.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15394.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16798.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL SENSATION TEST", "code_information": [{"code": "91120", "type": "CPT"}], "standard_charges": [{"minimum": 1829.31, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1829.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2874.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2874.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2874.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [{"code": "811", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8390.28, "maximum": 14404.03, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8390.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11999.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13199.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14404.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITHOUT MCC", "code_information": [{"code": "812", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5354.86, "maximum": 9192.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5354.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7658.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8424.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9192.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS MULTIPLE", "code_information": [{"code": "78121", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 289.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 455.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 455.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 455.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 192.1, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 205.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS SINGLE", "code_information": [{"code": "78120", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 277.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 435.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 435.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 435.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 149.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 160.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL SEQUESTRATION", "code_information": [{"code": "78140", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 381.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 599.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 599.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 599.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 205.77, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 219.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL SURVIVAL STUDY", "code_information": [{"code": "78130", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 447.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 703.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 703.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 703.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 241.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 258.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDAPT MOD SLV LG SZ 12-13 STIKTITEW/HA 71354051", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71354051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REDO COMPL CARDIAC ANOMALY", "code_information": [{"code": "33622", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDO ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37192", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCE BOWEL OBSTRUCTION", "code_information": [{"code": "44050", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION MAMMOPLASTY 19318", "code_information": [{"code": "19318", "type": "CPT"}, {"code": "1481737", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21137", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21138", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21139", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF PROCIDENTIA UNDER ANESTHESIA 45900", "code_information": [{"code": "45900", "type": "CPT"}, {"code": "1481740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1871.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62115", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62117", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF TESTICULAR TORSION 54600", "code_information": [{"code": "54600", "type": "CPT"}, {"code": "1481741", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OSTEOPLASTY-FACIAL BONES AUGMENTATION W/ GRAFT 21209", "code_information": [{"code": "21209", "type": "CPT"}, {"code": "1481738", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REEXPLORATION PELVIC WOUND", "code_information": [{"code": "49014", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REF FOR OTO EVAL", "code_information": [{"code": "G8856", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REF TO THERAPY", "code_information": [{"code": "G0042", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFILL AND MAINTENANCE IMPLANT. PUMP OR RES. FOR DRUG DEL. SPINAL/BRAIN INC. ELEC. ANALYSIS 95991", "code_information": [{"code": "95991", "type": "CPT"}, {"code": "17290342", "type": "CDM"}, {"code": "940", "type": "RC"}], "standard_charges": [{"minimum": 181.16, "maximum": 8450.0, "gross_charge": 1016.0, "discounted_cash": 355.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 181.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 284.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 284.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 284.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFILL/MAINT PORTABLE PUMP", "code_information": [{"code": "96521", "type": "CPT"}], "standard_charges": [{"minimum": 656.38, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 656.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1031.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1031.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1031.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESEVOIR FOR DRUG DELIVERY; SYSTEMIC 96522", "code_information": [{"code": "96522", "type": "CPT"}, {"code": "42710745", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 537.18, "maximum": 8450.0, "gross_charge": 1589.0, "discounted_cash": 556.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 652.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 652.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 804.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 590.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 537.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 844.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 844.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 844.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFRACT NOT +/- 1.0 W/IN 90D", "code_information": [{"code": "G9520", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G2209", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9726", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9728", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9730", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9732", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9734", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9736", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR H MLT INJ", "code_information": [{"code": "490T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR HANDS", "code_information": [{"code": "489T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGULATOR 0-15 LPM 870 CGA CONNECTION", "code_information": [{"code": "HCS8715M", "type": "CDM"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REGULATOR ANALOG CONTINUOUS ANDINTERMITTENT MINI COMBO VACUTRON", "code_information": [{"code": "22-15-1208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1332.0, "discounted_cash": 466.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REHAB SUPPORT MSK CARE MVP", "code_information": [{"code": "M1370", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT ARTERY EACH", "code_information": [{"code": "35697", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50780", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50782", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50783", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50785", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANTATION OF KIDNEY", "code_information": [{"code": "50380", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE HIP BONES", "code_information": [{"code": "27187", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE PULMONARY ARTERY", "code_information": [{"code": "33690", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS", "code_information": [{"code": "25490", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS AND ULNA", "code_information": [{"code": "25492", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE SHOULDER BONES", "code_information": [{"code": "23491", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE THIGH", "code_information": [{"code": "27495", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE ULNA", "code_information": [{"code": "25491", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINNERVATE LARYNX", "code_information": [{"code": "31590", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINSERTION OCULAR IMPLANT W/FOREIGN MAT. FOR REINFORCEMENT AND/OR ATTACH OF MUSCLES IMPLANT 65155", "code_information": [{"code": "65155", "type": "CPT"}, {"code": "44926787", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1836.78, "maximum": 8450.0, "gross_charge": 3795.0, "discounted_cash": 1328.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1836.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINSERTION OF SPINAL FIXATION DEVICE 22849", "code_information": [{"code": "22849", "type": "CPT"}, {"code": "1481743", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 14796.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINSERTION RUPTURED BICEPS/TRICEPS TENDON-DISTAL W/ OR W/O GRAFT 24342", "code_information": [{"code": "24342", "type": "CPT"}, {"code": "1481744", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE ENCIRCLING MATERIAL", "code_information": [{"code": "67115", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69955", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE INNER EAR CANAL", "code_information": [{"code": "69960", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE INTRINSIC MUSCLES HAND-EACH MUSCLE 26593", "code_information": [{"code": "26593", "type": "CPT"}, {"code": "1481749", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE MIDDLE EAR BONE", "code_information": [{"code": "69650", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF EXTENSIVE SCAR TISSUE WITHOUT DETACHING EXTRAOCULAR MUSCLE 67343", "code_information": [{"code": "67343", "type": "CPT"}, {"code": "1481750", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1411.34, "maximum": 8450.0, "gross_charge": 2916.0, "discounted_cash": 1020.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1411.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LUNG", "code_information": [{"code": "32220", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SHOULDER LIGAMENT", "code_information": [{"code": "23415", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61550", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61552", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50715", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50722", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50940", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE PROXIMAL HAMSTRING 27097", "code_information": [{"code": "27097", "type": "CPT"}, {"code": "1481751", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE TENDON ADDUCTOR HIP-OPEN 27001", "code_information": [{"code": "27001", "type": "CPT"}, {"code": "1481753", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE TENDON ADDUCTOR HIP-PERCUTANEOUS 27000", "code_information": [{"code": "27000", "type": "CPT"}, {"code": "1481752", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE TENDON ELBOW LATERAL OR MEDIAL W/ DEBRIDEMENT; OPEN 24358", "code_information": [{"code": "24358", "type": "CPT"}, {"code": "1481755", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE TENDON ELBOW LATERAL OR MEDIAL-PERCUTANEOUS 24357", "code_information": [{"code": "24357", "type": "CPT"}, {"code": "1481754", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE TENDON ELBOW W/DEBRIDEMENT-OPEN W/ TENDON REPAIR OR REATTACHMENT 24359", "code_information": [{"code": "24359", "type": "CPT"}, {"code": "1481756", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE TENDON HAMSTRING-OPEN KNEE TO HIP; SINGLE TENDON 27390", "code_information": [{"code": "27390", "type": "CPT"}, {"code": "1481757", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE THENAR MUSCLE(S) (EG. THUMB CONTRACTURE) 26508", "code_information": [{"code": "26508", "type": "CPT"}, {"code": "1481747", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE/REVISE URETER", "code_information": [{"code": "50725", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVA SCOUT MULTI-SINUS DILATION SYSTEM", "code_information": [{"code": "SCT0624MFSZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3271.0, "discounted_cash": 1144.85, "setting": "both", "billing_class": "facility"}]}, {"description": "RELIEVE CRANIAL PRESSURE", "code_information": [{"code": "61345", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOAD ECHELON GRY 60MM STERILE 6RW STPL ECR60M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD ENDOPATH W/GST 45MM GST45B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GST45B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD ENDOPATH W/GST 45MM GST45W", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "GST45W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD GST BLUE 60MM 6ROW GST60B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GST60B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 109.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD GST GREEN 60MM 6ROW GST60G", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GST60G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 109.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD HERNIA 4 MM BLACK MULTIFIRE ENDO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "174015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 292.0, "discounted_cash": 102.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD LINEAR CUTTER -ORDR QTY 12 6R45B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6R45B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD LINEAR CUTTER 75MM GREEN TRT75", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TRT75", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD MULTIFIRE ENDO HERNIA 4.8 BLK 174007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "174007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 292.0, "discounted_cash": 102.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLER 2.5 MM RED GIA 60", "code_information": [{"code": "GIA6025S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 170.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLER 2.5MM TO 3MM STAPLE VASCULAR PROXIMATE TI", "code_information": [{"code": "ESTRV30", "type": "CDM"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLER 2MM SKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30330L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLER LINEAR TITANIUM 60MM BLUE XR60B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XR60B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STPLR 45MM GRN REG LINEAR CUTTER ENDO THKTIS PISTOL GRIP ENDOPATH LF STRL", "code_information": [{"code": "TR45G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 81.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STPLR 55MM BLUE LINEAR CUTTER SAFETY LOCKOUT PROXIMATE LF TI STRL", "code_information": [{"code": "TCR55", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.9, "discounted_cash": 42.67, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD TRI 2.0 SUL 60 ART XTRA THK SIG60AXT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "SIG60AXT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1325.0, "discounted_cash": 463.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOC SKIN POCKET PLS GEN", "code_information": [{"code": "416T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOCATE POCKET FOR DEFIB", "code_information": [{"code": "33223", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOCATION OF TESTIS(ES)", "code_information": [{"code": "54680", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOCATION POCKET PACEMAKER", "code_information": [{"code": "33222", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEV W/O FLAP", "code_information": [{"code": "D7300", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEVICE W/FLAP", "code_information": [{"code": "D7299", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM AUTON ALG NSLN CAL SETUP", "code_information": [{"code": "740T", "type": "CPT"}], "standard_charges": [{"minimum": 146.57, "maximum": 230.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 146.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 230.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 230.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 230.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM AUTON ALG NSLN DATA COLL", "code_information": [{"code": "741T", "type": "CPT"}], "standard_charges": [{"minimum": 89.25, "maximum": 140.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ENDOVAS VENA CAVA FILTER", "code_information": [{"code": "37193", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL ICPMS", "code_information": [{"code": "93297", "type": "CPT"}], "standard_charges": [{"minimum": 119.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 119.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL SCRMS", "code_information": [{"code": "93298", "type": "CPT"}], "standard_charges": [{"minimum": 119.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 119.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV ICDS PHYS", "code_information": [{"code": "578T", "type": "CPT"}], "standard_charges": [{"minimum": 138.25, "maximum": 217.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV ICDS TECH", "code_information": [{"code": "579T", "type": "CPT"}], "standard_charges": [{"minimum": 92.44, "maximum": 145.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 92.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/IDS", "code_information": [{"code": "93296", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/LDLS PM", "code_information": [{"code": "93294", "type": "CPT"}], "standard_charges": [{"minimum": 138.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MLT DAY UROFLOW DEV SPLY", "code_information": [{"code": "812T", "type": "CPT"}], "standard_charges": [{"minimum": 158.45, "maximum": 248.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 158.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 248.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 248.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 248.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MLT DAY UROFLOW SETUP", "code_information": [{"code": "811T", "type": "CPT"}], "standard_charges": [{"minimum": 555.44, "maximum": 872.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 555.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 872.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 872.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 872.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM DEV", "code_information": [{"code": "99454", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM SETUP", "code_information": [{"code": "99453", "type": "CPT"}], "standard_charges": [{"minimum": 511.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PULM FLU MNTR ALYS", "code_information": [{"code": "608T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 251.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PULM FLU MNTR SETUP", "code_information": [{"code": "607T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 803.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR WRLS P-ART PRS SNR", "code_information": [{"code": "93264", "type": "CPT"}], "standard_charges": [{"minimum": 162.11, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 162.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 254.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 254.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 254.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA DEV SETUP&EDUCAJ", "code_information": [{"code": "604T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 796.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 506.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 796.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 796.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 796.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA PHYS/QHP EA 30D", "code_information": [{"code": "606T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 384.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 244.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 384.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 384.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 384.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA TECHL SPRT MIN 8", "code_information": [{"code": "605T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 249.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 158.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 249.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 249.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 249.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM PHYSIOL MNTR 1ST 20 MIN", "code_information": [{"code": "99457", "type": "CPT"}], "standard_charges": [{"minimum": 143.06, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 143.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM PHYSIOL MNTR EA ADDL 20", "code_information": [{"code": "99458", "type": "CPT"}], "standard_charges": [{"minimum": 144.65, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 144.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM R-T MTN NREHAB THER SPLY", "code_information": [{"code": "733T", "type": "CPT"}], "standard_charges": [{"minimum": 167.71, "maximum": 263.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 167.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 263.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 263.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 263.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM R-T MTN NREHAB TX MGMT", "code_information": [{"code": "734T", "type": "CPT"}], "standard_charges": [{"minimum": 1545.71, "maximum": 2428.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1545.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2428.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2428.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2428.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR 1ST 20 MIN", "code_information": [{"code": "98980", "type": "CPT"}], "standard_charges": [{"minimum": 144.65, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 144.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR 1ST SETUP&EDU", "code_information": [{"code": "98975", "type": "CPT"}], "standard_charges": [{"minimum": 535.15, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 535.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 840.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 840.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 840.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DEV SPLY CBT", "code_information": [{"code": "98978", "type": "CPT"}], "standard_charges": [{"minimum": 154.35, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 154.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 242.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 242.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 242.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DEV SPLY RESP", "code_information": [{"code": "98976", "type": "CPT"}], "standard_charges": [{"minimum": 167.71, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 167.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 263.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 263.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 263.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DV SPLY MSCSKL", "code_information": [{"code": "98977", "type": "CPT"}], "standard_charges": [{"minimum": 167.71, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 167.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 263.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 263.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 263.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR EA ADDL 20 MIN", "code_information": [{"code": "98981", "type": "CPT"}], "standard_charges": [{"minimum": 144.65, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 144.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 227.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM TX AMBLYOPIA I&R PHY/QHP", "code_information": [{"code": "706T", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 381.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM TX AMBLYOPIA SETUP&EDU", "code_information": [{"code": "704T", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 381.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM TX AMBLYOPIA TECH SPRT", "code_information": [{"code": "705T", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 381.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMIS12M NOT PHQ-9 SCORE <5", "code_information": [{"code": "G9510", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOT IMAGE SUBMIT BY PT", "code_information": [{"code": "G2010", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.32, "maximum": 64.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOT IMG SUB BY PT, NON E/M", "code_information": [{"code": "G2250", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.91, "maximum": 67.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG REV/REPORT", "code_information": [{"code": "93228", "type": "CPT"}], "standard_charges": [{"minimum": 117.61, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 117.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 184.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 184.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 184.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG REV/REPORT", "code_information": [{"code": "93270", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG TECH SUPP", "code_information": [{"code": "93229", "type": "CPT"}], "standard_charges": [{"minimum": 3170.7, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3170.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4982.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4982.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4982.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE CONTROL NEURO 2301", "code_information": [{"code": "2301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOTE CONTROL SC-5270", "code_information": [{"code": "SC-5270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT  15MINS", "code_information": [{"code": "G9984", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 10MINS", "code_information": [{"code": "G9486", "type": "HCPCS"}], "standard_charges": [{"minimum": 82.64, "maximum": 129.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 82.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 129.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 129.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 129.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 10MINS", "code_information": [{"code": "G9983", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 15MINS", "code_information": [{"code": "G9487", "type": "HCPCS"}], "standard_charges": [{"minimum": 165.29, "maximum": 259.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 165.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 259.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 259.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 259.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 25MINS", "code_information": [{"code": "G9488", "type": "HCPCS"}], "standard_charges": [{"minimum": 254.28, "maximum": 399.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 254.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 399.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 25MINS", "code_information": [{"code": "G9985", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 40MINS", "code_information": [{"code": "G9489", "type": "HCPCS"}], "standard_charges": [{"minimum": 359.19, "maximum": 564.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 359.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 564.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 564.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 564.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 40MINS", "code_information": [{"code": "G9986", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 10MINS", "code_information": [{"code": "G9481", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.23, "maximum": 132.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 84.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 10MINS", "code_information": [{"code": "G9978", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 20MINS", "code_information": [{"code": "G9482", "type": "HCPCS"}], "standard_charges": [{"minimum": 160.52, "maximum": 252.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 160.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 252.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 252.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 252.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 20MINS", "code_information": [{"code": "G9979", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 30 MINS", "code_information": [{"code": "G9980", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 30MINS", "code_information": [{"code": "G9483", "type": "HCPCS"}], "standard_charges": [{"minimum": 249.52, "maximum": 392.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 249.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 392.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 392.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 392.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 45MINS", "code_information": [{"code": "G9484", "type": "HCPCS"}], "standard_charges": [{"minimum": 421.16, "maximum": 661.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 421.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 661.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 661.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 661.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 45MINS", "code_information": [{"code": "G9981", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 60MINS", "code_information": [{"code": "G9485", "type": "HCPCS"}], "standard_charges": [{"minimum": 549.93, "maximum": 864.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 549.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 864.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 864.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 864.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 60MINS", "code_information": [{"code": "G9982", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC UR SPHINCTR COMP", "code_information": [{"code": "53448", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL ABDOMEN LYMPH NODES", "code_information": [{"code": "38564", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL ALLOGRAFT PANCREAS", "code_information": [{"code": "48556", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL AND REPLACEMENT OF EXTERNALLY ACCESSIBLE NEPHROURETERAL CATHETER; REQUIRING FLUORO 50387", "code_information": [{"code": "50387", "type": "CPT"}, {"code": "1480537", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL AND REPLACEMENT OF INFLATABLE PENILE PROSTHESIS THROUGH INFECTED FIELD INC. I&D 54411", "code_information": [{"code": "54411", "type": "CPT"}, {"code": "1481761", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL AND REPLACEMENT OF MULTI-COMPONENT INFLATABLE PENILE PROSTHESIS 54410", "code_information": [{"code": "54410", "type": "CPT"}, {"code": "1481760", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL AND REPLACEMENT OF NON-INFLATABLE PENILE PROSTHESIS THROUGH INFECTED FIELD INC. I&D 54417", "code_information": [{"code": "54417", "type": "CPT"}, {"code": "1481763", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL AND REPLACEMENT OF PENILE PROSTHESIS 54416", "code_information": [{"code": "54416", "type": "CPT"}, {"code": "1481762", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL ANTERIOR INSTRUMENTATION SPINE 22855", "code_information": [{"code": "22855", "type": "CPT"}, {"code": "1481782", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 9735.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL BENIGN TUMOR OF FACIAL BONE BY CONTOURING 21029", "code_information": [{"code": "21029", "type": "CPT"}, {"code": "1481764", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL BILIARY DRG CATH", "code_information": [{"code": "47537", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL CENTRAL VENOUS LINE W/ IMPLANTED ACCESS PORT 36590", "code_information": [{"code": "36590", "type": "CPT"}, {"code": "1481765", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL COMPLETE IIMS", "code_information": [{"code": "530T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL DRUG DELIVERY DEEP 20701", "code_information": [{"code": "20701", "type": "CPT"}, {"code": "45581518", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 4236.0, "discounted_cash": 1482.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2050.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL DUCT GLBLDR CALCULI", "code_information": [{"code": "47544", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY EXT. EYE CONJUNCTIVAL EMBEDDED SUBCONJUNCTIVAL OR SCLERA NON PERF. 65210", "code_information": [{"code": "65210", "type": "CPT"}, {"code": "21779392", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA 69205", "code_information": [{"code": "69205", "type": "CPT"}, {"code": "1481771", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA 69200", "code_information": [{"code": "69200", "type": "CPT"}, {"code": "1481772", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY GUM", "code_information": [{"code": "41805", "type": "CPT"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY IN MUSCLE/TENDON SHEATH-DEEP OR COMPLICATED 20525", "code_information": [{"code": "20525", "type": "CPT"}, {"code": "1481766", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY JAWBONE", "code_information": [{"code": "41806", "type": "CPT"}], "standard_charges": [{"minimum": 1067.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY MOUTH", "code_information": [{"code": "40804", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY MOUTH", "code_information": [{"code": "40805", "type": "CPT"}], "standard_charges": [{"minimum": 1067.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY NOSE-BY LATERAL RHINOTOMY 30320", "code_information": [{"code": "30320", "type": "CPT"}, {"code": "1481774", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY NOSE-OFFICE TYPE PROCEDURE 30300", "code_information": [{"code": "30300", "type": "CPT"}, {"code": "1481776", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 65.34, "maximum": 8450.0, "gross_charge": 135.0, "discounted_cash": 47.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY NOSE-REQUIRING GENERAL ANESTHESIA 30310", "code_information": [{"code": "30310", "type": "CPT"}, {"code": "1481775", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY SHOULDER-SUBCUTANEOUS 23330", "code_information": [{"code": "23330", "type": "CPT"}, {"code": "1481777", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP 24201", "code_information": [{"code": "24201", "type": "CPT"}, {"code": "1481770", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY UPPER ARM/ELBOW-SUBCUTANEOUS 24200", "code_information": [{"code": "24200", "type": "CPT"}, {"code": "1481769", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY-DEEP-THIGH/KNEE AREA 27372", "code_information": [{"code": "27372", "type": "CPT"}, {"code": "1481773", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY-SHOULDER-DEEP 23331", "code_information": [{"code": "1481778", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVAL IIMS ELECTRODE ONLY", "code_information": [{"code": "531T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IIMS IMPLT MNTR ONLY", "code_information": [{"code": "532T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE; UNILATERAL 69209", "code_information": [{"code": "69209", "type": "CPT"}, {"code": "42923656", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 29.52, "maximum": 8450.0, "gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 29.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPACTED CERUMEN W/INST. UNILATERAL 69210", "code_information": [{"code": "69210", "type": "CPT"}, {"code": "1772198", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPLANT INCLUDING SYNOVECTOMY; RADIAL HEAD 24164", "code_information": [{"code": "24164", "type": "CPT"}, {"code": "1481818", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPLANT-DEEP 20680", "code_information": [{"code": "20680", "type": "CPT"}, {"code": "1481786", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPLANT-SUPERFICIAL 20670", "code_information": [{"code": "20670", "type": "CPT"}, {"code": "1481787", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES 11976", "code_information": [{"code": "11976", "type": "CPT"}, {"code": "2189125", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER-INC. PUMP-RESERVOIR AND CUFF 53446", "code_information": [{"code": "53446", "type": "CPT"}, {"code": "1481823", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL INTACT MAMMARY IMPLANT 19328", "code_information": [{"code": "19328", "type": "CPT"}, {"code": "1481785", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN COMPLEX", "code_information": [{"code": "50225", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN RADICAL", "code_information": [{"code": "50230", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38550", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38555", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE IMPLANT", "code_information": [{"code": "27704", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARM ARTERY CLOT", "code_information": [{"code": "34111", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34001", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34051", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34101", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34151", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34201", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER", "code_information": [{"code": "51570", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51575", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51585", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER CYST", "code_information": [{"code": "51500", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51520", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51525", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51530", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER STONE", "code_information": [{"code": "51050", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61510", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61524", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61530", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61537", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61538", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61539", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61540", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61543", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61566", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX CERCLAGE SUTURE UNDER ANESTHESIA 59871", "code_information": [{"code": "59871", "type": "CPT"}, {"code": "1481789", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CHEST LINING", "code_information": [{"code": "32310", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35875", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35876", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44150", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44160", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44151", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44155", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44156", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COMPLETE CEREBROSPINAL FLUID SHUNT SYSTEM 62256", "code_information": [{"code": "62256", "type": "CPT"}, {"code": "1481790", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CORNEAL EPITHELIUM; W/APPLICATION OF CHELATING AGENT 65436", "code_information": [{"code": "65436", "type": "CPT"}, {"code": "44898365", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUT CHEMOCAUTERIZATION 65435", "code_information": [{"code": "65435", "type": "CPT"}, {"code": "17028704", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART", "code_information": [{"code": "33940", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART/LUNG", "code_information": [{"code": "33930", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR LIVER", "code_information": [{"code": "47133", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIGLOTTIS", "code_information": [{"code": "31420", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGEAL SPHINCTER AUGMENTATION DEVICE 43285", "code_information": [{"code": "43285", "type": "CPT"}, {"code": "44660559", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6255.0, "discounted_cash": 2189.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3027.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43107", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43108", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43113", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43124", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43130", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43135", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31205", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EXTERNAL EAR", "code_information": [{"code": "69120", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FACE WRINKLES", "code_information": [{"code": "15828", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20922", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREHEAD WRINKLES", "code_information": [{"code": "15824", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY FOOT DEEP 28192", "code_information": [{"code": "28192", "type": "CPT"}, {"code": "1845638", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY FOOT/COMPLICATED 28193", "code_information": [{"code": "28193", "type": "CPT"}, {"code": "2858358", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1027.53, "maximum": 8450.0, "gross_charge": 2123.0, "discounted_cash": 743.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1027.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY FROM PHARYNX 42809", "code_information": [{"code": "42809", "type": "CPT"}, {"code": "7616946", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH SIMPLE 20520", "code_information": [{"code": "20520", "type": "CPT"}, {"code": "1941671", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY INTRAOCULAR FROM ANTERIOR CHAMBER OF EYE OR LENS 65235", "code_information": [{"code": "65235", "type": "CPT"}, {"code": "1481796", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY INTRAOCULAR FROM POST. SEGMENT 65265", "code_information": [{"code": "65265", "type": "CPT"}, {"code": "42669163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1138.85, "maximum": 8450.0, "gross_charge": 2353.0, "discounted_cash": 823.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1138.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY INTRAOCULAR FROM POSTERIOR SEGMENT-MAGNETIC EXTRACTION 65260", "code_information": [{"code": "65260", "type": "CPT"}, {"code": "1481797", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY OR DACRYOLITH LACRIMAL PASSAGES 68530", "code_information": [{"code": "68530", "type": "CPT"}, {"code": "22687702", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY PELVIS OR HIP SUBCUTANEOUS TISSUE 27086", "code_information": [{"code": "27086", "type": "CPT"}, {"code": "6917908", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY SCROTUM 55120", "code_information": [{"code": "55120", "type": "CPT"}, {"code": "1481791", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY-EXTERNAL EYE; CONJUNCTIVAL-EMBEDDED 65220", "code_information": [{"code": "65220", "type": "CPT"}, {"code": "1481792", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 2144.0, "discounted_cash": 750.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1037.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY-FOOT-SUBCUTANEOUS 28190", "code_information": [{"code": "28190", "type": "CPT"}, {"code": "1582402", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 834.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31080", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31081", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31084", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31085", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31086", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31087", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47610", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47612", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GUM TISSUE", "code_information": [{"code": "41830", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEAD OF HUMERUS", "code_information": [{"code": "23195", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33120", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33130", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33542", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP JOINT LINING", "code_information": [{"code": "27054", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27090", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27091", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23155", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23156", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPACTED VAGINAL FOREIGN BODY UNDER ANESTHESIA 57415", "code_information": [{"code": "57415", "type": "CPT"}, {"code": "1481798", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1550.25, "maximum": 8450.0, "gross_charge": 3203.0, "discounted_cash": 1121.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1550.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPACTED WAX MD", "code_information": [{"code": "G0268", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANT HAND OR FINGER 26320", "code_information": [{"code": "26320", "type": "CPT"}, {"code": "1481799", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANTED MATERIAL ANTERIOR SEGMENT OF EYE 65920", "code_information": [{"code": "65920", "type": "CPT"}, {"code": "8675627", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANTED MATERIAL-POSTERIOR SEGMENT-EXTRAOCULAR 67120", "code_information": [{"code": "67120", "type": "CPT"}, {"code": "1481800", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANTED MATERIAL-POSTERIOR SEGMENT-INTRAOCULAR 67121", "code_information": [{"code": "67121", "type": "CPT"}, {"code": "1481801", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INFUSION PUMP", "code_information": [{"code": "36262", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INNER EYE LESION", "code_information": [{"code": "66770", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTERNALLY DWELLING URETERAL STENT VIA TRANSURETHRAL APP. W/O USE OF CYSTO W/RAD. 50386", "code_information": [{"code": "50386", "type": "CPT"}, {"code": "11906510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1475.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTRAUTERINE DEVICE 58301", "code_information": [{"code": "58301", "type": "CPT"}, {"code": "1587161", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1359.0, "discounted_cash": 475.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 657.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ISCHIAL BURSA", "code_information": [{"code": "27060", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY", "code_information": [{"code": "50340", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50234", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50236", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50280", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50290", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27332", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27333", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE PROSTHESIS", "code_information": [{"code": "27488", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31360", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31365", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX & PHARYNX", "code_information": [{"code": "31390", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31300", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31512", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEFT HEART VENT", "code_information": [{"code": "33989", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG ARTERY CLOT", "code_information": [{"code": "34203", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG VEINS/LESION", "code_information": [{"code": "37735", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS LESION", "code_information": [{"code": "66830", "type": "CPT"}], "standard_charges": [{"minimum": 2235.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2235.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL INTRACAPSULAR FOR DISLOCATED LENS 66930", "code_information": [{"code": "66930", "type": "CPT"}, {"code": "30638212", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1665.92, "maximum": 8450.0, "gross_charge": 3442.0, "discounted_cash": 1204.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1665.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE-1 OR MORE STAGES 66840", "code_information": [{"code": "66840", "type": "CPT"}, {"code": "1481802", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL; INTRACAPSULAR 66920", "code_information": [{"code": "66920", "type": "CPT"}, {"code": "1481803", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL; PARS PLANA APPROACH-WITH OR WITHOUT VITRECTOMY 66852", "code_information": [{"code": "66852", "type": "CPT"}, {"code": "1481804", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE WITH ASPIRATION 66850", "code_information": [{"code": "66850", "type": "CPT"}, {"code": "1481805", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL;EXTRACAPSULAR 66940", "code_information": [{"code": "66940", "type": "CPT"}, {"code": "28070132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG EXTRAPLEURAL", "code_information": [{"code": "32445", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION", "code_information": [{"code": "32540", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32140", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32150", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF MAMMARY IMPLANT MATERIAL 19330", "code_information": [{"code": "19330", "type": "CPT"}, {"code": "1481806", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF MULTI-COMPONENT INFLATABLE PENILE PROSTHESIS W/O REPLACEMENT 54406", "code_information": [{"code": "54406", "type": "CPT"}, {"code": "1481807", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NECK WRINKLES", "code_information": [{"code": "15825", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NEPHROSTOMY TUBE; REQ FLUORO GUIDANCE 50389", "code_information": [{"code": "50389", "type": "CPT"}, {"code": "37473318", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 9883.0, "discounted_cash": 3459.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4783.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1475.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64790", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64792", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NON INFLATABLE/INFLATABLE PENILE PROSTHESIS W/O REPLACEMENT 54415", "code_information": [{"code": "54415", "type": "CPT"}, {"code": "1481809", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OCULAR IMPLANT 65175", "code_information": [{"code": "65175", "type": "CPT"}, {"code": "1481808", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58940", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58943", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PACEMAKER SYSTEM", "code_information": [{"code": "33234", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS", "code_information": [{"code": "48155", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS LESION", "code_information": [{"code": "48120", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC DUCT", "code_information": [{"code": "48148", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC STONE", "code_information": [{"code": "48020", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIC STRUCTURES", "code_information": [{"code": "51597", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61546", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61548", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PM GENERATOR", "code_information": [{"code": "33233", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PREVIOUSLY IMPLANTED INTRATEHCAL OR EPIDURAL CATHETER 62355", "code_information": [{"code": "62355", "type": "CPT"}, {"code": "1863137", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 940.41, "maximum": 8450.0, "gross_charge": 1943.0, "discounted_cash": 680.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 940.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTAL MARKER", "code_information": [{"code": "46030", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1871.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45110", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45112", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45120", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM AND COLON", "code_information": [{"code": "45121", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RESIDUAL CERVIX", "code_information": [{"code": "57540", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB(S)", "code_information": [{"code": "32900", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42340", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SHUNT", "code_information": [{"code": "49429", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKIN TAGS MULTIPLE FIBROCUTANEOUS ANY AREA UP TO 15 LESIONS 11200", "code_information": [{"code": "11200", "type": "CPT"}, {"code": "4734926", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44120", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44121", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44125", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL NEUROSTIMULATOR ELEC. PLATE/PADDLES VIA LAMINOTOMY/LAMINECTOMY INC. FLUORO. 63662", "code_information": [{"code": "63662", "type": "CPT"}, {"code": "2580939", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAYS-INC. FLUOROSCOPY 63661", "code_information": [{"code": "63661", "type": "CPT"}, {"code": "1481811", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL SHUNT", "code_information": [{"code": "63746", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN PARTIAL", "code_information": [{"code": "38101", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38100", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38102", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43620", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43621", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43622", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43631", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43632", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43633", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43634", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43635", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUBCUTANEOUS RESERVOIR OR PUMP 62365", "code_information": [{"code": "62365", "type": "CPT"}, {"code": "1481812", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUBDELTOID CALCAREOUS DEPOSITS-OPEN 23000", "code_information": [{"code": "23000", "type": "CPT"}, {"code": "1481813", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SYNTHETIC ROD & INSERTION OF FLEXOR TENDON GRAFT HAND OR FINGER-EACH ROD 26392", "code_information": [{"code": "26392", "type": "CPT"}, {"code": "1481814", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15920", "type": "CPT"}], "standard_charges": [{"minimum": 1508.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15922", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TENDON FOR GRAFT", "code_information": [{"code": "20924", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60520", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60521", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60522", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONGUE", "code_information": [{"code": "41140", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TUNNELED CENTRAL VENOUS CATH. W/O SUBCUTANEOUS PORT OR PUMP 36589", "code_information": [{"code": "36589", "type": "CPT"}, {"code": "2189128", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 650.01, "maximum": 8450.0, "gross_charge": 1343.0, "discounted_cash": 470.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 650.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31225", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31230", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50650", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50660", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50610", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50620", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50630", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "51060", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53210", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53215", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53250", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34401", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34421", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34451", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34471", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34490", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VITREOUS-ANTERIOR APPROACH-PARTIAL REMOVAL 67005", "code_information": [{"code": "67005", "type": "CPT"}, {"code": "1481816", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VITREOUS-ANTERIOR APPROACH-SUBTOTAL W/ MECHANICAL VITRECTOMY 67010", "code_information": [{"code": "67010", "type": "CPT"}, {"code": "1481815", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25250", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25251", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE IN TEMPORAL BONE 69711", "code_information": [{"code": "69711", "type": "CPT"}, {"code": "1481817", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE 57287", "code_information": [{"code": "57287", "type": "CPT"}, {"code": "1772197", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL PACEMAKER ELECTRODE", "code_information": [{"code": "33235", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL PELVIC LYMPH NODES", "code_information": [{"code": "38562", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION SPINE 22850", "code_information": [{"code": "22850", "type": "CPT"}, {"code": "1481783", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 9735.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION SPINE 22852", "code_information": [{"code": "22852", "type": "CPT"}, {"code": "1481784", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 9735.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL PULSE GEN ONLY ISDSS", "code_information": [{"code": "682T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL SS DFB ELECTRODE", "code_information": [{"code": "573T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR&STAPL XREQ ANES", "code_information": [{"code": "15854", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR/STAPL XREQ ANES", "code_information": [{"code": "15853", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR/STAPLE REQ ANES", "code_information": [{"code": "15851", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTURE OR THIERSCH WIRE-ANAL CANAL 46754", "code_information": [{"code": "46754", "type": "CPT"}, {"code": "1481821", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL TISSUE EXPANDER(S) W/O INSERTION OF PROSTHESIS 11971", "code_information": [{"code": "11971", "type": "CPT"}, {"code": "1481822", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL TONGS OR HALO HEAD/ APPLIED BY ANOTHER PHYSICIAN 20665", "code_information": [{"code": "20665", "type": "CPT"}, {"code": "1481781", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL TUNNELED INTRAPERITONEAL CATHETER 49422", "code_information": [{"code": "49422", "type": "CPT"}, {"code": "1481767", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL UNDER ANESTHESIA OF EXTERNAL FIXATION SYSTEM 20694", "code_information": [{"code": "20694", "type": "CPT"}, {"code": "1481768", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL-NON BIODEGRADABLE DRUG DELIVERY IMPLANT 11982", "code_information": [{"code": "11982", "type": "CPT"}, {"code": "1481759", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29700", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29705", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29710", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25135", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25136", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMEN LYMPH NODES", "code_information": [{"code": "38780", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMINAL LYMPH NODES", "code_information": [{"code": "38747", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST 2 STAGE", "code_information": [{"code": "46285", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ANEURYSM SINUS", "code_information": [{"code": "61613", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33840", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33845", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33851", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTIC ASSIST DEVICE", "code_information": [{"code": "33968", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38740", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/CREATE POUCH", "code_information": [{"code": "51596", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51580", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51590", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51595", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLOOD CLOT FROM EYE", "code_information": [{"code": "65930", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CANAL FLUID", "code_information": [{"code": "61050", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY FLUID", "code_information": [{"code": "61020", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN ELECTRODES", "code_information": [{"code": "61535", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN TUMOR W/SCOPE", "code_information": [{"code": "62164", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CADAVER DONOR KIDNEY", "code_information": [{"code": "50300", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60600", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60605", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR PELVIS", "code_information": [{"code": "57545", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR VAGINA", "code_information": [{"code": "57555", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23170", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLOID CYST W/SCOPE", "code_information": [{"code": "62162", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61000", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61001", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA DEVICE OBSTRUCT", "code_information": [{"code": "75901", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 779.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1225.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1225.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1225.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 482.34, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 512.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA LUMEN OBSTRUCT", "code_information": [{"code": "75902", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 264.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 415.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 415.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 415.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 162.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 172.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE DRUG IMPLANT", "code_information": [{"code": "G0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69540", "type": "CPT"}], "standard_charges": [{"minimum": 869.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69554", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELCTRD TRANSVENOUSLY", "code_information": [{"code": "33244", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33236", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33237", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33238", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELTRD/THORACOTOMY", "code_information": [{"code": "33243", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ESOPHAGUS OBSTRUCTION", "code_information": [{"code": "74235", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 420.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 420.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 420.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE LESION", "code_information": [{"code": "65900", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID FOREIGN BODY", "code_information": [{"code": "67938", "type": "CPT"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68135", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/FIXATION", "code_information": [{"code": "27358", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/GRAFT", "code_information": [{"code": "27357", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FINGER BONE", "code_information": [{"code": "26185", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM BONE LESION", "code_information": [{"code": "25145", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY ADBOMEN", "code_information": [{"code": "49402", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY BRAIN", "code_information": [{"code": "61570", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65205", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65222", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY LARYNX", "code_information": [{"code": "31511", "type": "CPT"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE GASTRIC PORT OPEN", "code_information": [{"code": "43887", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38765", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP BONE LES DEEP", "code_information": [{"code": "27066", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27087", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15940", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15941", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15944", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15945", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23174", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPLANT BODY", "code_information": [{"code": "D6105", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INFECTED SKULL BONE", "code_information": [{"code": "61501", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR LESION", "code_information": [{"code": "69970", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTERIM IMPLANT", "code_information": [{"code": "D6198", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTESTINAL ALLOGRAFT", "code_information": [{"code": "44137", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRA-AORTIC BALLOON", "code_information": [{"code": "33974", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRACORPOREAL DEVICE", "code_information": [{"code": "33980", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRVAS FOREIGN BODY", "code_information": [{"code": "37197", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7469.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE JAW JOINT CARTILAGE", "code_information": [{"code": "21060", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY LIVING DONOR", "code_information": [{"code": "50320", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY OPEN", "code_information": [{"code": "50220", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27335", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUMB ARTIF DISC ADDL", "code_information": [{"code": "164T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33910", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33915", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG CATHETER", "code_information": [{"code": "32552", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG FOREIGN BODY", "code_information": [{"code": "32151", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG PNEUMONECTOMY", "code_information": [{"code": "32440", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MANDIBLE CYST COMPLEX", "code_information": [{"code": "21046", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID AIR CELLS", "code_information": [{"code": "69670", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MAXILLA CYST COMPLEX", "code_information": [{"code": "21048", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MIDDLE EAR NERVE", "code_information": [{"code": "69676", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE NON-RESORB BARRIER", "code_information": [{"code": "D4286", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART LUMBAR VERTEBRA", "code_information": [{"code": "22114", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK VERTEBRA", "code_information": [{"code": "22100", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF TEMPORAL BONE", "code_information": [{"code": "69535", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22101", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22112", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PELVIS LYMPH NODES", "code_information": [{"code": "38770", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PITUIT TUMOR W/SCOPE", "code_information": [{"code": "62165", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PULMONARY SHUNT", "code_information": [{"code": "33924", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PULSE GENERATOR", "code_information": [{"code": "33241", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTAL OBSTRUCTION", "code_information": [{"code": "45915", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1871.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTUM W/RESERVOIR", "code_information": [{"code": "45119", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15931", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15933", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15934", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15935", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15936", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15937", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SCREW RETAINED PLATE", "code_information": [{"code": "D7298", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23172", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FB DEEP", "code_information": [{"code": "23333", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER JOINT LINING", "code_information": [{"code": "23105", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SKIN NERVE LESION", "code_information": [{"code": "64788", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINAL CORD LESION", "code_information": [{"code": "63600", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64804", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64809", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64821", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64822", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15950", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15951", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15952", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15953", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15956", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15958", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THORACIC LYMPH NODES", "code_information": [{"code": "38746", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TRANSPLANTED KIDNEY", "code_information": [{"code": "50370", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER CALCULUS", "code_information": [{"code": "51065", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER STENT PERCUT", "code_information": [{"code": "50384", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS AFTER CESAREAN", "code_information": [{"code": "59525", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS LESION", "code_information": [{"code": "59100", "type": "CPT"}], "standard_charges": [{"minimum": 3365.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE COMPL", "code_information": [{"code": "57111", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE PART", "code_information": [{"code": "57107", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL COMPLETE", "code_information": [{"code": "57110", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL PARTIAL", "code_information": [{"code": "57106", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGUS N ELTRD", "code_information": [{"code": "64570", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION SCOPE/GRAFT", "code_information": [{"code": "31546", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33977", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33978", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN LMBR", "code_information": [{"code": "63102", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN THRC", "code_information": [{"code": "63101", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63082", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63086", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63088", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63091", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63103", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63308", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE W INSERT DRUG IMPLANT", "code_information": [{"code": "G0518", "type": "HCPCS"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31785", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31786", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE&REPLACE PM GEN SINGL", "code_information": [{"code": "33227", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25125", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25126", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT HIP BONE LESION", "code_information": [{"code": "27067", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/INSERT DRUG IMPLANT", "code_information": [{"code": "11983", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE UR SPHINCTER", "code_information": [{"code": "53447", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/REVISE MALE SLING", "code_information": [{"code": "53442", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/TRANSPLANT TENDON", "code_information": [{"code": "23440", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/TREAT LUNG LESIONS", "code_information": [{"code": "32141", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVER STAPLE SKIN STRL", "code_information": [{"code": "DYNJ04058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN DUAL LEAD", "code_information": [{"code": "33228", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN MULT LEADS", "code_information": [{"code": "33229", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMVL INSJ IMPLTBL GLUC SENS", "code_information": [{"code": "448T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL ABSCESS OPEN DRAIN", "code_information": [{"code": "50020", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY W/ URETERAL CATHETERIZATION 50553", "code_information": [{"code": "50553", "type": "CPT"}, {"code": "1481827", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY W/ BIOPSY 50574", "code_information": [{"code": "50574", "type": "CPT"}, {"code": "1481825", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1475.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL ENDOSCOPY THROUGH NEPHROTOMY W/ URETERAL CATHETERIZATION 50572", "code_information": [{"code": "50572", "type": "CPT"}, {"code": "1481826", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1475.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL ENDOSCOPY W/ ENDPYELOTOMY 50575", "code_information": [{"code": "50575", "type": "CPT"}, {"code": "1481995", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH CC", "code_information": [{"code": "683", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5348.78, "maximum": 9182.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5348.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7649.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8414.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9182.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH MCC", "code_information": [{"code": "682", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8958.43, "maximum": 15379.41, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8958.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12812.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14093.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15379.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITHOUT CC/MCC", "code_information": [{"code": "684", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3697.86, "maximum": 6348.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3697.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5288.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5817.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6348.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL SCOPE W/TUMOR RESECT", "code_information": [{"code": "50562", "type": "CPT"}], "standard_charges": [{"minimum": 1475.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1475.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80416", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 261.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 533.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 839.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 839.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 839.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 301.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 301.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80417", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 67.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 112.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 63.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 63.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENTAL TRUCLEAR SYSTEM", "code_information": [{"code": "72203772", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REOP REQ BLD GRFT OTH", "code_information": [{"code": "G8577", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REOPENING OF ABDOMEN", "code_information": [{"code": "49002", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REOPERATION BYPASS GRAFT", "code_information": [{"code": "35700", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REOPERATION CAROTID ADD-ON", "code_information": [{"code": "35390", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REP 3.5MM STERLING CUDA MICROBLADE", "code_information": [{"code": "C9952R", "type": "CDM"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP ARTHROWAND 90DEG RHT ANGL", "code_information": [{"code": "AC 1340-01R", "type": "CDM"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP ARTHROWAND ELIMINATOR 90 4.5MM RT ANGL", "code_information": [{"code": "AC 1345-01R", "type": "CDM"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP ARTHROWAND MULTIVAC 50 3.75MM XL SUCTION GREY/WHITE", "code_information": [{"code": "ASC 4730-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 1.5MM WIRE PASS", "code_information": [{"code": "1608-2-59R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 1.5MM X 85MM 2 FLUTE QUICK COUPLINGINSTR", "code_information": [{"code": "310.15R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 2.5MM EMERGE", "code_information": [{"code": "310.25EMR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 2.7MM X 100MM QUICK COUPLINGINSTR", "code_information": [{"code": "310.26R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 2MM 140MM QUICK COUPLING REPROCESS W/ DEPTH MARKINSTR", "code_information": [{"code": "323062R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 406.0, "discounted_cash": 142.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 2MM X 100MM QUICK COUPLING SSINSTR", "code_information": [{"code": "310.19R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 4.5MM CANNULATED ENDO KNEE STRLINSTR DISP", "code_information": [{"code": "7207315R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL QC GOLD 25X110MM", "code_information": [{"code": "310.25R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL QUICK COUPLING 3.5MM X 110MM", "code_information": [{"code": "7117-0073R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 179.0, "discounted_cash": 62.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL TWIST AO /QC/110MM 3.5MM", "code_information": [{"code": "310.35R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRLL 1.8MM X 110MM MINI QUICK COUPLING NON STRL W/ DEPTH MARKINSTR", "code_information": [{"code": "310.509R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE ENDO CTR SCOPE MOUNTING", "code_information": [{"code": "9900-BR", "type": "CDM"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 171.15, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE ENDO CTR SLIMLINE PROW TIP", "code_information": [{"code": "82020R", "type": "CDM"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 127.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE ETHMOIDECTOMY 2.9 X 110M STRT TRICUT INF TURB M4 ROT STRAIGHT", "code_information": [{"code": "18-82940H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 99.05, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE ETHMOIDECTOMY 4MM X 11CM TRICUT STRAIGHT", "code_information": [{"code": "18-84004H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 229.0, "discounted_cash": 80.15, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE ETHMOIDECTOMY 4MM X 11CM TRICUT STRAIGHT OFFSET", "code_information": [{"code": "18-84004R", "type": "CDM"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 77.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE GATOR LARGE 8.2CM", "code_information": [{"code": "C9961AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE INF TURB 2MM M4 ROT", "code_information": [{"code": "18-82040H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.0, "discounted_cash": 73.85, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE INFERIOR TURBINATE 2.9MM X 11CM", "code_information": [{"code": "18-82940R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 79.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE OSCILATING 5.5MM X 18MM .38MM", "code_information": [{"code": "2296-3-412R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE OSCILLATING 19.5 X 19.5 X 90 X 1.19MM STAND", "code_information": [{"code": "5071-303R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE OSCILLATING19 X 95 X 1.37MM", "code_information": [{"code": "5071-530R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE RECIPROCATING 77.5MM HVY DTY", "code_information": [{"code": "277-96-325R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAG 21.0 X 90 X 1.37MM", "code_information": [{"code": "6221-137-090R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAGGITAL 9 X 24MM OSCILLLATING AGGRESSIVE THIN", "code_information": [{"code": "SP-511R", "type": "CDM"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAGITTAL FLARE 48.5MM X 64NN X 12.5MM", "code_information": [{"code": "2108-197R", "type": "CDM"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 23.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAW 10 X 9.0 X X .43MM OSCILLATING SAGITTAL THIN SM BONE PNEUMICRO STRL", "code_information": [{"code": "KM-3101R", "type": "CDM"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAW 18.5MM X 9MM DOWN OFFFSET SAGITTAL HEAVY TPS", "code_information": [{"code": "2296-3-105R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAW 4.5MM X 25.4MM X .56MM SAGITTAL SM BONE", "code_information": [{"code": "KM-3102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAW 5.5MM X 18.5MM X .4MM MICRO SAGITTAL SS", "code_information": [{"code": "5023-144R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAW 9.5MM X 25MM X 0.6MM SAGITTAL FINE TOOTH SM BONE HALL", "code_information": [{"code": "5023-143R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAW 9MM X 18.5MM X .4MM SM SAGITTAL OSCILLATING THIN MED", "code_information": [{"code": "SP-111R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAW RECIPROCATING DOUBLE SIDED 70MM X .64MM X 12.5MM X 3.56MM", "code_information": [{"code": "277-96-275R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAW SAGITTAL 9 X .51 X 25MM SS STRL DISP", "code_information": [{"code": "2296-33-111R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 13 CM 4.8MM ARTHROSCOPIC STERLING GATORINSTR", "code_information": [{"code": "C9262R", "type": "CDM"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 3.5MM FORMULA RESECTOR YELLOW", "code_information": [{"code": "375-532-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 3.8MM X 13 CM BONE CUTTER ORTHO", "code_information": [{"code": "AR-8380BCR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 4.0MM AGGRESSIVE MENISCUS RED", "code_information": [{"code": "375-544-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 4.2MM 13 CM 15DEG PRE BENT BENDABLE MERLIN GREAT WHT", "code_information": [{"code": "C9299PR", "type": "CDM"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 4.2MM STERLING TIGER", "code_information": [{"code": "C9242R", "type": "CDM"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 4.5MM INCISOR PLUS ELITE SLATE STRT", "code_information": [{"code": "7210976R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 4MM X 13CM SABRETOOTHINSTR", "code_information": [{"code": "AR-8400STR", "type": "CDM"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 5.5MM BONE CUTTER MOST AGGRESSIVE", "code_information": [{"code": "AR-8550BCR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 5.5MM LG HUB GATOR", "code_information": [{"code": "9260AR", "type": "CDM"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 5MM DISSECTOR ATTCHMNT", "code_information": [{"code": "AR-8500DSR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 5MM EXCALIBURINSTR", "code_information": [{"code": "AR-8550EXR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER 5MM RESCETOR LF", "code_information": [{"code": "375-552-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHAVER TIGER 3.5MM STERLING", "code_information": [{"code": "C9240R", "type": "CDM"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHVR 3.5MM SLATE STRAIGHT ENDOINCISOR PLUS ELITE STRL DISP", "code_information": [{"code": "72200095R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHVR 3.8MM EXCALIBUR AGGRESSIVE FOR EXTENSIVE SOFT TISSUE DEBRIDEMENTINSTR", "code_information": [{"code": "AR-8380EXR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHVR 4.5MM MAROON FULL RADIUS STRAIGHT SHAFT DYONICS ELITE STRL DISP", "code_information": [{"code": "7210499R", "type": "CDM"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHVR 4.5MM VIOLET ENDO STRAIGHT SHAFTINCISOR PLUS PLATINUM STRL DISP", "code_information": [{"code": "72203013R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHVR 4MM X 13 CM DOUBLE CUT FOR EFFICIENT GENERAL SOFT TISSUE RESECTION AN", "code_information": [{"code": "AR-8400DCR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHVR 4MM X 13 CM DSSCTR FOR AGGRESSIVE RESECTION OF MENISCUS SYNOVIUM CART", "code_information": [{"code": "AR-8400DSR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHVR 4MM X 13 CM EXCALIBUR FOR EXTENSIVE SOFT TISSUE DEBRIDEMENTINSTR", "code_information": [{"code": "AR-8400EXR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHVR FORMULA AGGRESSIVE BARREL BUR 4MM", "code_information": [{"code": "375-941-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHVR FRST GRN 4.5MM SNVTR DYNC STR ARTHSCP STRL DISP", "code_information": [{"code": "7205310R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHVR SGE GRN 4MM ACRBLS STR STRL DISP", "code_information": [{"code": "72200730R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SHVR VIOL 4.5MM INC+ STR STRL DISP", "code_information": [{"code": "7205345R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SURG 3.5MM FULL RADIUS STRAIGHT ELITE DISP", "code_information": [{"code": "7210751R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SURG MED 31MM X 9MM LNG STRL DISP", "code_information": [{"code": "2296-3-125R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE XPS 40DEG RADNOID POWER", "code_information": [{"code": "18-84008TAR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BONE CUTTER 4.0 X 13CM", "code_information": [{"code": "AR-8400BCR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BUR 4.0MM FORMULA SLAP", "code_information": [{"code": "375-941-500R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BUR BARREL 6 FLUTE 5.5MM", "code_information": [{"code": "375-951-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BUR CARBIDE 8 FLUTE OVAL 4MM", "code_information": [{"code": "ZB-136R", "type": "CDM"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BUR DRILL 5.5MM FORMULA BARREL 12 FLUTE STANDARD", "code_information": [{"code": "375-951-012R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BUR DRILL AUGER 5MM CORK SCREW", "code_information": [{"code": "375-450-500R", "type": "CDM"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BUR DRILL BONE 5.5MM 6 FLUTE ROUND", "code_information": [{"code": "375-950-000R", "type": "CDM"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BUR EGG (replaced with K02)", "code_information": [{"code": "1607-2-35R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BUR FAST CUT 3.2MM 6 FLUTE ROUND", "code_information": [{"code": "1608-6-149R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BUR MICRO 8 FLUTE LNG OVAL HALL", "code_information": [{"code": "5092-136R", "type": "CDM"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BUR ROUND 6.0MM X 54MM 16 FLUTE", "code_information": [{"code": "1608-2-15R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BUR SHAVER DYONICS 4MM ELITE STRAIGHT ACROMIONIZER MAUVE", "code_information": [{"code": "72200724R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BURR ABRADER 5.5MM X 18 CM BLACK LNG SHAVER PARTIAL HOOD", "code_information": [{"code": "72200082R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 32.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BURR BARREL 6 FLUTE 4MM UNHOODED LF", "code_information": [{"code": "375-941-200R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BURR BONE 4.0MM 6 FLUTE RED RND RAPID AGGRESSIVE", "code_information": [{"code": "375-940-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BURR ENDO 5.5MM BRICK RED SHVR STRAIGHT SHAFT ACROMINOBLASTER STRLINSTR DISP", "code_information": [{"code": "7205669R", "type": "CDM"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BURR MICRO 4.0MM X 54MM EGG 10 FLUTE SS", "code_information": [{"code": "1608-2-35R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BURR MICRO 6.1MM PEARINSTR", "code_information": [{"code": "1608-2-5R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BURR ROUND 55MM 4MM 16 FLUTE SS", "code_information": [{"code": "1608-2-55R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BURR SHAVER SLT 4.5MM HELICUT", "code_information": [{"code": "7205727R", "type": "CDM"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BURR STRAIGHT 4MM AQUA ABRADER SNGL USE ENDO DYONICS DISP", "code_information": [{"code": "7205324R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.0, "discounted_cash": 59.15, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BURR SURG 5MM X 13 CM OVAL 8 FLUTEINSTR", "code_information": [{"code": "AR-8500OBER", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA 6.5 X 75MM DRI LOK FULL THREAD", "code_information": [{"code": "3910-075-650R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA 6.5MM X 75MM THREADED DRI-LOK", "code_information": [{"code": "3910075650R", "type": "CDM"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA 6MM X 7 CM TRANSLUCENT FOR DIRECT VISUALIZATION OFINSTRUEMNTS A", "code_information": [{"code": "AR-6535R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA ARTHSCP 90MM CL-TRC 8.5MM PLYCRB", "code_information": [{"code": "72200902R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA BTTN 8MM X 3 CM LOW PROFILE DUAL FLANGE DESIGN SHLDR SILICONE PASSPORT", "code_information": [{"code": "AR-6592-08-30R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA BTTN 8MM X 5 CM SHOULDER KNEE HIP ELBOW FOR ARTHROSCOPIC SYS PASSPORT SC", "code_information": [{"code": "AR-6592-08-50R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA ENDO 8 X 75MM DRI LOK THREAD", "code_information": [{"code": "3910075800R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA ENDO 85MM 7MM", "code_information": [{"code": "C7360R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA ENDO TRANSL GRN 85MM OBT DRY-DOC DISP 5MM", "code_information": [{"code": "C7350R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA SHOULDER 5MM X 75MM DRI-LOK SMOOTH", "code_information": [{"code": "3910-075-501R", "type": "CDM"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA SURG 5MM X 7 CM LOW PROFILE", "code_information": [{"code": "AR-6548R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA SURG 8.25MM X 7 CM TWISTIN NOTCHED", "code_information": [{"code": "AR-6530NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA SURG FOR ARTHROSCOPIC ACL OR PCL RECONSRUCTION STRL DISP", "code_information": [{"code": "AR-1802DR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA THREADED 7.0MMX75MM 5PK CLEAR ST", "code_information": [{"code": "214116R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA THREADED CLEAR WITH OBTURATOR ORANGE 5.5MM", "code_information": [{"code": "214108R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULAINSTR 5.75MM X 7 CM SMTH OPTIONAL 1-WAY STPCCK POLYCARBONATE W/ OBTURATOR", "code_information": [{"code": "AR-6562R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP COMPRESSION GARMENT 18IN MD VASOPRESS DVT CALF", "code_information": [{"code": "VP 501MR", "type": "CDM"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP COMPRESSION GARMENT 24IN LG VASOPRESS DVT CALF", "code_information": [{"code": "VP 501LR", "type": "CDM"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF BLOOD PRESSURE 4 X 12IN AUTO SINGLE PORT-BLADDER", "code_information": [{"code": "60-7085-102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF BLOOD PRESSURE 4 X 12IN SINGLE PORT-BLADDER", "code_information": [{"code": "60-7075-102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF BLOOD PRESSURE DBL PORT SNLGBLADDER", "code_information": [{"code": "60-7070-107R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF CALF VENAFLOW 19.0 X 11.5IN", "code_information": [{"code": "3010PLR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF CALF VENAFLOW 19.0 X 11.5IN ELITE", "code_information": [{"code": "3040R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF FOOT VENAFLOW 16.0 X 9.0IN", "code_information": [{"code": "3016PLR", "type": "CDM"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 18 X 4IN CYLINDRICAL COLOR SPSB", "code_information": [{"code": "5921-218-136R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 24 X 4IN CYLINDRICAL COLOR SPSB", "code_information": [{"code": "60-7075-104R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 30 X 4IN CYLINDRICAL COLOR SPSB", "code_information": [{"code": "5921-030-136R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 34IN 1 PORT 1 BLADDER PUMP LN CONN DISP", "code_information": [{"code": "60-7075-106R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.08, "discounted_cash": 18.93, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 34IN AUTO SNGL BLADDER DUAL PORT", "code_information": [{"code": "60-7070-006R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 4 X 24IN SNGL BLADDER-PORT", "code_information": [{"code": "5921-024-136R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 4 X 42IN SNGL BLADDER-PORT", "code_information": [{"code": "60-7075-107R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF ZIMMER 18\"", "code_information": [{"code": "60-7075-103R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP DEVICE CANNULA 5.5MM X 75MM ORANGE SMOOTH CLEAR", "code_information": [{"code": "214106R", "type": "CDM"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REP DISK PROTECTIVE 7MM X 1IN BIOPATCH", "code_information": [{"code": "3152R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "discounted_cash": 41.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REP DRILL BIT FAST 2.0MM", "code_information": [{"code": "FDB2.0R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REP ELECTRODE HOOK 3.5MMINTEGRATED HANDPIECE VAPR", "code_information": [{"code": "227305R", "type": "CDM"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP EXPRESSEW III NEEDLE PK5", "code_information": [{"code": "214141R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 73.15, "setting": "both", "billing_class": "facility"}]}, {"description": "REP FORCEP BX ENDOJAW ALLIGATOR JAW-STEP", "code_information": [{"code": "FB-220UR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REP GARMENT CALF LG", "code_information": [{"code": "DVT20R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REP HOOK ELECTRODE 8.5ININSULATED ARTHROSCOPIC SS", "code_information": [{"code": "E1510R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REP INSTRUMENT CANNULA 5MM X 75MM FULLY THREADED ARTHROSCOPIC DRI LOK DISP", "code_information": [{"code": "3910-075-500R", "type": "CDM"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP INSTRUMENT CNULA 5.75MM X 7 CM OPTIONAL 1-WAY STPCCK POLYCARBONATE W/ OBTURATOR", "code_information": [{"code": "AR-6560R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP KIT ENDO CTR 4MM SINGLE PORTAL", "code_information": [{"code": "9971R", "type": "CDM"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 73.15, "setting": "both", "billing_class": "facility"}]}, {"description": "REP KNIFE RETROGRADE LIGAMENT DISP", "code_information": [{"code": "200-1003R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 438.0, "discounted_cash": 153.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REP KNIFE SAFEGUARD MINI", "code_information": [{"code": "8-0003R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "REP MASK SURG PARTICULATE RESPIRATOR HYPOALLERGENIC TYPE N95 NIOSH APPROVED MOLDED F", "code_information": [{"code": "1860R", "type": "CDM"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NDL DISSECTION 45 DEG 3/32IN MICRO COLORADO SLV", "code_information": [{"code": "N117R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NEEDLE INJ SUREFIRE FOR USEIN ARTHROSCOPIC AND MINI OPEN PROCEDURES SCORPIONINSTR", "code_information": [{"code": "AR-13991NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NEEDLE INJECTION HUMPBACK MULTIFIRE SCORPIONINSTR DISP", "code_information": [{"code": "AR-13995NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NEEDLE INJECTION SHOULDER SCORPION STRLINSTR", "code_information": [{"code": "AR-13990NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NEEDLE SCORPION", "code_information": [{"code": "AR13990NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NPH/URT CATH W/DIL STRIC", "code_information": [{"code": "C7546", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER FISTU", "code_information": [{"code": "46715", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER/VESTIB FISTU", "code_information": [{"code": "46716", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REP PROBE ABLATION 3MM 90DEG ASPIRATING SHOULDER MONOPOLAR LOW PROFILE FOR OPES ASPIRATING ABLATOR W", "code_information": [{"code": "AR-9703A-90R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 302.0, "discounted_cash": 105.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP PUSHER KNOT SIXTH FINGER W/ SUT PASSER", "code_information": [{"code": "AR-1930SR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.0, "discounted_cash": 50.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RASP CROSS CUT SML", "code_information": [{"code": "ZR-082R", "type": "CDM"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RASP CROSS CUT SML TEAR", "code_information": [{"code": "SR-51-082R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RASP MICRO CROSS CUT SML", "code_information": [{"code": "5053-082R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RASP RECIP 11MM X 5.3MM SML BONE", "code_information": [{"code": "KM5100-37-113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.0, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RASP SURG 6.5MM LG MICRO CROSS CUT RECIPROCATING HALL", "code_information": [{"code": "5053-083R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REP REAMER BONE 8.58MM PILOTED HEADEDINSTR", "code_information": [{"code": "AR-1455R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RETRACTOR LONSTAR", "code_information": [{"code": "3307GR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RETRIEVER SUT SM YELLOW ARTHRO ROTATOR CUFF LF STRL DISP", "code_information": [{"code": "9892R", "type": "CDM"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RETRIEVER SUTURE HOFFEE BLUE LASSO", "code_information": [{"code": "22701R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE 5.5 X 25.0MM OSCILLATING SML", "code_information": [{"code": "2296-33-414R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE AGGRESSIVE OSCILLATING SML", "code_information": [{"code": "SP-111AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE BUSA 60 X 35MM DUAL CUT", "code_information": [{"code": "2108-107-4S1R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE BUSA 85 X 25M SAGITTAL", "code_information": [{"code": "2108-151R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE MICRO OSCILLATING FINE TOOTH 5.5MM X 28.5", "code_information": [{"code": "5023-164R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE SAGITTAL 9 X 25MM OSCILLATING", "code_information": [{"code": "KM3-111R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BONE OSCILLATING 25 X 90 X 1.19MM STAND WIDE", "code_information": [{"code": "5071-323R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 22.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SCISSOR ENDO .5IN X 35 CM 5 MM CURVEDINSTR DISP", "code_information": [{"code": "ES0101R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 37.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SET CNULA 5.5MM 70MM GRAY CONICAL TIP DIST HOLE THRD W/ CANNULA AND OBTURATOR W/", "code_information": [{"code": "4616R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SET CNULA 5.5MM 70MM ORANGE CONICAL TIP THRD W/ CANNULA AND OBTURATOR WITHOUT DI", "code_information": [{"code": "7204895R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SET CNULA 70MM SHLDR WITHOUT FENESTRATION BLUNT TROCAR DOUBLE SEAL STRL DISP", "code_information": [{"code": "9718R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SET CNULA 7MM 70MM LIME GRN CONICAL TIP THRD W/ CANNULA AND OBTURATOR WITHOUT DI", "code_information": [{"code": "7204896R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SHAVER BLADE TOMCAT FORMULA SERIES YELLOW/WHI STR", "code_information": [{"code": "375-535-000R", "type": "CDM"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SHAVER CUDA 30 LRG MERLIN BENDABLE", "code_information": [{"code": "P9356R", "type": "CDM"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SLEEVE CMPR STD KN-HI SCD ANEMB LTWT BRTHBL NS DISP 17IN", "code_information": [{"code": "DVT10R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SYSTEM SINUPLASTY FRONTAL SINUS GUIDE CATH TIP BLLN RELIEVA", "code_information": [{"code": "RSF70R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 466.0, "discounted_cash": 163.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SYSTEM SINUPLASTY SPHENOID SINUS GUIDE CATH TIP BLLN RELIEVA", "code_information": [{"code": "RSS0R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 482.0, "discounted_cash": 168.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TAP FOR 3.5MM CORTEX SCREWS 3.5MM X 110MM GOLD", "code_information": [{"code": "311.32R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TAP FOR CANCELLOUS BONE SCREWS 4.0MM X 110MM", "code_information": [{"code": "311.34R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 167.0, "discounted_cash": 58.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TIP ASPIRATION 25DEG 12DEG PURPLE PINK BYPASS SYS MINI FLARED TURBOSONICS KELMAN", "code_information": [{"code": "8065751177R", "type": "CDM"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TIP PHACO 0.9MM ABS KELMAN 30D TAPERED POINT", "code_information": [{"code": "8065750263R", "type": "CDM"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TIP PHACO 30DEG 0.9MM TURBO SONIC ABS OZIL MINI FLARED", "code_information": [{"code": "8065751176R", "type": "CDM"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TIP PHACO 30DEG X .09MM RND MICRO FLARED", "code_information": [{"code": "8065740837R", "type": "CDM"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TIP PHACO 45DEG MICRO KELMAN", "code_information": [{"code": "8065750852R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET 18 X 4 DISP SINGLE PORT RED", "code_information": [{"code": "5921-218-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET 24IN DPSB W LUER LOCK", "code_information": [{"code": "60-7070-004R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET COMPRESSION LUER LOCK 18IN RED", "code_information": [{"code": "60-7070-003R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET CUFF SINGLE HOSE DUAL BLADDER PLC 24 INCH", "code_information": [{"code": "60-7085-103R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET CYLINDRICAL 24IN X 4IN YELLOW SNGL BLADDER W/ 40IN TUBING COLOR CUFF", "code_information": [{"code": "5921-024-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET CYLINDRICAL 30IN X 4IN ROYAL BLUE SNGL BLADDER DUAL PORT W/ 40IN TUBI", "code_information": [{"code": "5921-030-235R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET CYLINDRICAL 34IN X 4IN PURPLE SNGL BLADDER W/ 40IN TUBING COLOR CUFF", "code_information": [{"code": "5921-034-136R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET PNEUMATIC 34IN X 4IN BLACK 2 PART QUICK REPROCESS", "code_information": [{"code": "5921-024-235R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET PROTECTION 18IN X 3IN RED COLOR CUFF CYLINDRICAL", "code_information": [{"code": "5921-018-235R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET STERILE DISP 12 INCH", "code_information": [{"code": "60-7070-102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET STERILE DISP 24 INCH", "code_information": [{"code": "60-7070-105R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TROCAR AUDIBLE DILATING SHIELD", "code_information": [{"code": "CD7012GR", "type": "CDM"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TROCAR ENDOPATH XCEL 100MM STAB SLEEVE", "code_information": [{"code": "CB11LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 281.0, "discounted_cash": 98.35, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TROCAR LAPSCP BLDLS 100CM 5MM", "code_information": [{"code": "2B5LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.04, "discounted_cash": 24.16, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TROCAR VERSAPORT 5MM TO 11MM W/ RADIOLUCENT SLEEVE", "code_information": [{"code": "179095PR", "type": "CDM"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WAND ELECTRODE 3.5MM SIDE EFFECT ONE PIECE VAPRINSTR", "code_information": [{"code": "227301R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WAND EVAC 70D TONSIL ADENOID PLASMA SUCTION", "code_information": [{"code": "EIC 5874-01R", "type": "CDM"}], "standard_charges": [{"gross_charge": 281.0, "discounted_cash": 98.35, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WAND SUCTION 3MM 70DEG ICW COVAC", "code_information": [{"code": "ASC 3730-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 77.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WAND SUPER MULTIVAC 50 SUCTION 50DEG SOFT TISSUE", "code_information": [{"code": "ASC 4830-01R", "type": "CDM"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 77.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WAND TRISTAR 3MM 50D SUCTION INTEGRATED CABLE", "code_information": [{"code": "ASC 4630-01R", "type": "CDM"}], "standard_charges": [{"gross_charge": 230.0, "discounted_cash": 80.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WANDINTEGRATED TABLE 70 DEGREEE XTRA EVAC", "code_information": [{"code": "EICA5872-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR & REVISE NERVE ADD-ON", "code_information": [{"code": "64874", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ACHILLES TENDON PRIMARY OPEN OR PERCUTANEOUS 27650", "code_information": [{"code": "27650", "type": "CPT"}, {"code": "1481828", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ACHILLES TENDON PRIMARY OPEN OR PERCUTANEOUS W/ GRAFT 27652", "code_information": [{"code": "27652", "type": "CPT"}, {"code": "1481829", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ACHILLES TENDON SECONDARY 27654", "code_information": [{"code": "27654", "type": "CPT"}, {"code": "1481830", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANOMALY W/CONDUIT", "code_information": [{"code": "33608", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANORECTAL FIST W/PLUG", "code_information": [{"code": "46707", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANT. ABD. HERNIA INITIAL INC. IMPLANT MESH LESS THAN 3 CM 49591", "code_information": [{"code": "49591", "type": "CPT"}, {"code": "46163781", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1852.26, "maximum": 8450.0, "gross_charge": 3827.0, "discounted_cash": 1339.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1852.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANT. ABD. HERNIA INITIAL INC. IMPLANT MESH; 3 CM TO 10 CM 49593", "code_information": [{"code": "49593", "type": "CPT"}, {"code": "46163783", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1690.61, "maximum": 8450.0, "gross_charge": 3493.0, "discounted_cash": 1222.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1690.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANT. ABD. HERNIA INITIAL INC. MESH LESS THAN 3 CM INCARCERATED 49592", "code_information": [{"code": "49592", "type": "CPT"}, {"code": "46163782", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6195.0, "discounted_cash": 2168.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2998.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANT. ABD. HERNIA INITIAL INCL. MESH; 3 CM TO 10 CM INCARCERATED/STRANGULATED 49594", "code_information": [{"code": "49594", "type": "CPT"}, {"code": "46163784", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6572.0, "discounted_cash": 2300.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3180.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ART INTRAMURAL", "code_information": [{"code": "33507", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERIAL TRUNK", "code_information": [{"code": "33786", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35082", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35092", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35103", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE ARM", "code_information": [{"code": "35013", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE BELLY", "code_information": [{"code": "35122", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE CHEST", "code_information": [{"code": "35022", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE GROIN", "code_information": [{"code": "35132", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE NECK", "code_information": [{"code": "35002", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE SPLEEN", "code_information": [{"code": "35112", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE THIGH", "code_information": [{"code": "35142", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY TRANSLOCATION", "code_information": [{"code": "33506", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY W/TUNNEL", "code_information": [{"code": "33505", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER & VAGINA", "code_information": [{"code": "57289", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER/VAGINA LESION", "code_information": [{"code": "51900", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35180", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35182", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35184", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35188", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35189", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35190", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35201", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35206", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35207", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35211", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35216", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35221", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35231", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35236", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35241", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35246", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35251", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35256", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35261", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35266", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35271", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35276", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35281", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35286", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL; DIRECT LOWER EXTREMITY 35226", "code_information": [{"code": "35226", "type": "CPT"}, {"code": "42629785", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL FISTULA", "code_information": [{"code": "44650", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44620", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44625", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44660", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44661", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-SKIN FISTULA", "code_information": [{"code": "44640", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BRAIN FLUID LEAKAGE", "code_information": [{"code": "62100", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BRONCHUS ADD-ON", "code_information": [{"code": "32501", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BY ENLARGEMENT", "code_information": [{"code": "33610", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CARPAL BONE SHORTEN", "code_information": [{"code": "25394", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40700", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40701", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40702", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40720", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40761", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLITORIS", "code_information": [{"code": "56805", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR COLLATERAL LIGAMENT-MP OR IP JOINT 26540", "code_information": [{"code": "26540", "type": "CPT"}, {"code": "1481834", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR COMPONENT(S) OF MULTI-COMPONENT-INFLATABLE PENILE PROSTHESIS 54408", "code_information": [{"code": "54408", "type": "CPT"}, {"code": "1481956", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CORPOREAL TEAR", "code_information": [{"code": "54437", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35001", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35005", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35011", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35021", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35081", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35091", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35102", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35111", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35121", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35131", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35141", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35151", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67110", "type": "CPT"}], "standard_charges": [{"minimum": 2110.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2110.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA CRTX", "code_information": [{"code": "67101", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2011.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA PC", "code_information": [{"code": "67105", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DIAPHRAGM LACERATION", "code_information": [{"code": "39501", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DISLOCATED JAW", "code_information": [{"code": "21490", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DISLOCATING PERONEAL TENDONS; W/ FIBULAR OSTEOTOMY 27676", "code_information": [{"code": "27676", "type": "CPT"}, {"code": "1481993", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DISLOCATING PERONEAL TENDONS; W/O FIBULAR OSTEOTOMY 27675", "code_information": [{"code": "27675", "type": "CPT"}, {"code": "1481992", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33611", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33612", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61618", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EPISPADIAS 54380", "code_information": [{"code": "54380", "type": "CPT"}, {"code": "1481846", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER W/ INCONTINENCE 54385", "code_information": [{"code": "54385", "type": "CPT"}, {"code": "1481847", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43305", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43312", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43420", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43425", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43410", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43415", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTENSOR TENDON DISTAL PRIMARY OR SEC. W/GRAFT 26434", "code_information": [{"code": "26434", "type": "CPT"}, {"code": "1480286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTENSOR TENDON DISTAL PRIMARY OR SEC. W/O GRAFT 26433", "code_information": [{"code": "26433", "type": "CPT"}, {"code": "1480285", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTENSOR TENDON FINGER W/ FREE GRAFT-EACH TENDON 26420", "code_information": [{"code": "26420", "type": "CPT"}, {"code": "1481852", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTENSOR TENDON FINGER W/O FREE GRAFT-EACH TENDON 26418", "code_information": [{"code": "26418", "type": "CPT"}, {"code": "1481853", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTENSOR TENDON FINGER-CENTRAL SLIP-SECONDARY 26426", "code_information": [{"code": "26426", "type": "CPT"}, {"code": "1481851", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTENSOR TENDON HAND W/ FREE GRAFT-EACH TENDON 26412", "code_information": [{"code": "26412", "type": "CPT"}, {"code": "1481854", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTENSOR TENDON HAND W/O FREE GRAFT-EACH TENDON 26410", "code_information": [{"code": "26410", "type": "CPT"}, {"code": "1481850", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTENSOR TENDON LEG PRIMARY W/O GRAFT 27664", "code_information": [{"code": "27664", "type": "CPT"}, {"code": "1481855", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTENSOR TENDON LEG SECONDARY W/ OR W/O GRAFT 27665", "code_information": [{"code": "27665", "type": "CPT"}, {"code": "1481856", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTRA TOE(S)", "code_information": [{"code": "28344", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67915", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67922", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69740", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69745", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FASCIAL DEFECT OF LEG 27656", "code_information": [{"code": "27656", "type": "CPT"}, {"code": "42705290", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER DEFORMITY", "code_information": [{"code": "26590", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45805", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45825", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FLEXOR TENDON FOOT SECONDARY W/FREE GRAFT 28202", "code_information": [{"code": "28202", "type": "CPT"}, {"code": "1481858", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FLEXOR TENDON FOOT W/O FREE GRAFT 28200", "code_information": [{"code": "28200", "type": "CPT"}, {"code": "1481859", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT 27658", "code_information": [{"code": "27658", "type": "CPT"}, {"code": "1481860", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FLEXOR TENDON LEG SECONDARY W/ OR W/O GRAFT 27659", "code_information": [{"code": "27659", "type": "CPT"}, {"code": "1481861", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FLEXOR TENDON ZONE 2 DIGITAL FLEXOR TENDON SHEATH W/O FREE GRAFT 26356", "code_information": [{"code": "26356", "type": "CPT"}, {"code": "1481862", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FLEXOR TENDON-NOT IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH W/O FREE GRAFT 26350", "code_information": [{"code": "26350", "type": "CPT"}, {"code": "1481857", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28555", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33770", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33771", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33774", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33775", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33776", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33777", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33778", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33779", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33780", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33781", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GUM", "code_information": [{"code": "41872", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND DEFORMITY", "code_information": [{"code": "26580", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33641", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33681", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33684", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33688", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECTS", "code_information": [{"code": "33647", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33500", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33501", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT", "code_information": [{"code": "33732", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT(S)", "code_information": [{"code": "33730", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HERNIA FEMORAL-INCARCERATED/STRANGULATED 49557", "code_information": [{"code": "49557", "type": "CPT"}, {"code": "1481869", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HERNIA FEMORAL-INCARCERATED/STRANGULATED ANY AGE 49553", "code_information": [{"code": "49553", "type": "CPT"}, {"code": "1481871", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HERNIA FEMORAL-RECURRENT/REDUCIBLE 49555", "code_information": [{"code": "49555", "type": "CPT"}, {"code": "1481868", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HERNIA FEMORAL-REDUCIBLE ANY AGE 49550", "code_information": [{"code": "49550", "type": "CPT"}, {"code": "1481870", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HERNIA INGUINAL LAPAROSCOPIC-INITIAL 49650", "code_information": [{"code": "49650", "type": "CPT"}, {"code": "1481866", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HERNIA INGUINAL LAPAROSCOPIC-RECURRENT 49651", "code_information": [{"code": "49651", "type": "CPT"}, {"code": "1481867", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HERNIA INGUINAL-RECURRENT/INCARCERATED/STRANGULATED ANY AGE 49521", "code_information": [{"code": "49521", "type": "CPT"}, {"code": "1481892", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HERNIA INGUINAL-RECURRENT/REDUCIBLE ANY AGE 49520", "code_information": [{"code": "49520", "type": "CPT"}, {"code": "1481891", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HERNIA INGUINAL-SLIDING-ANY AGE 49525", "code_information": [{"code": "49525", "type": "CPT"}, {"code": "1481893", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HYPOSPADIAS 1 STAGE W/ SIMPLE MEATAL ADVANCEMENT 54322", "code_information": [{"code": "54322", "type": "CPT"}, {"code": "1481902", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HYPOSPADIAS 2ND STAGE GREATER THAN 3CM 54312", "code_information": [{"code": "54312", "type": "CPT"}, {"code": "1481903", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HYPOSPADIAS 2ND STAGE LESS THAN 3CM 54308", "code_information": [{"code": "54308", "type": "CPT"}, {"code": "1481904", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HYPOSPADIAS 2ND STAGE W/ SKIN GRAFT 54316", "code_information": [{"code": "54316", "type": "CPT"}, {"code": "1481905", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HYPOSPADIAS 3RD STAGE 54318", "code_information": [{"code": "54318", "type": "CPT"}, {"code": "1481906", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HYPOSPADIAS-1 STAGE-W/ URETHROPLASTY BY LOCAL SKIN FLAP/URETHRAL MOBILIZATION 54326", "code_information": [{"code": "54326", "type": "CPT"}, {"code": "1481901", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HYPOSPADIAS-1 STAGE-W/ URETHROPLASTY BY LOCAL SKIN FLAPS 54324", "code_information": [{"code": "54324", "type": "CPT"}, {"code": "1481900", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR IMMEDIATE WOUNDS NECK/HAND/FT AND/OR EXT. GENT. 3.0CM 12047", "code_information": [{"code": "12047", "type": "CPT"}, {"code": "44626047", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1346.97, "maximum": 8450.0, "gross_charge": 2783.0, "discounted_cash": 974.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1346.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INCOMPLETE CIRCUMCISION 54163", "code_information": [{"code": "54163", "type": "CPT"}, {"code": "11284188", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL HERNIA INGUINAL-AGE 5 YEARS OR OLDER-INCARCERATED/STRANGULATED 49507", "code_information": [{"code": "49507", "type": "CPT"}, {"code": "1481884", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL HERNIA INGUINAL-AGE 5 YEARS OR OLDER-REDUCIBLE 49505", "code_information": [{"code": "49505", "type": "CPT"}, {"code": "1481883", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL HERNIA INGUINAL-AGE 6 MONTHS TO UNDER 5 YEARS-INCARCERATED/STRANGULATED 49501", "code_information": [{"code": "49501", "type": "CPT"}, {"code": "1481886", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL HERNIA INGUINAL-AGE 6 MONTHS TO UNDER 5 YEARS-REDUCIBLE 49500", "code_information": [{"code": "49500", "type": "CPT"}, {"code": "1481885", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL HERNIA INGUINAL-FULL/PRE TERM INFANT-INCARCERATED/STRANGULATED 49496", "code_information": [{"code": "49496", "type": "CPT"}, {"code": "1481888", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL HERNIA INGUINAL-FULL/PRE TERM INFANT-REDUCIBLE 49495", "code_information": [{"code": "49495", "type": "CPT"}, {"code": "1481887", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL HERNIA INGUINAL-PRE-TERM INFANT-INCARCERATED/STRANGULATED 49492", "code_information": [{"code": "49492", "type": "CPT"}, {"code": "1481890", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL HERNIA INGUINAL-PRE-TERM INFANT-REDUCIBLE 49491", "code_information": [{"code": "49491", "type": "CPT"}, {"code": "1481889", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INTERMED. WOUNDS OF SCALP/AXILLAE/TRUNK OR EXT. 7.6 TO 12.5CM 12034", "code_information": [{"code": "12034", "type": "CPT"}, {"code": "1863136", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1319.0, "discounted_cash": 461.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 638.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INTERMEDIATE WOUND OF FACE/EAR/EYE/NOSE 12052", "code_information": [{"code": "12052", "type": "CPT"}, {"code": "1700104", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 1368.0, "discounted_cash": 478.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 662.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR INTRINSIC MUSCLES HAND EACH 26591", "code_information": [{"code": "26591", "type": "CPT"}, {"code": "1481908", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LAC PALATE<2 CM", "code_information": [{"code": "42180", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LAMINECTOMY DEFECT", "code_information": [{"code": "63295", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB DUAL", "code_information": [{"code": "33220", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB ONE", "code_information": [{"code": "33218", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47350", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47360", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47361", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47362", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG EPIPHYSES", "code_information": [{"code": "27734", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LUMBAR HERNIA", "code_information": [{"code": "49540", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LUNG HERNIA", "code_information": [{"code": "32800", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33320", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33322", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR VESSEL", "code_information": [{"code": "33321", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW W/ LOCAL TISSUE 24345", "code_information": [{"code": "24345", "type": "CPT"}, {"code": "1481707", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 14296.0, "discounted_cash": 5003.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 6919.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69666", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69667", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MODIFIED FONTAN", "code_information": [{"code": "33615", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH LACERATION", "code_information": [{"code": "40830", "type": "CPT"}], "standard_charges": [{"minimum": 598.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH LACERATION", "code_information": [{"code": "40831", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH/NOSE FISTULA", "code_information": [{"code": "30600", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL SEPTAL PERFORATIONS 30630", "code_information": [{"code": "30630", "type": "CPT"}, {"code": "1700100", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL VALVE COLLAPSE SUBCUTANEOUS SUBMUCOSAL REMODELING 30469", "code_information": [{"code": "30469", "type": "CPT"}, {"code": "46163812", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2741.37, "maximum": 9357.0, "gross_charge": 5664.0, "discounted_cash": 1982.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2741.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL VALVE COLLAPSE W/SUBCUTANEOUS/SUBMUCOSAL LAT. WALL IMPLANT 30468", "code_information": [{"code": "30468", "type": "CPT"}, {"code": "45838027", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2792.68, "maximum": 9357.0, "gross_charge": 5770.0, "discounted_cash": 2019.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2792.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL VESTIULAR STENOSIS NASAL WALL RECON 30465", "code_information": [{"code": "30465", "type": "CPT"}, {"code": "1643985", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2375.47, "maximum": 9357.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64837", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE/SHORTEN BONE", "code_information": [{"code": "64876", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NON-UNION-METACARPAL OR PHALANX W/ OR W/O INTERNAL FIXATION 26546", "code_information": [{"code": "26546", "type": "CPT"}, {"code": "1481911", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION OR MALUNION TARSAL BONES 28320", "code_information": [{"code": "28320", "type": "CPT"}, {"code": "2189130", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION OR MALUNION TIBIA W /SLIDING GRAFT 27722", "code_information": [{"code": "27722", "type": "CPT"}, {"code": "1772203", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 9735.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION RADIUS & ULNA W/ AUTOGRAFT 25420", "code_information": [{"code": "25420", "type": "CPT"}, {"code": "1481913", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION RADIUS & ULNA-W/O GRAFT 25415", "code_information": [{"code": "25415", "type": "CPT"}, {"code": "1481912", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9735.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION RADIUS OR ULNA W/AUTOGRAFT 25405", "code_information": [{"code": "25405", "type": "CPT"}, {"code": "1481915", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9735.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION RADIUS OR ULNA-W/O GRAFT 25400", "code_information": [{"code": "25400", "type": "CPT"}, {"code": "1481914", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION/MALUNION HUMERUS W/ ILIAC OR OTHER AUTOGRAFT 24435", "code_information": [{"code": "24435", "type": "CPT"}, {"code": "1481916", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION/MALUNION HUMERUS W/O GRAFT 24430", "code_information": [{"code": "24430", "type": "CPT"}, {"code": "1481917", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION/MALUNION METATARSAL BONES 28322", "code_information": [{"code": "28322", "type": "CPT"}, {"code": "1481918", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NOSE TO LIP FISTULA", "code_information": [{"code": "42260", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ABDOMINAL WALL", "code_information": [{"code": "49900", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46751", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46761", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL STRICTURE", "code_information": [{"code": "46705", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33414", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33417", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER OPENING", "code_information": [{"code": "51880", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER WOUND", "code_information": [{"code": "51865", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLEPHAROPTOSIS; CONJUNCTIVO-TARSO-MULLER'S MUSCLE-LEVATOR RESECTION 67908", "code_information": [{"code": "67908", "type": "CPT"}, {"code": "1481919", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE W/AUTOLOGOUS FASCIAL SLING 67902", "code_information": [{"code": "67902", "type": "CPT"}, {"code": "1481920", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE W/SUTURE OR OTHER MATERIAL 67901", "code_information": [{"code": "67901", "type": "CPT"}, {"code": "1481921", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLEPHAROPTOSIS; LEVATOR RESECTION OR ADVANCEMENT EXTERNAL APPROACH 67904", "code_information": [{"code": "67904", "type": "CPT"}, {"code": "1481922", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLEPHAROPTOSIS; LEVATOR RESECTION OR ADVANCEMENT INTERNAL APPROACH 67903", "code_information": [{"code": "67903", "type": "CPT"}, {"code": "1481923", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLEPHAROPTOSIS; SUPERIOR RECTUS TECHNIQUE WITH FASCIAL SLING 67906", "code_information": [{"code": "67906", "type": "CPT"}, {"code": "1481924", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BODY CAST", "code_information": [{"code": "29720", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL LESION", "code_information": [{"code": "44605", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BROW PTOSIS 67900", "code_information": [{"code": "67900", "type": "CPT"}, {"code": "1481925", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46744", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46746", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46748", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF COMPLEX RETINAL DETACHMENT 67113", "code_information": [{"code": "67113", "type": "CPT"}, {"code": "1481926", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2631.5, "maximum": 9357.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DEFECT WITH AUTOGRAFT RADIUS AND ULNA 25426", "code_information": [{"code": "25426", "type": "CPT"}, {"code": "26062999", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39503", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39540", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39541", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK-NO LAMINECTOMY 63707", "code_information": [{"code": "63707", "type": "CPT"}, {"code": "1481927", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 391.45, "maximum": 8450.0, "gross_charge": 1186.24, "discounted_cash": 415.18, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 574.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 391.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ECTROPION; EXCISION TARSAL WEDGE 67916", "code_information": [{"code": "67916", "type": "CPT"}, {"code": "1481929", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ECTROPION; EXTENSIVE 67917", "code_information": [{"code": "67917", "type": "CPT"}, {"code": "1481930", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ECTROPION; SUTURE 67914", "code_information": [{"code": "67914", "type": "CPT"}, {"code": "1481931", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ENCEPHALOCELE SKULL VAULT INCLUDING CRANIOPLASTY 62120", "code_information": [{"code": "62120", "type": "CPT"}, {"code": "1481933", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ENTEROCELE ABDOMINAL APPROACH 57270", "code_information": [{"code": "57270", "type": "CPT"}, {"code": "1481934", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ENTEROCELE VAGINAL APPROACH 57268", "code_information": [{"code": "57268", "type": "CPT"}, {"code": "1481935", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ENTROPION; EXCISION TARSAL WEDGE 67923", "code_information": [{"code": "67923", "type": "CPT"}, {"code": "1481936", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ENTROPION; EXTENSIVE 67924", "code_information": [{"code": "67924", "type": "CPT"}, {"code": "1481937", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ENTROPION; SUTURE 67921", "code_information": [{"code": "67921", "type": "CPT"}, {"code": "1481938", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EPISPADIAS WITH EXSTROPHY OF BLADDER 54390", "code_information": [{"code": "54390", "type": "CPT"}, {"code": "1481940", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43300", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43310", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65272", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65273", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65286", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64864", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64865", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FIBULA EPIPHYSIS", "code_information": [{"code": "27732", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAMMERTOE", "code_information": [{"code": "28286", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART CHAMBERS", "code_information": [{"code": "33670", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DAMAGE", "code_information": [{"code": "33545", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECT", "code_information": [{"code": "33720", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33660", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33665", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33692", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33694", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33697", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33702", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33710", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33300", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33305", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HYPOSPADIAS COMPLICATIONS-SIMPLE 54340", "code_information": [{"code": "54340", "type": "CPT"}, {"code": "1481944", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HYPOSPADIAS COMPLICATIONS/ EXTENSIVE DISSECTION W/ FLAP OR GRAFT 54348", "code_information": [{"code": "54348", "type": "CPT"}, {"code": "1481942", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HYPOSPADIAS COMPLICATIONS/MOBILIZATION SKIN FLAPS W/ GRAFT 54344", "code_information": [{"code": "54344", "type": "CPT"}, {"code": "1481943", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF IMPERFORATED ANUS", "code_information": [{"code": "46742", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF INTERMEDIATE WOUNDS-FACIAL-EARS-MUCOUS MEMBRANES 2.5 CM OR LESS 12051", "code_information": [{"code": "12051", "type": "CPT"}, {"code": "1481947", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF INTERMEDIATE WOUNDS-NECK-HANDS-FEET-GENITALIA 12.6-20.0 CM 12045", "code_information": [{"code": "12045", "type": "CPT"}, {"code": "1481946", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF IRIS CILIARY BODY 66680", "code_information": [{"code": "66680", "type": "CPT"}, {"code": "1481948", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KIDNEY WOUND", "code_information": [{"code": "50500", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LACERATE CORNEA AND/OR SCLERA PERFORATING NOT INVOLVING UVEAL TISSUE 65280", "code_information": [{"code": "65280", "type": "CPT"}, {"code": "1481951", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LACERATE CORNEA AND/OR SCLERA PERFORATING W/ REPOS./RESECT. OF UVEAL TISSUE 65285", "code_information": [{"code": "65285", "type": "CPT"}, {"code": "1481952", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LACERATE CORNEA NONPERFORATING W/ OR W/O REMOVAL OF FOREIGN BODY 65275", "code_information": [{"code": "65275", "type": "CPT"}, {"code": "1481953", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LACERATION CONJUNCTIVA-DIRECT CLOSURE 65270", "code_information": [{"code": "65270", "type": "CPT"}, {"code": "1481955", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27740", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27742", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27725", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27727", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MESENTERY", "code_information": [{"code": "44850", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33425", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33426", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33427", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NASAL VESTIBULAR LATERAL WALL STENOSIS WITH IMPLANTS C9749", "code_information": [{"code": "C9749", "type": "HCPCS"}, {"code": "45314861", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5434.0, "discounted_cash": 1901.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR OF NONUNION OF CARPAL BONE/ EACH EXCLUDING SCAPHOID 25431", "code_information": [{"code": "25431", "type": "CPT"}, {"code": "1481957", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NONUNION SCAPHOID BONE W/ OR W/O RADIAL STYLOIDECTOMY 25440", "code_information": [{"code": "25440", "type": "CPT"}, {"code": "1481958", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF PELVIC FLOOR DEFECT W/ MESH-VAGINAL APPROACH 57267", "code_information": [{"code": "57267", "type": "CPT"}, {"code": "1481960", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RADIUS OR ULNA DEFECT W/ AUTOGRAFT 25425", "code_information": [{"code": "25425", "type": "CPT"}, {"code": "1481961", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTOCELE 45560", "code_information": [{"code": "45560", "type": "CPT"}, {"code": "1481977", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RETINAL DETACHMENT; SCLERAL BUCKLING 67107", "code_information": [{"code": "67107", "type": "CPT"}, {"code": "1481965", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RETINAL DETACHMENT; WITH VITRECTOMY 67108", "code_information": [{"code": "67108", "type": "CPT"}, {"code": "1481966", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED SPLEEN", "code_information": [{"code": "38115", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED UTERUS", "code_information": [{"code": "58520", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT 66225", "code_information": [{"code": "66225", "type": "CPT"}, {"code": "1481967", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63700", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63702", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63704", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63706", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STERNUM SEPARATION", "code_information": [{"code": "21750", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STOMACH LESION", "code_information": [{"code": "43840", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SYMBLEPHARON; CONJUNCTIVOPLASTY WITHOUT GRAFT 68330", "code_information": [{"code": "68330", "type": "CPT"}, {"code": "1481969", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SYNDACTYLY EACH WEB SPACE W/SKIN FLAP 26560", "code_information": [{"code": "26560", "type": "CPT"}, {"code": "1941665", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF THIGH", "code_information": [{"code": "27470", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA", "code_information": [{"code": "27720", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA EPIPHYSIS", "code_information": [{"code": "27730", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TUNICA VAGINALIS HYDROCELE 55060", "code_information": [{"code": "55060", "type": "CPT"}, {"code": "1481970", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER", "code_information": [{"code": "50900", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER LESION", "code_information": [{"code": "51535", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53275", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53520", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53502", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53505", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53510", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53515", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRAL LESION", "code_information": [{"code": "57230", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF UTERUS", "code_information": [{"code": "59350", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31750", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31755", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31760", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31800", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31805", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WOUND EXTRAOCULAR MUSCLE TENDON AND/OR TENON'S CAPSULE 65290", "code_information": [{"code": "65290", "type": "CPT"}, {"code": "1481971", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OMPHALOCELE-SMALL/PRIMARY CLOSURE 49600", "code_information": [{"code": "49600", "type": "CPT"}, {"code": "1481976", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OVIDUCT", "code_information": [{"code": "58750", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PACK MENISCAL ROOT WITH ULTRATAPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71935068", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1918.0, "discounted_cash": 671.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42182", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42235", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PRIMARY TORN LIGAMENT AND/OR CAPSULE-KNEE; COLLATERAL 27405", "code_information": [{"code": "27405", "type": "CPT"}, {"code": "1481978", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PROFUNDUS TENDON W/ INTACT SUPERFICIALIS TENDON; PRIMARY EACH 26370", "code_information": [{"code": "26370", "type": "CPT"}, {"code": "1481979", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PROSTH VALVE CLOT", "code_information": [{"code": "33496", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PUL VENOUS STENOSIS", "code_information": [{"code": "33726", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ARTERY", "code_information": [{"code": "33917", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ATRESIA", "code_information": [{"code": "33920", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR QUADRICEPS 27430", "code_information": [{"code": "27430", "type": "CPT"}, {"code": "1481980", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RECT/BLADDER FISTULA", "code_information": [{"code": "45800", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTOURETHRAL FISTULA", "code_information": [{"code": "45820", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM/REMOVE SIGMOID", "code_information": [{"code": "45550", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RETINAL DETACH BY SCLERAL BUCKLING/ VITRECTOMY PATIENT W/ PREVIOUS IPSI 67112", "code_information": [{"code": "1481984", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5022.0, "discounted_cash": 1757.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR RUPTD POPLITEAL ART", "code_information": [{"code": "35152", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RUPTURED MUSCULOTENDINOUS CUFF (EG-ROTATOR CUFF) OPEN; ACUTE 23410", "code_information": [{"code": "23410", "type": "CPT"}, {"code": "1481986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RUPTURED MUSCULOTENDINOUS CUFF (EG-ROTATOR CUFF) OPEN; CHRONIC 23412", "code_information": [{"code": "23412", "type": "CPT"}, {"code": "1481987", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42505", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33813", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33814", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33852", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33853", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33617", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33619", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9949", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SPINAL FLUID LEAKAGE", "code_information": [{"code": "63709", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STERN/NUSS W/O SCOPE", "code_information": [{"code": "21742", "type": "CPT"}], "standard_charges": [{"minimum": 3365.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STERNUM/NUSS W/SCOPE", "code_information": [{"code": "21743", "type": "CPT"}], "standard_charges": [{"minimum": 3365.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH OPENING", "code_information": [{"code": "43870", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH-BOWEL FISTULA", "code_information": [{"code": "43880", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SYNDACTYLY EACH WEB SPACE W/ SKIN FLAPS/GRAFTS 26561", "code_information": [{"code": "26561", "type": "CPT"}, {"code": "1481730", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SYNDACTYLY EACH WEB SPACE W/ SKIN FLAPS/GRAFTS-COMPLEX 26562", "code_information": [{"code": "26562", "type": "CPT"}, {"code": "1481731", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SYSTEM 0DEG PEEKTRUESPAN MENISCAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1323.0, "discounted_cash": 463.05, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33418", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33419", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TENDON OR MUSCLE-UPPER ARM/ELBOW EACH 24341", "code_information": [{"code": "24341", "type": "CPT"}, {"code": "1481831", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TENDON SHEATH EXTENSOR FOREARM/WRIST W/FREE GRAFT 25275", "code_information": [{"code": "25275", "type": "CPT"}, {"code": "1481994", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TENDON/MUSCLE EXTENSOR FOREARM/WRIST-SECONDARY W/FREE GRAFT EACH 25274", "code_information": [{"code": "25274", "type": "CPT"}, {"code": "1481988", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT ESOPHAGUS", "code_information": [{"code": "42953", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT WOUND", "code_information": [{"code": "42900", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41250", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41251", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41252", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TOOTH SOCKET", "code_information": [{"code": "41874", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36575", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36576", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49605", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49606", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49610", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49611", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR UPPER JAW FISTULA", "code_information": [{"code": "30580", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR URO SPHINCTER", "code_information": [{"code": "53449", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA", "code_information": [{"code": "57335", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VALVE FEMORAL VEIN", "code_information": [{"code": "34501", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VENOUS ANOMALY", "code_information": [{"code": "33724", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33802", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33803", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL GRAFT DEFECT", "code_information": [{"code": "35870", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WOUND 2.5 CM OR LESS NECK/HANDS/FEET/EXTERNAL GENITALIA 12041", "code_information": [{"code": "12041", "type": "CPT"}, {"code": "1482002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 300.08, "maximum": 8450.0, "gross_charge": 620.0, "discounted_cash": 217.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 300.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WOUND 2.5 CM OR LESS SCALP/AXILLAE-TRUNK/EXTREMITIES EXCLUDING HAND/FOOT 12031", "code_information": [{"code": "12031", "type": "CPT"}, {"code": "1482003", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 213.92, "maximum": 8450.0, "gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 213.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WOUND 2.6-7.5 CM NECK/HANDS/FEET/EXTERNAL GENITALIA 12042", "code_information": [{"code": "12042", "type": "CPT"}, {"code": "1482004", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WOUND 2.6-7.5 CM SCALP/AXILLAE-TRUNK/EXTREMITIES EXCLUDING HAND/FOOT 12032", "code_information": [{"code": "12032", "type": "CPT"}, {"code": "1482005", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-COMPLEX -FACE-NECK-AXILLAE-GENITALIA-HANDS-FEET 2.6CM -7.5CM 13132", "code_information": [{"code": "13132", "type": "CPT"}, {"code": "1481836", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-COMPLEX TRUNK 2.6CM -7.5CM 13101", "code_information": [{"code": "13101", "type": "CPT"}, {"code": "1481842", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-COMPLEX-EYELIDS-NOSE-EARS-LIPS 1.0CM OR LESS 13150", "code_information": [{"code": "1481837", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR-COMPLEX-EYELIDS-NOSE-EARS-LIPS 1.1CM TO 2.5CM 13151", "code_information": [{"code": "13151", "type": "CPT"}, {"code": "1481839", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-COMPLEX-EYELIDS-NOSE-EARS-LIPS 2.6CM TO 7.5CM 13152", "code_information": [{"code": "13152", "type": "CPT"}, {"code": "1481838", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-COMPLEX-FACE-NECK-AXILLAE-GENITALIA-HANDS-FEET 1.1CM -2.5CM 13131", "code_information": [{"code": "13131", "type": "CPT"}, {"code": "1481835", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-COMPLEX-SCALP-ARMS-LEGS 2.6CM -7.5CM 13121", "code_information": [{"code": "13121", "type": "CPT"}, {"code": "1481840", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-COMPLEX-TRUNK 1.1CM -2.5CM 13100", "code_information": [{"code": "13100", "type": "CPT"}, {"code": "1481841", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-PRIMARY-TORN LIGAMENT/CAPSULE-KNEE-CRUCIATE & COLLATERAL LIGAMENTS 27409", "code_information": [{"code": "27409", "type": "CPT"}, {"code": "1481843", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-PRIMARY-TORN LIGAMENT/CAPSULE-KNEE-CRUCIATE LIGAMENTS 27407", "code_information": [{"code": "27407", "type": "CPT"}, {"code": "1481844", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-TENDON-EXTENSOR- FOOT; SECONDARY W/ FREE GRAFT-EACH TENDON 28210", "code_information": [{"code": "28210", "type": "CPT"}, {"code": "1481849", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-TENDON-EXTENSOR-FOOT; PRIMARY OR SECONDARY-EACH TENDON 28208", "code_information": [{"code": "28208", "type": "CPT"}, {"code": "1481848", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FEMUR HEAD/NECK", "code_information": [{"code": "27170", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26428", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF BRONCHUS", "code_information": [{"code": "31770", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF THIGH", "code_information": [{"code": "27472", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27724", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPEAT CONTROL OF NOSEBLEED", "code_information": [{"code": "30906", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33362", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33363", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33364", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33365", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE PERQ", "code_information": [{"code": "33361", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33367", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33368", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33369", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE BRAIN CAVITY SHUNT", "code_information": [{"code": "62258", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE CVAD CATH", "code_information": [{"code": "36580", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49451", "type": "CPT"}], "standard_charges": [{"minimum": 789.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE G-J TUBE PERC", "code_information": [{"code": "49452", "type": "CPT"}], "standard_charges": [{"minimum": 789.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE G/C TUBE PERC", "code_information": [{"code": "49450", "type": "CPT"}], "standard_charges": [{"minimum": 789.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE MATERIAL PROSTHESIS", "code_information": [{"code": "D6197", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE PICVAD CATH", "code_information": [{"code": "36585", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TRICUSPID VALVE", "code_information": [{"code": "33465", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36578", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36581", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36582", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36583", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE URETER BY BOWEL", "code_information": [{"code": "50840", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/BP", "code_information": [{"code": "33983", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/O BP", "code_information": [{"code": "33982", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD PUMP EXT", "code_information": [{"code": "33981", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62194", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62225", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33405", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33406", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33410", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33411", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33412", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33413", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF CONTACT LENS", "code_information": [{"code": "92326", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF MITRAL VALVE", "code_information": [{"code": "33430", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF TISSUE EXPANDER W/PERMANENT PROSTHESIS 11970", "code_information": [{"code": "11970", "type": "CPT"}, {"code": "1740093", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1058.5, "maximum": 9357.0, "gross_charge": 2187.0, "discounted_cash": 765.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1058.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT PULMONARY VALVE", "code_information": [{"code": "33475", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT/IRRIGATION OR REVISION OF LUMBOSUBARACHNOID SHUNT 63744", "code_information": [{"code": "63744", "type": "CPT"}, {"code": "1482011", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT/REVISION CEREBROSPINAL FLUID SHUNT 62230", "code_information": [{"code": "62230", "type": "CPT"}, {"code": "1482010", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANT FOREARM COMPLETE", "code_information": [{"code": "20805", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION ARM COMPLETE", "code_information": [{"code": "20802", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20816", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20822", "type": "CPT"}], "standard_charges": [{"minimum": 3365.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION FOOT COMPLETE", "code_information": [{"code": "20838", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION HAND COMPLETE", "code_information": [{"code": "20808", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION OF PENIS", "code_information": [{"code": "54438", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20824", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20827", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOS CAR MODULJ TRANVNS ELT", "code_information": [{"code": "415T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOS PREV IMPLTBL SUBQ DFB", "code_information": [{"code": "33273", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOS PREV SS IMPL DFB ELTRD", "code_information": [{"code": "574T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSG PERQ R/L HRT VAD", "code_information": [{"code": "33993", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSG PHRNC NRV STIM TRNSVN", "code_information": [{"code": "33281", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION GASTROSTOMY TUBE", "code_information": [{"code": "43761", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION L VENTRIC LEAD", "code_information": [{"code": "33226", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION PACING-DEFIB LEAD", "code_information": [{"code": "33215", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION VENOUS CATHETER", "code_information": [{"code": "36597", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS-REQ. INCISION 66825", "code_information": [{"code": "66825", "type": "CPT"}, {"code": "1482012", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR CUFF TOURNIQUET 30IN DL PORT BLADDER PUMP LN CONN DISP", "code_information": [{"code": "60-7070-105-00R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REPR OF ANAL FISTULA W/GLUE", "code_information": [{"code": "46706", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH DBL PROC", "code_information": [{"code": "46712", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH SNGL PROC", "code_information": [{"code": "46710", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR PUL ART UNIFOCAL W/CPB", "code_information": [{"code": "33926", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPRDTVE MED ALYS 24 CHRMSM", "code_information": [{"code": "254U", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 1093.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1093.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1093.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPRGRMG IO RTA ELTRD RA", "code_information": [{"code": "473T", "type": "CPT"}], "standard_charges": [{"minimum": 289.25, "maximum": 454.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 289.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 454.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 454.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 454.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPROCESSED SAW BLADE 21X90X1.37MM", "code_information": [{"code": "6221-137-90R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT 7/>", "code_information": [{"code": "92604", "type": "CPT"}], "standard_charges": [{"minimum": 308.35, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 308.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 484.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 484.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 484.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT <7", "code_information": [{"code": "92602", "type": "CPT"}], "standard_charges": [{"minimum": 321.05, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 321.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 504.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPTILASE TEST", "code_information": [{"code": "85635", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REQ RET OR W/IN 90D OF SURG", "code_information": [{"code": "G9514", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REREVISE EYE MUSCLES ADD-ON", "code_information": [{"code": "67332", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RES CHANGE SC < 0", "code_information": [{"code": "G2167", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RES CHANGE SC >=0", "code_information": [{"code": "G2152", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUM/CHEST", "code_information": [{"code": "32504", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUMOR", "code_information": [{"code": "32503", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT BACK TUM 5 CM/>", "code_information": [{"code": "21936", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT CLAVICLE TUMOR", "code_information": [{"code": "23200", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM COMPLEX", "code_information": [{"code": "39561", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM SIMPLE", "code_information": [{"code": "39560", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT DISTAL FINGER TUMOR", "code_information": [{"code": "26262", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FIBULA TUMOR", "code_information": [{"code": "27646", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR 3 CM/>", "code_information": [{"code": "28047", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR < 3 CM", "code_information": [{"code": "28046", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FORARM/WRIST TUM 3CM>", "code_information": [{"code": "25078", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FOREARM/WRIST TUM<3CM", "code_information": [{"code": "25077", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HEART SAC LESION", "code_information": [{"code": "33050", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM INCL ACETABUL", "code_information": [{"code": "27076", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM W/INNOM BONE", "code_information": [{"code": "27077", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUMOR", "code_information": [{"code": "27075", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM 5 CM/>", "code_information": [{"code": "27059", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM 5 CM/>", "code_information": [{"code": "27616", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM < 5 CM", "code_information": [{"code": "27615", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL CYST", "code_information": [{"code": "39200", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL TUMOR", "code_information": [{"code": "39220", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT METATARSAL TUMOR", "code_information": [{"code": "28173", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT NASOPHARYNX SKULL", "code_information": [{"code": "61586", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT NECK THORAX TUMOR<5CM", "code_information": [{"code": "21557", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT NECK TUMOR 5 CM/>", "code_information": [{"code": "21558", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58950", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58951", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58952", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT PHALANX OF TOE TUMOR", "code_information": [{"code": "28175", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT PROX HUMERUS TUMOR", "code_information": [{"code": "23220", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT RADIUS/ULNAR TUMOR", "code_information": [{"code": "25170", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT RECUR GYN MAL W/LYM", "code_information": [{"code": "58958", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT RECURRENT GYN MAL", "code_information": [{"code": "58957", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT SCAPULA TUMOR", "code_information": [{"code": "23210", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT SHOULDER TUMOR 5 CM/>", "code_information": [{"code": "23078", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TALUS/CALCANEUS TUM", "code_information": [{"code": "27647", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TARSAL TUMOR", "code_information": [{"code": "28171", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM 5 CM/>", "code_information": [{"code": "27364", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TIBIA TUMOR", "code_information": [{"code": "27645", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/DEBRIDE PANCREAS", "code_information": [{"code": "48105", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61600", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61601", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61605", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61606", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61607", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61608", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61615", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61616", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTING DEVICE HANDPIECE AVETA FLEX DISPOSABLE 2.9MM 210-080", "code_information": [{"code": "210-080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1692.0, "discounted_cash": 592.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RESECTION FIRST CERVICAL RIB W/SYMPATHECTOMY 21616", "code_information": [{"code": "21616", "type": "CPT"}, {"code": "1482029", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTION FIRST/CERVICAL RIB 21615", "code_information": [{"code": "21615", "type": "CPT"}, {"code": "1482028", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTION OF ELBOW JOINT", "code_information": [{"code": "24155", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTION OF PALATE OR EXTENSIVE RESECTION OF LESION 42120", "code_information": [{"code": "42120", "type": "CPT"}, {"code": "23738727", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTION OF SCROTUM 55150", "code_information": [{"code": "55150", "type": "CPT"}, {"code": "1482032", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTION PARTIAL/COMPLETE PHALANGEAL BASE-EACH TOE 28126", "code_information": [{"code": "28126", "type": "CPT"}, {"code": "1482033", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTION-DISTAL END OF PHALANX-EACH TOE 28153", "code_information": [{"code": "28153", "type": "CPT"}, {"code": "1482027", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTOR FULL 4.2MM RADIUS", "code_information": [{"code": "9247A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.0, "discounted_cash": 214.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RESECTOR FULL 5.5MM RADIUS", "code_information": [{"code": "9246A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 55.65, "setting": "both", "billing_class": "facility"}]}, {"description": "RESECTOR FULL RADIUS 3.5MM STERLING", "code_information": [{"code": "C9248", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RESECTOR MERLIN 3.5MM FULL RADIUS REPROCESS STERLINGINSTR", "code_information": [{"code": "C9248R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RESECTOR SURG 4.5MM MAROON FULL RADIUS COMPATIBLE W/ VALLEYLAB ERBE AND VULCAN G", "code_information": [{"code": "7209700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 578.35, "discounted_cash": 202.42, "setting": "both", "billing_class": "facility"}]}, {"description": "RESERVOIR BIOFLEX 75CC TITAN", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "ER8075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4415.0, "discounted_cash": 1545.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RESERVOIR BULB 100CC WOUND DRAINAGE SUCTION SILICONE JACKSON PRATT LF", "code_information": [{"code": "SU130-1305", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "RESERVOIR CONCEAL 65ML TO 100ML", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "720185-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4004.0, "discounted_cash": 1401.4, "setting": "both", "billing_class": "facility"}]}, {"description": "RESERVOIR SPHERICAL 65 ML", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "72404155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5508.0, "discounted_cash": 1927.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21480", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21485", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESOURCE-INTEN SVC DURING OV", "code_information": [{"code": "G0501", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESP SYNCYTIAL VIRUS AG IA", "code_information": [{"code": "87420", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 12-25 TARGETS", "code_information": [{"code": "87633", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 643.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1062.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1671.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 3-5 TARGETS", "code_information": [{"code": "87631", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 197.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 363.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 6-11 TARGETS", "code_information": [{"code": "87632", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 329.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 556.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 874.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 874.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 874.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 314.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 314.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIR IADNA 18 VIRAL&2 BACT", "code_information": [{"code": "115U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 396.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 396.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 396.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATOR MOTION MGMT SIMUL", "code_information": [{"code": "77293", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1585.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2493.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2493.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2493.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 716.28, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 761.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY FLOW VOLUME LOOP", "code_information": [{"code": "94375", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC", "code_information": [{"code": "178", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7347.05, "maximum": 12613.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7347.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10507.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11558.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12613.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC", "code_information": [{"code": "177", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11248.08, "maximum": 19310.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11248.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16087.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17695.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19310.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC", "code_information": [{"code": "179", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5308.63, "maximum": 9113.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5308.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7592.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8351.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9113.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITH CC", "code_information": [{"code": "181", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6813.57, "maximum": 11697.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6813.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9744.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10719.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11697.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITH MCC", "code_information": [{"code": "180", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10583.81, "maximum": 18169.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10583.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15137.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16650.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18169.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITHOUT CC/MCC", "code_information": [{"code": "182", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4817.74, "maximum": 8270.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4817.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6890.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7579.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8270.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SENSING LEAD", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "4340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6953.0, "discounted_cash": 2433.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [{"code": "204", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4827.47, "maximum": 8287.56, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4827.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6904.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7594.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8287.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYNCYTIAL AG IF", "code_information": [{"code": "87280", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [{"code": "208", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15480.02, "maximum": 26575.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15480.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22139.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24353.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26575.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [{"code": "207", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34892.7, "maximum": 59902.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34892.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49904.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 54894.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59902.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY VIRUS ANTIBODY", "code_information": [{"code": "86756", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 63.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 63.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTORE/REMODEL VENTRICLE", "code_information": [{"code": "33548", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTRATA\u00c2\u00ae WOUND MATRIX 10CM X 12.5CM RWM1-4X5", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "RWM1-4X5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10094.0, "discounted_cash": 3532.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTRICTOR CEMENT 12MM PLUG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "415-00-120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [{"code": "815", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6042.85, "maximum": 10374.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6042.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8642.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9506.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10374.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC", "code_information": [{"code": "814", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11507.21, "maximum": 19755.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11507.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16457.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18103.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19755.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "816", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4021.47, "maximum": 6903.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4021.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5751.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6326.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6903.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICYTE/HGB CONCENTRATE", "code_information": [{"code": "85046", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETR BONE FLAP TO FIX SKULL", "code_information": [{"code": "62148", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETRACTOR 12MM ENDO PADDLE", "code_information": [{"code": "173046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR IRIS FLEXIBLE NYLON HOOK FOR MECHANICAL IRIS DILATION STRL", "code_information": [{"code": "611.74", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 347.0, "discounted_cash": 121.45, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR IRIS FLEXIBLE NYLON HOOK FOR MECHANICAL IRIS DILATION STRL DISP", "code_information": [{"code": "611.75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR LAP 10MM FAN ENDO RETRACT II DISP", "code_information": [{"code": "176647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 718.0, "discounted_cash": 251.3, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR O C-SECTIONS", "code_information": [{"code": "G6313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR RNG 31.8CM X 18.3CM DOUBLE PEEL POUCH NORYL RESIN W/ 2 CATH CLIPS LF S", "code_information": [{"code": "3304GR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.57, "discounted_cash": 125.15, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR SPINE 18MM X 6CM METRX XTUBE BEVELED ANGLED", "code_information": [{"code": "9569816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 494.96, "discounted_cash": 173.24, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR SYS WOUND 5 - 9CM INCISIO C8302", "code_information": [{"code": "C8302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 183.0, "discounted_cash": 64.05, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR SYSTEM LIF ILLUMINATION 169-510-S", "code_information": [{"code": "169-510-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2080.5, "discounted_cash": 728.18, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR WOUND PROTECTOR ALEXIS LARGE", "code_information": [{"code": "C8403", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 287.1, "discounted_cash": 100.49, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR WOUND PROTECTOR ALEXIS MEDIUM", "code_information": [{"code": "C8402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.35, "discounted_cash": 72.57, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR WOUND SM 2.5CM TO 6CM ALEXIS PROTECTOR DISP", "code_information": [{"code": "C8301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.35, "discounted_cash": 72.57, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR XPAND IRIS RETRACTOR", "code_information": [{"code": "346722", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 394.0, "discounted_cash": 137.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVAL DEVICE SPECIMEN 2.2 X 5.5IN X 235ML 10MM ENDO INTRODUCER", "code_information": [{"code": "TRS100SB2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.6, "discounted_cash": 47.46, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVAL OF OOCYTE", "code_information": [{"code": "58970", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1475.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETRIEVAL SYSTEM INZII ENDO POUCH", "code_information": [{"code": "CD004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVER ENDO-CATCH II 15MM 173049", "code_information": [{"code": "173049", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 565.0, "discounted_cash": 197.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVER SUT 10.1IN HEWSON FOR REPAIRING ACL AND PCL LIGAMENT TEARS LF STRLINST", "code_information": [{"code": "71111579R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVER SUT 10.1IN HEWSON UNIVERSALINSTR", "code_information": [{"code": "7111-1579", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 654.0, "discounted_cash": 228.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RETROBULBAR INJECTION 67500", "code_information": [{"code": "67500", "type": "CPT"}, {"code": "46262163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 183.43, "maximum": 8450.0, "gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 183.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETROGRADE EJACULATION ANAL", "code_information": [{"code": "89331", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 78.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 78.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 78.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV ARTIFIC DISC ADDL", "code_information": [{"code": "98T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 3471.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV RPLCM ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22861", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV RPLCM RTHRP 1NTRSPC LMBR", "code_information": [{"code": "22862", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV. OF PRIOR HYPOSPADIAS REPAIR REQ. EXT. DISSECTION/EXC. PREVIOUS STRUCTURES 54352", "code_information": [{"code": "54352", "type": "CPT"}, {"code": "1481945", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV GEN", "code_information": [{"code": "271T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV LEAD", "code_information": [{"code": "270T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV TOTAL", "code_information": [{"code": "269T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/RPLCMT SK-MNT CRNL NSTM", "code_information": [{"code": "61891", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/RPLCT HPGLSL NSTM ARY PG", "code_information": [{"code": "64583", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-ATHER", "code_information": [{"code": "C9766", "type": "HCPCS"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-STENT", "code_information": [{"code": "C9765", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC INTRAVASC LITHOTRIPSY", "code_information": [{"code": "C9764", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITH-STEN-ATH TIB/PER", "code_information": [{"code": "C9775", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-ATHER TIB/PER", "code_information": [{"code": "C9774", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-STENT TIB/PER", "code_information": [{"code": "C9773", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP TIBI/PERONE", "code_information": [{"code": "C9772", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP-STENT-ATHER", "code_information": [{"code": "C9767", "type": "HCPCS"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASCULARIZATION PENIS", "code_information": [{"code": "37788", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVERSED INSERT PERFORM HUMERAL SYSTEM DWP1366", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP1366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSED TRAY LOW OFFSET + 12 DWF512", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3972.0, "discounted_cash": 1390.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REVIEW PATIENT SPIROMETRY", "code_information": [{"code": "94016", "type": "CPT"}], "standard_charges": [{"minimum": 114.44, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 179.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32905", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32906", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE ABDOMEN-VENOUS SHUNT", "code_information": [{"code": "49426", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE ADDITIONAL LEG TENDON", "code_information": [{"code": "27692", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE BLADDER & URETER(S)", "code_information": [{"code": "51565", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61705", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61708", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61710", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CORNEA WITH IMPLANT", "code_information": [{"code": "65770", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE ESOPHAGUS & STOMACH", "code_information": [{"code": "43325", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE ADD-ON", "code_information": [{"code": "67340", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE W/SUTURE", "code_information": [{"code": "67334", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S) ADD-ON", "code_information": [{"code": "67320", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21260", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21261", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21263", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21267", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21268", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67820", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67825", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67830", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67835", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID DEFECT", "code_information": [{"code": "67909", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68360", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GASTRIC PORT OPEN", "code_information": [{"code": "43886", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35879", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35881", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE HEAD/NECK OF FEMUR", "code_information": [{"code": "27179", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27137", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27138", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LEG VEIN", "code_information": [{"code": "37700", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LOW BACK NERVE(S)", "code_information": [{"code": "64714", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDONS", "code_information": [{"code": "27686", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LUMB ARTIF DISC ADDL", "code_information": [{"code": "165T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33820", "type": "CPT"}], "standard_charges": [{"minimum": 2347.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33822", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33824", "type": "CPT"}], "standard_charges": [{"minimum": 2347.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65125", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65150", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE OVARIAN TUBE(S)", "code_information": [{"code": "58752", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25315", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25316", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PROSTH VAG GRAFT LAP", "code_information": [{"code": "57426", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24370", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24371", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS CRVL", "code_information": [{"code": "63250", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS THRC", "code_information": [{"code": "63251", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE CORD VSL THRLMB", "code_information": [{"code": "63252", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43860", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43865", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE TEAR DUCT OPENING", "code_information": [{"code": "68705", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE THIGH MUSCLES/TENDONS", "code_information": [{"code": "27400", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50727", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50728", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URINE FLOW", "code_information": [{"code": "50830", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT OPEN ABD", "code_information": [{"code": "57296", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE VENTRICLE MUSCLE", "code_information": [{"code": "33416", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE WINDPIPE SCAR", "code_information": [{"code": "31830", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68335", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE ELECTRD ANTRUM", "code_information": [{"code": "43882", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEUROELECTRODE", "code_information": [{"code": "61880", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/REPL VAGUS N ELTRD", "code_information": [{"code": "64569", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION / REMOVAL PERIPHERAL OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER 64595", "code_information": [{"code": "64595", "type": "CPT"}, {"code": "4327087", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION CAPSULECTOMY BREAST 19370", "code_information": [{"code": "19370", "type": "CPT"}, {"code": "1480220", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION COLOSTOMY-SIMPLE 44340", "code_information": [{"code": "44340", "type": "CPT"}, {"code": "1482045", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION DOWEL - ZORC CANNILATED 10X33MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PCDXL10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2386.8, "discounted_cash": 835.38, "setting": "both", "billing_class": "facility"}]}, {"description": "REVISION DOWEL - ZORC CANNILATED 12X35MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PCDXL12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2781.0, "discounted_cash": 973.35, "setting": "both", "billing_class": "facility"}]}, {"description": "REVISION DOWEL - ZORC CANNILATED 13X35MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PCDXL13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2364.0, "discounted_cash": 827.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REVISION DOWEL - ZORC CANNILATED 16X32MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PCDXL16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2364.0, "discounted_cash": 827.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REVISION DOWEL - ZORC CANNILATED 9X31MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "PCDXL9", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2364.0, "discounted_cash": 827.4, "setting": "both", "billing_class": "facility"}]}, {"description": "REVISION GASTROPLASTY", "code_information": [{"code": "43848", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION ILEOSTOMY-SIMPLE 44312", "code_information": [{"code": "44312", "type": "CPT"}, {"code": "1482047", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION INC. REMOVAL OF PROSTHETIC VAGINAL GRAFT VAGINAL APPROACH 57295", "code_information": [{"code": "57295", "type": "CPT"}, {"code": "1969164", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION INC. REPLACE SPINAL NEUROSTIMULATOR ELEC PLATE VIA LAMINOTOMY/ECTOMY 63664", "code_information": [{"code": "63664", "type": "CPT"}, {"code": "1764941", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION INC. REPLACEMENT OF SPINAL NEUROSTIMULATOR ELECTRODE W/FLOURO 63663", "code_information": [{"code": "63663", "type": "CPT"}, {"code": "1740094", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION MASTOIDECTOMY; RESULTING IN MODIFIED RADICAL MASTOIDECTOMY 69602", "code_information": [{"code": "69602", "type": "CPT"}, {"code": "8675623", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2631.5, "maximum": 9357.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF AMPUTATION", "code_information": [{"code": "24935", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF AORTIC VALVE", "code_information": [{"code": "92986", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF AQUEOUS SHUNT", "code_information": [{"code": "66184", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE REQERVOIR; WITH GRAFT 66185", "code_information": [{"code": "66185", "type": "CPT"}, {"code": "2926109", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4719.0, "discounted_cash": 1651.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2283.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER & BOWEL", "code_information": [{"code": "51960", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER/URETHRA", "code_information": [{"code": "51800", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "59325", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37140", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37145", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37160", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37180", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44345", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44346", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65600", "type": "CPT"}], "standard_charges": [{"minimum": 1067.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65760", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65765", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF DIAPHRAGM", "code_information": [{"code": "39545", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF ELBOW JOINT", "code_information": [{"code": "24470", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67882", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF FEMUR EPIPHYSIS", "code_information": [{"code": "27185", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33476", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33478", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33735", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33736", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33737", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART VEINS", "code_information": [{"code": "33645", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONE", "code_information": [{"code": "27147", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONES", "code_information": [{"code": "27156", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [{"code": "467", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21761.93, "maximum": 37359.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21761.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31124.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34236.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37359.83, "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": 32517.89, "maximum": 55825.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32517.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46507.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51158.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55825.15, "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": 17047.0, "maximum": 29265.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17047.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24380.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26818.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29265.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HORSESHOE KIDNEY", "code_information": [{"code": "50540", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24410", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24420", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOMY", "code_information": [{"code": "44314", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF INFUSION PUMP", "code_information": [{"code": "36261", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66762", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21295", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21296", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50400", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50405", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27440", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27441", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27445", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LARYNX", "code_information": [{"code": "31400", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LEG VEIN", "code_information": [{"code": "37780", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER LEG", "code_information": [{"code": "27715", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LUNG", "code_information": [{"code": "32940", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37650", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37660", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33420", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33422", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "92987", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21700", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21720", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21725", "type": "CPT"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE/RIB", "code_information": [{"code": "21705", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PELVIS", "code_information": [{"code": "27158", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54420", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54430", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54435", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42892", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42894", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY ARTERY", "code_information": [{"code": "33788", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "33474", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "92990", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF RECONSTRUCTED BREAST 19380", "code_information": [{"code": "19380", "type": "CPT"}, {"code": "1482048", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF STAPEDECTOMY OR STAPEDOTOMY 69662", "code_information": [{"code": "69662", "type": "CPT"}, {"code": "1482049", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33460", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33468", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER ARM", "code_information": [{"code": "24940", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETER", "code_information": [{"code": "50700", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "57220", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF URINARY TRACT", "code_information": [{"code": "51820", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF UTERUS", "code_information": [{"code": "58540", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GEN OR REC. 61888", "code_information": [{"code": "61888", "type": "CPT"}, {"code": "1891044", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 13748.0, "discounted_cash": 4811.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 6654.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR GENERATOR/RECEIVER 63688", "code_information": [{"code": "63688", "type": "CPT"}, {"code": "1482051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY 64585", "code_information": [{"code": "64585", "type": "CPT"}, {"code": "9909517", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 6507.0, "discounted_cash": 2277.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3149.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION SUBVALVULAR TISSUE", "code_information": [{"code": "33415", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TIPS", "code_information": [{"code": "37183", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL HIP ARTHROPLASTY BOTH COMPONENTS W/ OR W/O ALLOGRAFT 27134", "code_information": [{"code": "27134", "type": "CPT"}, {"code": "1744366", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "gross_charge": 19174.0, "discounted_cash": 6710.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 9280.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 6327.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL KNEE ARTHROPLASTY W/ OR W/O ALLOGRAFT 1 COMPONENT 27486", "code_information": [{"code": "27486", "type": "CPT"}, {"code": "1480021", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.67, "maximum": 14796.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL KNEE ARTHROPLASTY W/ OR W/O ALLOGRAFT FEMORAL AND ENTIRE TIBIAL COMPONENT 27487", "code_information": [{"code": "27487", "type": "CPT"}, {"code": "1480022", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 14796.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL SHOULDER ARTHROPLASTY INC. ALLOGRAFT HUMERAL AND GLENOID COMPONENT 23474", "code_information": [{"code": "23474", "type": "CPT"}, {"code": "10956191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 9878.0, "discounted_cash": 3457.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 3259.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL SHOULDER ARTHROPLASTY W/ALLOGRAFT HUMERAL OR GLENOID COMPONENT 23473", "code_information": [{"code": "23473", "type": "CPT"}, {"code": "5922062", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "gross_charge": 8628.0, "discounted_cash": 3019.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4175.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION/REMOVAL ISDNS PTN", "code_information": [{"code": "588T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION/REPAIR OF OPERATIVE WOUND OF ANTERIOR SEGMENT EYE-ANY TYPE 66250", "code_information": [{"code": "66250", "type": "CPT"}, {"code": "1481959", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST AUTOG VN GRF", "code_information": [{"code": "35884", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST NONAUTOG GRF", "code_information": [{"code": "35883", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ RPLCMT/RMVL VRT TETHRG", "code_information": [{"code": "790T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBF", "code_information": [{"code": "819T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBQ", "code_information": [{"code": "818T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA PN W/INT NSTIM", "code_information": [{"code": "64598", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SAC W/NSTIM", "code_information": [{"code": "787T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SPI W/NSTIM", "code_information": [{"code": "785T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVSC OPN/PRQ TIB/PERO STENT", "code_information": [{"code": "37234", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RF CANNULA SIDEKICK 10CM LENGTH 10MM TIP 18 GUAGE WIDTH", "code_information": [{"code": "RFK-C101018S-ZK-P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "RF CANNULA VENOM CVD 18G 100MM", "code_information": [{"code": "406-860-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 267.93, "discounted_cash": 93.78, "setting": "both", "billing_class": "facility"}]}, {"description": "RF CANNULA VENOM CVD 18G 150MM", "code_information": [{"code": "406-860-225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.52, "discounted_cash": 109.38, "setting": "both", "billing_class": "facility"}]}, {"description": "RF SPECTRSC NTRAOP MRGN ASMT", "code_information": [{"code": "546T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 287.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 182.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 287.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 287.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 287.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RFC1 REPEAT XPNSJ VRNT ALYS", "code_information": [{"code": "378U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 197.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RH IG FULL-DOSE IM", "code_information": [{"code": "90384", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RH IG IV", "code_information": [{"code": "90386", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RH IG MINIDOSE IM", "code_information": [{"code": "90385", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP NEXT GNRJ SEQ", "code_information": [{"code": "222U", "type": "CPT"}], "standard_charges": [{"minimum": 407.35, "maximum": 1713.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP RHD1-10&RHCE5", "code_information": [{"code": "198U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 407.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 407.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHEUMATOID FACTOR QUANT", "code_information": [{"code": "86431", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHEUMATOID FACTOR TEST QUAL", "code_information": [{"code": "86430", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHEUMATOLOGY SS", "code_information": [{"code": "G4032", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHINECTOMY TOTAL 30160", "code_information": [{"code": "30160", "type": "CPT"}, {"code": "3170910", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHINOPLASTY COMPLETE 30410", "code_information": [{"code": "30410", "type": "CPT"}, {"code": "1482054", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHINOPLASTY COMPLETE W/MAJOR SEPTAL REPAIR 30420", "code_information": [{"code": "30420", "type": "CPT"}, {"code": "1482055", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHINOPLASTY FOR CONGENITAL NASAL DEFORMITY-TIP ONLY 30460", "code_information": [{"code": "30460", "type": "CPT"}, {"code": "1482056", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHINOPLASTY FOR CONGENITAL NASAL DEFORMITY-TIP/SEPTUM/OSTEOTOMIES 30462", "code_information": [{"code": "30462", "type": "CPT"}, {"code": "1482057", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHINOPLASTY PRIMARY/LATERAL AND ALAR CARTLAGES AND/OR ELEVATION OF NASAL TIP 30400", "code_information": [{"code": "30400", "type": "CPT"}, {"code": "1482058", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHINOPLASTY-INTERMEDIATE REVISION/BONY WORK W/OSTEOTOMIES 30435", "code_information": [{"code": "30435", "type": "CPT"}, {"code": "1482059", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHINOPLASTY-MAJOR REVISION/NASAL TIP AND OSTEOTOMIES 30450", "code_information": [{"code": "30450", "type": "CPT"}, {"code": "1482060", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHINOPLASTY-SECONDARY/MINOR REVISION 30430", "code_information": [{"code": "30430", "type": "CPT"}, {"code": "1482061", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG REPORT", "code_information": [{"code": "93042", "type": "CPT"}], "standard_charges": [{"minimum": 31.8, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG TRACING", "code_information": [{"code": "93041", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG WITH REPORT", "code_information": [{"code": "93040", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTIDECTOMY FROWN LINES 15826", "code_information": [{"code": "15826", "type": "CPT"}, {"code": "1482063", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTIDECTOMY SMAS FLAP 15829", "code_information": [{"code": "15829", "type": "CPT"}, {"code": "1482065", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIA NONANTIBODY", "code_information": [{"code": "83519", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIB CARTILAGE GRAFT", "code_information": [{"code": "21230", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RICKETTSIA ANTIBODY", "code_information": [{"code": "86757", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 29.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 77.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIGHT HEART CATH", "code_information": [{"code": "93451", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 10923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIGHT VENTRICULAR RECORDING", "code_information": [{"code": "93603", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4355.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6843.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RING ASSEMBLY VILEX DSF-A01", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-A01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35303.0, "discounted_cash": 12356.05, "setting": "both", "billing_class": "facility"}]}, {"description": "RING DYNEX FULL 230MM DF-R100-230", "code_information": [{"code": "DF-R100-230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3756.0, "discounted_cash": 1314.6, "setting": "both", "billing_class": "facility"}]}, {"description": "RING DYNEX TOE 205MM DF-R025-205", "code_information": [{"code": "DF-R025-205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4517.0, "discounted_cash": 1580.95, "setting": "both", "billing_class": "facility"}]}, {"description": "RING FULL 180MM EXTERNAL SUPPORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "56-10950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2463.0, "discounted_cash": 862.05, "setting": "both", "billing_class": "facility"}]}, {"description": "RING FULL 205MM DF-R100-205", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DF-R100-205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2163.0, "discounted_cash": 757.05, "setting": "both", "billing_class": "facility"}]}, {"description": "RING MALYUGIN 2.0 X 6.25MM", "code_information": [{"code": "MAL-1001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.96, "discounted_cash": 167.29, "setting": "both", "billing_class": "facility"}]}, {"description": "RING MALYUGIN 2.0 X 7.0MM", "code_information": [{"code": "MAL-1002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.96, "discounted_cash": 167.29, "setting": "both", "billing_class": "facility"}]}, {"description": "RING RETR 9-14CM LG ALEXIS WND WND RETR SYS DISP STRL", "code_information": [{"code": "C8303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 287.1, "discounted_cash": 100.49, "setting": "both", "billing_class": "facility"}]}, {"description": "RING RETRACTOR 13MM X 18MM LONESTAR", "code_information": [{"code": "3340G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.0, "discounted_cash": 65.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RING RETRACTOR LONESTAR", "code_information": [{"code": "3307G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 185.02, "discounted_cash": 64.76, "setting": "both", "billing_class": "facility"}]}, {"description": "RING RETRCT 31.8 CM X 18.3 CM ROSEN WITHOUT STAY KIT NORYL GT LF STRL DISP", "code_information": [{"code": "3304G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "RING TENSION 12MM CAPSULAR", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "STBL12US", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 428.0, "discounted_cash": 149.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RIV3 VACCINE NO PRESERV IM", "code_information": [{"code": "90673", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIV4 VACC RECOMBINANT DNA IM", "code_information": [{"code": "90682", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV BATTERY ONLY", "code_information": [{"code": "862T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV TRNSMTR ONLY", "code_information": [{"code": "863T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RLCJ PULSE GEN ONLY ISDSS", "code_information": [{"code": "681T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC ESP<100", "code_information": [{"code": "69727", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC>=100", "code_information": [{"code": "69728", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69726", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV PRSTC MTRL/MESH ABD WALL", "code_information": [{"code": "11008", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61892", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLC PM DUL W/L VNT LEAD", "code_information": [{"code": "C7540", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BATTERY", "code_information": [{"code": "520T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BOTH", "code_information": [{"code": "519T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM LD", "code_information": [{"code": "33288", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM PG", "code_information": [{"code": "33287", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPL CAR MODULJ PLS GN", "code_information": [{"code": "414T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN 2 LEAD", "code_information": [{"code": "33263", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN MLT LD", "code_information": [{"code": "33264", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT TOT HRT SYS", "code_information": [{"code": "33928", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL ARTIFIC DISC ADDL CRVCL", "code_information": [{"code": "95T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 3565.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL CAR MODULJ TRANVNS ELT", "code_information": [{"code": "413T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL CARDIAC MODULJ PLS GEN", "code_information": [{"code": "412T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL HPGLSL NSTIM ARY PG", "code_information": [{"code": "64584", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL I-ARTIC RX DELIVERY DEV", "code_information": [{"code": "20705", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL IMED RX DELIVERY DEVICE", "code_information": [{"code": "20703", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLT VSTIBULAR DEV UNI", "code_information": [{"code": "726T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "447T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL NINFCT MESH HERNIA RPR", "code_information": [{"code": "49623", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL OF SUBQ DEFIBRILLATOR", "code_information": [{"code": "33272", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ LEFT HEART VAD", "code_information": [{"code": "33992", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ RIGHT HEART VAD", "code_information": [{"code": "33997", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BATTERY ONLY", "code_information": [{"code": "518T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BOTH COMPNT", "code_information": [{"code": "861T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM PG ONLY", "code_information": [{"code": "33280", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM SYS", "code_information": [{"code": "33278", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33279", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PROSTHHUMRL&ULNAR CMPNT", "code_information": [{"code": "24160", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL RPLCMT HRT SYS F/TRNSPL", "code_information": [{"code": "33929", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL SINUS TARSI IMPLANT", "code_information": [{"code": "510T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL SKIN TAGS EA ADDL 10", "code_information": [{"code": "11201", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL SS IMPL DFB PG ONLY", "code_information": [{"code": "580T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33286", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL THYRD W/AUTOTRAN PARATH", "code_information": [{"code": "C7555", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL TOT ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22864", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL TOT ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22865", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL& REPLC PULSE GEN 1 LEAD", "code_information": [{"code": "33262", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL&RIMPLTJ ANT SGM IMPLT", "code_information": [{"code": "661T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL&RINSJ SINUS TARSI IMPLT", "code_information": [{"code": "511T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT IMPLT VSTBLR DEV", "code_information": [{"code": "727T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT SS IMPL DFB PG", "code_information": [{"code": "614T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROBOT LIN-RADSURG COM, FIRST", "code_information": [{"code": "G0339", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROBT LIN-RADSURG FRACTX 2-5", "code_information": [{"code": "G0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROCEPHIN 1GM", "code_information": [{"code": "MED0249", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROCEPHIN 250MG", "code_information": [{"code": "MED0248", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 115MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "50-10060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 3.5MM X 50MM ROD 96-S050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "96-S050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 3.5MM X 70MM OS-2008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS-2008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 317.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 30MM MIS CURVED ROD G350-5-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "G350-5-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 40MM CURVED AMENDIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10707-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 40MM FIXED PERCUTANEOUS SCREW PALISADE (STERILE PACKED)", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "670-4040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 45MM 482806545", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 197.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 45MM FIXED PERCUTANEOUS SCREW PALISADE (STERILE PACKED)", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "670-4045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 45MM MIS CURVED ROD G350-5-45", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "G350-5-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 5.5 X 45MM BENT 15210-55-045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15210-55-045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 5.5 X 95MM 62210-095", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 5.5MM X 100MM 4866150100", "code_information": [{"code": "4866150100", "type": "CDM"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 5.5MM X 45MM 5560554045T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5560554045T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 50MM STAINLESS STEEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5079-5-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 55MM 0707-5555", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "707-5555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 6.0 X 480MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48232480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 6.0MMX35MM RAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4823008035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1364.0, "discounted_cash": 477.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 6.35MM STRAIGHT HEX END W/STOP CP GRADE 4 500MM 134.001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "134.001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 60 CURVED TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCBA35060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 60MM MIS CURVED ROD G350-5-60", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "G350-5-60", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 60MM PREBENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10/6/5560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 65MM PREBENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10/6/5565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 70MM 62210-070", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD 70MM CURVED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-C070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD ALIGNMENTINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SW1108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 32.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BB-TAK SMALL AR-18700-34", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-18700-34", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BENT 5.5MM X 105MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PR55105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BENT 5.5MM X 95MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PR5595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BONE 5.5 X 35MM ES2 TITANIUM HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 197.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BONE 5.5 X 50MM ES2 TITANIUM HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 197.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BONE 5.5 X 65MM ES2 TITANIUM HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BONE ES2 TITANIUM HEX 5.5 X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BULLETED 5.5 X 30 1001-E5530 1001-E5530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BULLETED 50MM 1001-E5550 1001-E5550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BULLETED LORDOSED DIA 5.5 55MM LENGTH 62210-055", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BULLETED LORDOSED DIA 5.5 X 85MM LENGTH 62210-085", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BULLETED LORDOSED DIA. 5.5 35MM LENGTH 62210-035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BULLETED LORDOSED DIA. 5.5 80MM LENGTH 62210-080", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BULLETED LORDOSED IDA 5.5 50MM LENGTH 62210-050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD BULLETTED 5.5 X 70MM 1001-E5570 1001-E5570", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CARBON CONNECTING 3MM X 40MM 5079-6-040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5079-6-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CERVICAL 3.5MM X 100MM OS-2011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS-2011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CONTOURED ROD SIZE ?3.5X75 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7601-63575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 129.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED 100MM 62210-100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED 100MM PR55100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PR55100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED 3.5MM X 40MM LG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-002-03-3540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED 40MM 62210-040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 55 MIS TI MPS SYSTEM 0107-55055", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "107-55055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 99.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 60 MIS TI MPS SYSTEM 0107-55060", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "107-55060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED 60MM 62210-060", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED 65MM 62210-065", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED 95MM TI 6AI 4V MPR5595", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPR5595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED MIS 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "G350-5-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED MIS 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "G350-5-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED MIS 5.5 X 35 TI MODULAR PEDICLE SYSTEM 0107-55035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "107-55035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED MIS 5.5 X 40 TI MODULAR PEDICLE SYSTEM 0107-55040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "107-55040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED SPINE 5.0M X 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1-80120-5535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 853.0, "discounted_cash": 298.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CURVED THRESHOLD 45MM 530-2045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "530-2045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD D3.5X150MM OS2013", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS2013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD ES2 5.5X100MM HEX RAD ROD 482806100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD ES2 5.5X110MM HEX STRAIGHT ROD 482807110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482807110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD ES2 5.5X55MM HEX RAD ROD 482806055", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 197.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD ES2 5.5X60MM HEX RAD ROD 482806060", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 197.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD ES2 5.5X70MM HEX RAD ROD 482806070", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD ES2 5.5X75MM HEX RAD ROD 482806075", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD EX FIX CARBON FIBER 11X200MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "394.83", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 213.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD FXTN 35MM CURVED FIXED POSITION PREBENT SERENGETI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD FXTN 40MM CURVED FIXED POSITION PREBENT SERENGETI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD FXTN 60MM HEX IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD FXTN 90MM CURVED FIXED POSITION PREBENT SERENGETI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD GUIDE 3MM X 1000MM BALL TIP", "code_information": [{"code": "7163-1626", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1341.0, "discounted_cash": 469.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD HEX ES2 5.5 X 40mm", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD HINDFOOT BALL TIPPED GUIDE 3.0MM X 550MM P31-955-1550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P31-955-1550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 603.0, "discounted_cash": 211.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD IBS 2.0C DIAM2.0 LG20MM 17", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S20 ST020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD IFUSE TORQ 11.5MM X 40MM 11540T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11540T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6644.0, "discounted_cash": 2325.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD IFUSE TORQ 11.5MM X 60MM 11560T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11560T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6400.0, "discounted_cash": 2240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD IFUSE TORQ IFUSE 11.5MM X 35MM 11535T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11535T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6644.0, "discounted_cash": 2325.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD INFINITY PRE-CUT 3.5 MM X 40MM 3603740", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3603740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD INFINITY PRE-CUT 3.5 MM X 70MM 3603770", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3603770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD INFINITY PRE-CUT 3.5MM X 25MM 3603725", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3603725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD INFINITY PRE-CUT 3.5MM X 30MM 3603730", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3603730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD INFINITY PRE-CUT 3.5MM X 50MM 3603750", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3603750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD INFINITY PRE-CUT 3.5MM X 80MM 3603780", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3603780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD INFINITY STANDARD 3.5MM X240MM 3605240", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3605240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD INTRAMEDULLARY 6MM X 80MM CURVED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48238080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD INTRAMEDULLARY 90MM PRE LORDOSED W/ HEX AND TAPER PHOENIX IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-4090 ORTHOFIX", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD LORDOTIC 5.5MM X 80MM ACBB55080", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ACBB55080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1574.0, "discounted_cash": 550.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD LORSTED 5.5 X 45MM 62210-045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62210-045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MANTIS LONG HEX RAD 6.0 X 35MM 48486035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48486035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X100 MM TI 1001-E55100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E55100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X110 MM TI 1001-E55110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E55110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X120 MM TI 1001-E55120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E55120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X130 MM TI 1001-E55130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E55130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X140 MM TI 1001-E55140", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E55140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X150 MM TI 1001-E55150", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E55150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X45 MM TI 1001-E5545", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X65 MM TI 1001-E5565", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X75 MM TI 1001-E5575", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X80 MM TI 1001-E5580", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X85 MM TI 1001-E5585", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5585", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MI RODS CONTOURED BULLETED HEX 5.5X95 MM TI 1001-E5595", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MIS 5.5MM X 45MM PRE-BENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPR5545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MIS 5.5MM X 50MM PRE-BENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPR5550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MIS 5.5MM X 65MM PRE-BENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPR5565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MIS 5.5MM X 75MM PRE-BENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPR5575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MIS 5.5MM X 85MM PRE-BENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPR5585", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MIS CRVD 5.5MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "R5506-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2647.0, "discounted_cash": 926.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MIS PRE-BENT 5.5MM X 55MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPR5555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD MIS PRE-BENT 60MM G350-5-55", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "G350-5-55", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD PIN INTRODUCER 11G X 15CM DIAMOND 310-0009", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "310-0009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5844.0, "discounted_cash": 2045.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD PIN INTRODUCER 8G X 13G 310-0010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "310-0010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5844.0, "discounted_cash": 2045.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD POSITIONING 2MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AGB200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 451.0, "discounted_cash": 157.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD POSITIONING 3MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AGB300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD POSITIONING SMART TOE 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XDB002001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 110.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD PRE BENT 5.5MM X 75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PR5575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD PRE-BENT 6.0X60 11-C060", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11-C060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 317.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD PRE-BENT 6.0X85 11-C085", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11-C085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1100.0, "discounted_cash": 385.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD PRE-BENT MIS 5.5MM X 70MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPR5570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD PRE-BENT TI 6AL 4V (ELI) 5.5 X 60MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPR5560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD PRE-LORDOSED W/ HEX AND TAPER 80MM 20-4080", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-4080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD PREBENT 80MM 10-C080", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-C080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD PREBENT APHEAL 70MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FE.RC.0070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD PRESS-FIT LONG POST AEQUALIS PERFORM REVERSED DWJ002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1049.0, "discounted_cash": 367.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RAD 6.0 X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48238045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RAD 6.0 X 90MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48238090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RAD 6.0MM X 50MM 48238050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48238050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RAD XIA 60MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48238060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RAD XIA 70MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48238070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS 5.5 X 600MM SPINAL WITH HEX 486613600", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "486613600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 406.0, "discounted_cash": 142.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS 5.5 X 60MM SPINAL WITH HEX 486613060", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "486613060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS 6.0MM X 120MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48238120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS MAX RAD 5.5X 110MM 486615510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "486615510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS RAD 5.5X 100MM 486615000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "486615000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS RAD 5.5X 110MM 486615010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "486615010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS RAD 5.5X 120MM 486615020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "486615020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS RAD 5.5X 35MM 486615035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "486615035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS RAD 5.5X 45MM 486615045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "486615045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS RAD 5.5X 50MM 486615050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "486615050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS RAD 5.5X 70MM 486615070", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "486615070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RADIUS RAD 5.5X 90MM 486615090", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "486615090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD REAMING 2.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "351.706.8", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 286.0, "discounted_cash": 100.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD REAMING 2.5MM X 950MM W/ OLIVE STRLINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "351.706S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 438.0, "discounted_cash": 153.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RETROVERSION FOR SNGL USE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWD163", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 94.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD SIZE 3.5X25 MM CONTOURED 7601-63525", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7601-63525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD SIZE 3.5X35 MM CONTOURED 7601-63535", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7601-63535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD SIZE 3.5X55 MM CONTOURED 7601-63555", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7601-63555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD SPINAL 5.5X40MM INVICTUS TITANIUM 15210-55-040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15210-55-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD SPINAL YUKON CONTOUR OCCIPITOCERVICOTHORACIC NONSTERILE 45MM X 3.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7601-63545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD SPINE 3.5 X 80MM SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS-2009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD SPINE SERENGETI 5.5 X 55MM CONTOURED BULLET NOSE HEX END", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1001-E5555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD STABLZN 10MM DIAINTERPHLEX FLEXIBLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "360-2810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1473.0, "discounted_cash": 515.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD STRAIGHT 5.5MM X 460MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SR55460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD STRAIGHT 6.0X150 11-S150", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11-S150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 317.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD STRT ZAVATION 150MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11-5150-M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 317.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD SURG 2MM X 600MM BALL TIP GRADUATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7175-1146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 702.0, "discounted_cash": 245.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD THREADED NUT X-FIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3.311.061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD TI LORDOTIC 5.5 MM X 50MM KODIAK 15210-55-050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15210-55-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD TI MIS LORDOTIC VI2 5.5MM X 45MM 15295-55-045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15295-55-045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD TITANIUM 3.5MM-50MM LORODTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCBA35050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD TO ROD COUPLING , 3.0/3.0MM", "code_information": [{"code": "4960-1-010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1585.0, "discounted_cash": 554.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD XIA 3 TI RAD DIAM 6MM L 100MM 48238100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48238100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD XIA 3 TI RAD DIAM 6MM L 110MM 48238110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48238110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD XIA LP VITALLIUM 6.0MM 03822601", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3822601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RODS 75MM 482806575", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 197.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROLL DENTAL 1 1/2IN X 3/8IN WHT QUILTED ABSORBING LF STRL", "code_information": [{"code": "D31-207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ROLL DENTAL QUILTED STERILE 1 1 2X3 31-207", "code_information": [{"code": "31-207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ROOM/BED: Inpatient Private", "code_information": [{"code": "1363822", "type": "CDM"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 1608.0, "discounted_cash": 562.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROOM/BED: Observation", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "1363823", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 561.04, "maximum": 881.63, "gross_charge": 182.0, "discounted_cash": 63.7, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 561.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 881.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 881.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 881.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROPIVACAINE 0.2% 10 ML", "code_information": [{"code": "MED0178", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE 0.2% SOLN 100 ML INJ", "code_information": [{"code": "MED0750", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE 0.2%/NAROPIN 20ML", "code_information": [{"code": "MED0179", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE 0.5% INJ SOL 20ML", "code_information": [{"code": "MED0340", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE 1%/NAROPIN 10ML VIAL", "code_information": [{"code": "MED0180", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE/ON-Q (NAROPIN/ON-Q) 0.2%/300ML PUMP", "code_information": [{"code": "MED0181", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 284.0, "discounted_cash": 99.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE/ON-Q (NAROPIN/ON-Q) 0.2%/400ML PUMP", "code_information": [{"code": "MED0182", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 445.0, "discounted_cash": 155.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVICAINE HCL 0.5%/ NAROPIN 30ML", "code_information": [{"code": "MED0183", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "ROTARY WING AIR MILEAGE", "code_information": [{"code": "A0436", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROTARY WING AIR TRANSPORT", "code_information": [{"code": "A0431", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROTAVIRUS AG IA", "code_information": [{"code": "87425", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROTAVIRUS ANTIBODY", "code_information": [{"code": "86759", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROTICULATOR DISSECTING 5MM 36CM STANDARD W/ RATCHET HANDLE AND MONOPOLAR CAUTERY", "code_information": [{"code": "1776645", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 286.0, "discounted_cash": 100.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ROUTER HOODED 4.5MM 130MM REPROCESS BLADE SHAVER VORTEX STRL", "code_information": [{"code": "H9131", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 58.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROUTER VORTEX 4.5MM X 130MM 5 FLUTE BURR ARTHRO REPROCESS STERLING STRL", "code_information": [{"code": "H9131R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ROUTINE FOOTCARE PT W LOPS", "code_information": [{"code": "G0247", "type": "HCPCS"}], "standard_charges": [{"minimum": 225.0, "maximum": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROUTINE OPHTHALMOLOGICAL EXA", "code_information": [{"code": "S0620", "type": "HCPCS"}], "standard_charges": [{"minimum": 193.91, "maximum": 304.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 193.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 304.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 304.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 304.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROUTINE OPHTHALMOLOGICAL EXA", "code_information": [{"code": "S0621", "type": "HCPCS"}], "standard_charges": [{"minimum": 154.17, "maximum": 242.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 154.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 242.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 242.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 242.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 1 AREA 1 D IMG", "code_information": [{"code": "78800", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 730.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1148.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1148.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1148.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 476.69, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 507.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 2+AREA 1+D IMG", "code_information": [{"code": "78801", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 992.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1559.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1559.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1559.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 508.04, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 540.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 1 AREA", "code_information": [{"code": "78803", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1311.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2062.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2062.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2062.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 696.16, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 740.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 2 AREAS", "code_information": [{"code": "78831", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2812.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4421.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4421.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4421.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1323.18, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1407.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 1", "code_information": [{"code": "78830", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1894.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2978.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2978.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2978.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 864.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 919.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 2", "code_information": [{"code": "78832", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3713.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5838.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5838.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5838.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1701.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1810.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 1 D IMG", "code_information": [{"code": "78802", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1277.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2007.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2007.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2007.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 574.76, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 611.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 2+D IMG", "code_information": [{"code": "78804", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2346.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3689.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3689.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3689.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1262.9, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1343.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP QUAN MEAS SINGLE AREA", "code_information": [{"code": "78835", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 363.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 571.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 571.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 571.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 162.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 172.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP THERAPY UNLISTED PX", "code_information": [{"code": "79999", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 417.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1037.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1630.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1630.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1630.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62143", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE NO REVJ TRC", "code_information": [{"code": "43762", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE REVJ GSTRST TRC", "code_information": [{"code": "43763", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69730", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCM OI IMPLT SK TC ESP<100", "code_information": [{"code": "69719", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCMT A-VALVE TLCJ AUTOL PV", "code_information": [{"code": "33440", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCMT OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69717", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9675.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST > 10 NCR/STRN", "code_information": [{"code": "49596", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST > 10 RDC", "code_information": [{"code": "49595", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR 3-10 NCR/STRN", "code_information": [{"code": "49616", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR 3-10 RDC", "code_information": [{"code": "49615", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR < 3 NCR/STRN", "code_information": [{"code": "49614", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR < 3 RDC", "code_information": [{"code": "49613", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 NCR/STRN", "code_information": [{"code": "49618", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 RDC", "code_information": [{"code": "49617", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA NTRANASL", "code_information": [{"code": "30540", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA TRSNPLTN", "code_information": [{"code": "30545", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "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": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "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": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M >30.0 CM", "code_information": [{"code": "12018", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR FE/E/EN/L/M 12.6-20.0 CM", "code_information": [{"code": "12016", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR FE/E/EN/L/M 20.1-30.0 CM", "code_information": [{"code": "12017", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH VERMILION ONLY", "code_information": [{"code": "40650", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH<HALF VER HEIGHT", "code_information": [{"code": "40652", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH>1HALF VER HT/CPX", "code_information": [{"code": "40654", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HERNIA RDC", "code_information": [{"code": "49621", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HRNA NCR/STRN", "code_information": [{"code": "49622", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR PUL ART UNIFOCAL W/O CPB", "code_information": [{"code": "33925", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR S/N/A/GEN/TRK20.1-30.0CM", "code_information": [{"code": "12006", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRNK >30.0 CM", "code_information": [{"code": "12007", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR&REFIT SPCT PRSTH APHAKIA", "code_information": [{"code": "92371", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR&REFITG SPECT XCP APHAKIA", "code_information": [{"code": "92370", "type": "CPT"}], "standard_charges": [{"minimum": 73.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 73.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 114.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 114.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 114.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPRDTVE MED RNA GEN PRFL 238", "code_information": [{"code": "253U", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 4549.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4549.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4549.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPT DOC CLASS HISTO TYPE", "code_information": [{"code": "G9422", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPT WO IMP/CON MMR/MSI", "code_information": [{"code": "M1195", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPTS W/ IMP/CON MMR/MSI", "code_information": [{"code": "M1193", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSA LOWER EXTR EXAM", "code_information": [{"code": "350T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 548.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSA SPINE EXAM", "code_information": [{"code": "348T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 769.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSA UPPER EXTR EXAM", "code_information": [{"code": "349T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 769.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSC MNL PED MED O2 RSRV BG MSK LF DISP SP2", "code_information": [{"code": "AMB530613000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "RSECT HIP TUM INCL FEMUR", "code_information": [{"code": "27078", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSN NO TRTMT CHEM HER2", "code_information": [{"code": "G2207", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV ASSAY W/OPTIC", "code_information": [{"code": "87807", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV DNA/RNA AMP PROBE", "code_information": [{"code": "87634", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 179.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 281.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 281.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 281.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 101.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 101.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MAB IM 50MG", "code_information": [{"code": "90378", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN .5ML IM", "code_information": [{"code": "90380", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN 1 ML IM", "code_information": [{"code": "90381", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV VACC MRNA LIPID NANO IM", "code_information": [{"code": "90683", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV VACC PREF BIVALENT IM", "code_information": [{"code": "90678", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV VACC PREF RECOMB ADJT IM", "code_information": [{"code": "90679", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RTA POLARIZE SCAN OC SCR BI", "code_information": [{"code": "469T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 39.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RTS FLEXIBLE 1ST MPJ IMPLANT W/ GROMMETS SIZE 1", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "M30SE010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2396.0, "discounted_cash": 838.6, "setting": "both", "billing_class": "facility"}]}, {"description": "RTS FLEXIBLE 1ST MPJ IMPLANT W/ GROMMETS, SIZE 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M30 SE020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2396.0, "discounted_cash": 838.6, "setting": "both", "billing_class": "facility"}]}, {"description": "RTS INSTRUMENTS SIZE 3-4", "code_information": [{"code": "M03S0003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1793.0, "discounted_cash": 627.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RTS INSTRUMENTS, SIZE 1-2", "code_information": [{"code": "M03 S0002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 855.42, "discounted_cash": 299.4, "setting": "both", "billing_class": "facility"}]}, {"description": "RUBELLA ANTIBODY", "code_information": [{"code": "86762", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUBEOLA AG IF", "code_information": [{"code": "87283", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 76.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 155.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 243.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 243.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 243.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUBEOLA ANTIBODY", "code_information": [{"code": "86765", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUNX1 GENE TARGETED SEQ ALYS", "code_information": [{"code": "81334", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 411.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 840.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1321.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1321.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1321.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 474.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 474.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUSSELL VIPER VENOM DILUTED", "code_information": [{"code": "85613", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RV1 VACC 2 DOSE LIVE ORAL", "code_information": [{"code": "90681", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RV5 VACC 3 DOSE LIVE ORAL", "code_information": [{"code": "90680", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX ACE OR ARB THERAPY", "code_information": [{"code": "G8935", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX ASY PRSMV 30+RX/METABLT", "code_information": [{"code": "227U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 249.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 158.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB ADVRS TRGT SEQ ALYS", "code_information": [{"code": "29U", "type": "CPT"}], "standard_charges": [{"minimum": 1068.86, "maximum": 2976.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1892.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1068.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1068.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB ADVRS VRNT ALYS 25", "code_information": [{"code": "434U", "type": "CPT"}], "standard_charges": [{"minimum": 1892.79, "maximum": 2976.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1892.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB ADVRS VRNT ALYS 33", "code_information": [{"code": "438U", "type": "CPT"}], "standard_charges": [{"minimum": 1149.82, "maximum": 1808.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB GEN SEQ ALYS PNL 6", "code_information": [{"code": "81418", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1892.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2976.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1320.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1320.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB GENRX IA 16 GENES", "code_information": [{"code": "392U", "type": "CPT"}], "standard_charges": [{"minimum": 1149.82, "maximum": 1923.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB WARF TRGT SEQ ALYS", "code_information": [{"code": "30U", "type": "CPT"}], "standard_charges": [{"minimum": 193.15, "maximum": 537.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 342.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 537.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 537.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 537.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 193.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 193.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB/PCX DNA 16 GEN ALYS", "code_information": [{"code": "347U", "type": "CPT"}], "standard_charges": [{"minimum": 1149.82, "maximum": 1923.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB/PCX DNA 25 GEN ALYS", "code_information": [{"code": "348U", "type": "CPT"}], "standard_charges": [{"minimum": 1068.86, "maximum": 1808.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1068.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1068.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB/PCX DNA 27 GEN ALYS", "code_information": [{"code": "350U", "type": "CPT"}], "standard_charges": [{"minimum": 1149.82, "maximum": 1923.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1923.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB/PCX DNA 27GEN RX IA", "code_information": [{"code": "349U", "type": "CPT"}], "standard_charges": [{"minimum": 1068.86, "maximum": 1808.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1149.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1808.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1068.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1068.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METB ADVRS TRGT SQ ALY 20", "code_information": [{"code": "380U", "type": "CPT"}], "standard_charges": [{"minimum": 600.17, "maximum": 600.17, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 600.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METRONIDAZOLE 500 MG 100 MLINJECTION", "code_information": [{"code": "2B3421", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "RX MNTR 1+ORAL ONC RX&SBSTS", "code_information": [{"code": "110U", "type": "CPT"}], "standard_charges": [{"minimum": 39.04, "maximum": 108.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX MNTR 14+ DRUGS & SBSTS", "code_information": [{"code": "54U", "type": "CPT"}], "standard_charges": [{"minimum": 214.5, "maximum": 597.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 379.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 214.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 214.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX MNTR 65 COM DRUGS URINE", "code_information": [{"code": "93U", "type": "CPT"}], "standard_charges": [{"minimum": 89.48, "maximum": 249.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 158.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX MNTR LC-MS/MS ORAL FLUID", "code_information": [{"code": "11U", "type": "CPT"}], "standard_charges": [{"minimum": 164.78, "maximum": 458.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 291.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 458.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 458.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 458.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 164.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 164.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX MNTR LC-MS/MS UR/BLD 31", "code_information": [{"code": "51U", "type": "CPT"}], "standard_charges": [{"minimum": 278.94, "maximum": 776.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 493.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 776.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 776.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 776.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 278.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 278.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX MNTR NZM IA 35+ORAL FLU", "code_information": [{"code": "116U", "type": "CPT"}], "standard_charges": [{"minimum": 355.56, "maximum": 990.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 629.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 355.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 355.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX SODIUM 100ML CHLORIDE ADD VANTAGE .9PCT", "code_information": [{"code": "409-7101-67", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RX TEST DEF 90+ RX/SBSTS UR", "code_information": [{"code": "82U", "type": "CPT"}], "standard_charges": [{"minimum": 355.56, "maximum": 990.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 629.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 990.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 355.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 355.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX TEST PRSMV UR W/DEF CONF", "code_information": [{"code": "7U", "type": "CPT"}], "standard_charges": [{"minimum": 164.78, "maximum": 458.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 291.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 458.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 458.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 458.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 164.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 164.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RXT BREAST APPL PLACE/REMOV", "code_information": [{"code": "C9726", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2508.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2508.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Radiology Diagnostic Angiocardiography", "code_information": [{"code": "321", "type": "RC"}], "standard_charges": [{"minimum": 268.0, "maximum": 313.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 313.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 268.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Radiology, Diagnostic Arteriography", "code_information": [{"code": "323", "type": "RC"}], "standard_charges": [{"minimum": 268.0, "maximum": 313.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 313.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 268.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Radiology, Diagnostic Arthrography", "code_information": [{"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 268.0, "maximum": 313.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 313.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 268.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Radiology, Diagnostic Chest X-Ray", "code_information": [{"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 268.0, "maximum": 313.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 313.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 268.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Radiology, Diagnostic General Classification", "code_information": [{"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 268.0, "maximum": 313.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 313.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 268.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Radiology, Diagnostic Other", "code_information": [{"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 268.0, "maximum": 313.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 313.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 268.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Rare diseases (constitutional disease/hereditary disorders), rapid whole genome and mitochondrial DNA sequencing for single-nucleotide variants, insertions/deletions, copy number variations, peripheral blood, buffy coat, saliva, buccal or tissue sample, r", "code_information": [{"code": "532U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 1713.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Rare diseases (constitutional/heritable disorders), identification of copy number variations, inversions, insertions, translocations, and other structural variants by optical genome mapping", "code_information": [{"code": "454U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 102.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Rare diseases (constitutional/heritable disorders), whole genome sequence analysis for chromosomal abnormalities, copy number variants, duplications/deletions, inversions, unbalanced translocations, regions of homozygosity (ROH), inheritance pattern that ", "code_information": [{"code": "469U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 1713.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Rare diseases (constitutional/heritable disorders), whole-genome sequence analysis combination of short and long reads, for single-nucleotide variants, insertions/deletions and characterized intronic variants, copy-number variants, duplications/deletions,", "code_information": [{"code": "567U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 1713.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Recommended follow-up interval for repeat colonoscopy of 10 years documented  in colonoscopy report and communicated with patient", "code_information": [{"code": "M1377", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Red blood cell antigen (fetal RhD gene analysis), next-generation sequencing of circulating cell-free DNA (cfDNA) of blood in pregnant individuals known to be RhD negative, reported as positive or negative", "code_information": [{"code": "494U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 1713.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Red blood cell antigen (fetal RhD), PCR analysis of exon 4 of RHD gene and housekeeping control gene GAPDH from whole blood in pregnant individuals at 10+ weeks gestation known to be RhD negative, reported as fetal RhD status", "code_information": [{"code": "536U", "type": "CPT"}], "standard_charges": [{"minimum": 1089.51, "maximum": 1713.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1089.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1713.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Red blood cells, leukocytes reduced, each unit P9016", "code_information": [{"code": "P9016", "type": "HCPCS"}, {"code": "4684278", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "Red blood cells, leukocytes reduced, oxygen/ carbon dioxide reduced, each unit", "code_information": [{"code": "P9027", "type": "HCPCS"}], "standard_charges": [{"minimum": 1113.44, "maximum": 1749.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1113.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1749.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1749.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1749.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Refilling & maintenance of implantable pump or reservoir for drug delivery, systemic 96522", "code_information": [{"code": "96522", "type": "CPT"}, {"code": "43028188", "type": "CDM"}, {"code": "940", "type": "RC"}], "standard_charges": [{"minimum": 537.18, "maximum": 8450.0, "gross_charge": 1589.0, "discounted_cash": 556.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 652.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 652.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 804.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 590.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 537.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 844.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 844.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 844.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Relocation of skin pocket for implanted cardiac contractility modulation-defibrillation pulse generator", "code_information": [{"code": "925T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Remote monitoring of a wireless left atrial pressure sensor for up to 30 days, including data from daily uploads of left atrial pressure recordings, interpretation(s) and trend analysis, with adjustments to the diuretics plan, treatment paradigm threshold", "code_information": [{"code": "934T", "type": "CPT"}], "standard_charges": [{"minimum": 162.11, "maximum": 254.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 162.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 254.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 254.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 254.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Remote monitoring of an implanted inferior vena cava sensor for up to 30 days, including at least weekly downloads of inferior vena cava area recordings, interpretation(s), trend analysis, and report(s) by a physician or other qualified health care profes", "code_information": [{"code": "983T", "type": "CPT"}], "standard_charges": [{"minimum": 164.45, "maximum": 258.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 164.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 258.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 258.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 258.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Remote monitoring of implantable inferior vena cava pressure sensor, physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial set-up and patient education on use of equipment", "code_information": [{"code": "982T", "type": "CPT"}], "standard_charges": [{"minimum": 568.32, "maximum": 893.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 568.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 893.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 893.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 893.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Impregnated Ovum Outside The Uterus And Entire Uterus", "code_information": [{"code": "59135", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Foreign Material In Brain Using An Endoscope", "code_information": [{"code": "62163", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Mastoid Bone With Implantation Of Cochlear Stimulating System, Accessed Through The Skin", "code_information": [{"code": "69715", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Mastoid Bone With Removal And Replacement (Accessed Through The Skin) Of Cochlear Stimulating System", "code_information": [{"code": "69718", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Neurostimulator Electrodes And Pulse Generator For Vagus Nerve Blocking Therapy For Obesity Using An Endoscope", "code_information": [{"code": "314T", "type": "CPT"}], "standard_charges": [{"minimum": 8027.0, "maximum": 8027.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Pulse Generator For Vagus Nerve Blocking Therapy For Treatment Of Obesity", "code_information": [{"code": "315T", "type": "CPT"}], "standard_charges": [{"minimum": 8027.0, "maximum": 8027.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Spine Bone With Incision Of Both Upper Spinal Cord Tracts", "code_information": [{"code": "63196", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Spine Bone With Incision Of Middle Spinal Cord, 2 Stages Within 14 Days", "code_information": [{"code": "63199", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Spine Bone With Incision Of One Middle Spinal Cord Tract", "code_information": [{"code": "63195", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Spine Bone With Incision Of One Upper Spinal Cord Tract", "code_information": [{"code": "63194", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Spine Bone With Incision Of Upper Spinal Cord, 2 Stages Within 14 Days", "code_information": [{"code": "63198", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Sutures Under Anesthesia By Same Surgeon", "code_information": [{"code": "15850", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Upper Spine Bone With Removal Of Ligaments, 1 Or 2 Segments", "code_information": [{"code": "63180", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal Of Upper Spine Bone With Removal Of Ligaments, More Than 2 Segments", "code_information": [{"code": "63182", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4935.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal and replacement of permanent cardiac contractility modulation-defibrillation pulse generator only", "code_information": [{"code": "923T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal of a peritoneal ascites pump system, including implanted peritoneal ascites pump and indwelling bladder and peritoneal catheters", "code_information": [{"code": "874T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal of a permanent cardiac contractility modulation-defibrillation system component(s); dual (pacing and defibrillation) transvenous leads only", "code_information": [{"code": "922T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal of a permanent cardiac contractility modulation-defibrillation system component(s); pulse generator only", "code_information": [{"code": "919T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal of a permanent cardiac contractility modulation-defibrillation system component(s); single transvenous defibrillation lead only", "code_information": [{"code": "921T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal of a permanent cardiac contractility modulation-defibrillation system component(s); single transvenous pacing lead only", "code_information": [{"code": "920T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal of epicranial neurostimulator system", "code_information": [{"code": "969T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal of integrated neurostimulation system, vagus nerve", "code_information": [{"code": "910T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal of sub-scalp implanted electrode array, receiver, and telemetry unit for continuous bilateral electroencephalography monitoring system, including imaging guidance", "code_information": [{"code": "958T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Removal or replacement of magnet from coil assembly that is connected to continuous bilateral electroencephalography monitoring system, including imaging guidance", "code_information": [{"code": "959T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Renal Function Panel", "code_information": [{"code": "80069", "type": "CPT"}, {"code": "9745376", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 132.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Extra Blood Flow Tract From Left Heart Chamber To Aorta", "code_information": [{"code": "33722", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Hernia At Navel Patient Age 5 Years Or Older", "code_information": [{"code": "49585", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Hernia At Navel Patient Younger Than Age 5 Years", "code_information": [{"code": "49580", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Hernia Between Abdominal Muscles", "code_information": [{"code": "49590", "type": "CPT"}], "standard_charges": [{"minimum": 3058.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Hernia Using An Endoscope", "code_information": [{"code": "49652", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Incisional Hernia Using An Endoscope, Initial Or Primary", "code_information": [{"code": "49654", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Incisional Hernia Using An Endoscope, Recurrent Of Secondary", "code_information": [{"code": "49656", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Incisional Or Abdominal Hernia, Initial Or Primary, Not Trapped", "code_information": [{"code": "49560", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Incisional Or Abdominal Hernia, Recurrent Of Secondary, Not Trapped", "code_information": [{"code": "49565", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Not Trapped Incisional Or Abdominal Hernia, In The Upper Stomach Area", "code_information": [{"code": "49570", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Trapped Hernia At Navel Patient Age 5 Years Or Older", "code_information": [{"code": "49587", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Trapped Hernia At Navel Patient Younger Than Age 5 Years", "code_information": [{"code": "49582", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Trapped Hernia Using An Endoscope", "code_information": [{"code": "49653", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Trapped Incisional Hernia Using An Endoscope, Primary", "code_information": [{"code": "49655", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Trapped Incisional Hernia Using An Endoscope, Secondary", "code_information": [{"code": "49657", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Trapped Incisional Or Abdominal Hernia", "code_information": [{"code": "49561", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Trapped Incisional Or Abdominal Hernia In The Upper Stomach Area", "code_information": [{"code": "49572", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair Of Trapped Recurrent Incisional Or Abdominal Hernia", "code_information": [{"code": "49566", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s) les", "code_information": [{"code": "C7565", "type": "HCPCS"}], "standard_charges": [{"minimum": 2411.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Replacement Of Pulse Generator For Vagus Nerve Blocking Therapy For Treatment Of Obesity", "code_information": [{"code": "316T", "type": "CPT"}], "standard_charges": [{"minimum": 8027.0, "maximum": 8027.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Replacement of a subcutaneous peritoneal ascites pump, including reconnection between pump and indwelling bladder and peritoneal catheters, including initial programming and imaging, when performed", "code_information": [{"code": "871T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Replacement of indwelling bladder and peritoneal catheters, including tunneling of catheter(s) and connection with previously implanted peritoneal ascites pump, including imaging and programming, when performed", "code_information": [{"code": "872T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Replacement of integrated neurostimulation system, vagus nerve, including analysis and programming, when performed", "code_information": [{"code": "909T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Replacement of sub-scalp implanted electrode array, receiver, and telemetry unit with tunneling of electrode for continuous bilateral electroencephalography monitoring system, including imaging guidance", "code_information": [{"code": "960T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 6045.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Repositioning of previously implanted cardiac contractility modulation-defibrillation transvenous electrode(s)/lead(s), including fluoroscopic guidance and programming of sensing and therapeutic parameters", "code_information": [{"code": "924T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Reproductive medicine (preimplantation genetic assessment), analysis for known genetic disorders from trophectoderm biopsy, linkage analysis of disease-causing locus, and when possible, targeted mutation analysis for known familial variant, reported as lo", "code_information": [{"code": "552U", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrangements, aneuploidy, and a mitochondrial DNA score, results reported as normal/ba", "code_information": [{"code": "553U", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrangements, aneuploidy, ploidy, a mitochondrial DNA score, and embryo quality contro", "code_information": [{"code": "555U", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from trophectoderm biopsy for aneuploidy, ploidy, a mitochondrial DNA score, and embryo quality control, results reported as normal ", "code_information": [{"code": "554U", "type": "CPT"}], "standard_charges": [{"minimum": 126.15, "maximum": 198.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Respiratory Diagnostic Testing (Response To Co2)", "code_information": [{"code": "94400", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Respiratory Services Inhalation Services", "code_information": [{"code": "412", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 140.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Services, General", "code_information": [{"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 140.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Services, Hyperbaric Oxygen Therapy", "code_information": [{"code": "413", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 140.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Services, Other", "code_information": [{"code": "419", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 140.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 140.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory syncytial virus, monoclonal antibody, seasonal dose, 0.7 mL, for intramuscular use", "code_information": [{"code": "90382", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Revision Of Attachment Of Stomach And Small Bowel", "code_information": [{"code": "43850", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Revision Of Attachment Of Stomach To Upper Small Bowel", "code_information": [{"code": "43855", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Revision Of Previous Mastoid Surgery, With Removal Of A Portion Of The Temporal Bone", "code_information": [{"code": "69605", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Revision Or Replacement Of Neurostimulator Electrodes For Vagus Nerve Blocking Therapy For Obesity Using An Endoscope", "code_information": [{"code": "313T", "type": "CPT"}], "standard_charges": [{"minimum": 5839.0, "maximum": 5839.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5839.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Revision of a subcutaneously implanted peritoneal ascites pump system, any component (ascites pump, associated peritoneal catheter, associated bladder catheter), including imaging and programming, when performed", "code_information": [{"code": "873T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Revision of sub-scalp implanted electrode array, receiver, and telemetry unit for electrode, when required, including imaging guidance", "code_information": [{"code": "957T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Rheumatoid factor IgA and IgM, cyclic citrullinated peptide (CCP) antibodies, and scavenger receptor A (SR-A) by immunoassay, blood", "code_information": [{"code": "521U", "type": "CPT"}], "standard_charges": [{"minimum": 15.66, "maximum": 24.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Room And Board (3 And 4 Beds) Detoxification", "code_information": [{"code": "136", "type": "RC"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board (3 And 4 Beds) Psychiatric", "code_information": [{"code": "134", "type": "RC"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board (3 And 4 Beds) Rehabilitation", "code_information": [{"code": "138", "type": "RC"}], "standard_charges": [{"minimum": 1400.0, "maximum": 2260.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1400.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1784.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1435.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1435.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Deluxe Private Detoxification", "code_information": [{"code": "146", "type": "RC"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Deluxe Private General", "code_information": [{"code": "140", "type": "RC"}], "standard_charges": [{"minimum": 988.0, "maximum": 988.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Deluxe Private Psychiatric", "code_information": [{"code": "144", "type": "RC"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Deluxe Private Rehabilitation", "code_information": [{"code": "148", "type": "RC"}], "standard_charges": [{"minimum": 1400.0, "maximum": 2260.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1400.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1784.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1435.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1435.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Private (One Bed) Detoxification", "code_information": [{"code": "116", "type": "RC"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Private (One Bed) General", "code_information": [{"code": "110", "type": "RC"}], "standard_charges": [{"minimum": 988.0, "maximum": 988.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Private (One Bed) Pediatric", "code_information": [{"code": "113", "type": "RC"}], "standard_charges": [{"minimum": 988.0, "maximum": 988.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Private (One Bed) Psychiatric", "code_information": [{"code": "114", "type": "RC"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Private (One Bed) Rehabilitation", "code_information": [{"code": "118", "type": "RC"}], "standard_charges": [{"minimum": 1400.0, "maximum": 2260.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1400.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1784.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1435.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1435.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Detoxification", "code_information": [{"code": "126", "type": "RC"}], "standard_charges": [{"minimum": 988.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) General", "code_information": [{"code": "120", "type": "RC"}], "standard_charges": [{"minimum": 988.0, "maximum": 988.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Pediatric", "code_information": [{"code": "123", "type": "RC"}], "standard_charges": [{"minimum": 988.0, "maximum": 988.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 988.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Psychiatric", "code_information": [{"code": "124", "type": "RC"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Rehabilitation", "code_information": [{"code": "128", "type": "RC"}], "standard_charges": [{"minimum": 1400.0, "maximum": 2260.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1400.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1784.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1435.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1435.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Detoxification", "code_information": [{"code": "156", "type": "RC"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Psychiatric", "code_information": [{"code": "154", "type": "RC"}], "standard_charges": [{"minimum": 2840.0, "maximum": 3596.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3596.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2840.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Rehabilitation", "code_information": [{"code": "158", "type": "RC"}], "standard_charges": [{"minimum": 1400.0, "maximum": 2260.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1400.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1784.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 1435.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 1435.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Rpr intst excl anrect fist", "code_information": [{"code": "C9796", "type": "HCPCS"}], "standard_charges": [{"minimum": 1719.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "S BOWEL ENDOSCOPE W/STENT", "code_information": [{"code": "44379", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "S&I STENT/CHEST VERT ART", "code_information": [{"code": "76T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SAFTY CNCRNS SCRN AND NEG", "code_information": [{"code": "G9923", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALES TAX", "code_information": [{"code": "S9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVA TEST, HORMONE LEVEL;", "code_information": [{"code": "S3650", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVA TEST, HORMONE LEVEL;", "code_information": [{"code": "S3652", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 355.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 226.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 355.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 355.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 355.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND FUNCTION EXAM", "code_information": [{"code": "78232", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 371.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 584.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 584.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 584.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 201.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 215.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND IMAGING", "code_information": [{"code": "78230", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 689.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1084.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1084.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1084.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 340.03, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 362.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND PROCEDURES", "code_information": [{"code": "139", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7507.03, "maximum": 12887.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7507.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10736.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11810.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12887.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SALMONELLA ANTIBODY", "code_information": [{"code": "86768", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALPINGECTOMY-COMPLETE OR PARTIAL-UNILATERAL OR BILATERAL 58700", "code_information": [{"code": "58700", "type": "CPT"}, {"code": "1482070", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 736.23, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 736.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALPINGO-OOPHORECTOMY-COMPLETE OR PARTIAL-UNILATERAL OR BILATERAL 58720", "code_information": [{"code": "58720", "type": "CPT"}, {"code": "1482071", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 9357.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALVATION BOLT 5.0 X 110MM SB050110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB050110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3036.0, "discounted_cash": 1062.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SAME DAY NB DISCHARGE", "code_information": [{"code": "99463", "type": "CPT"}], "standard_charges": [{"minimum": 511.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SAME PATH/DERM PERF BIOPSY", "code_information": [{"code": "G9939", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 ANTB QUANTITATIVE", "code_information": [{"code": "86413", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 107.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 COVID-19 AMP PRB", "code_information": [{"code": "87635", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 73.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 73.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 COVID-19 ANTIBODY", "code_information": [{"code": "86769", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 107.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 60.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 60.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 COVID19 W/OPTIC", "code_information": [{"code": "87811", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 105.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 165.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 165.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 165.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 59.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 59.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV & INF VIR A&B AG IA", "code_information": [{"code": "87428", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 78.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 124.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 124.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 124.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 101.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 101.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV CORONAVIRUS AG IA", "code_information": [{"code": "87426", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 115.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 181.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 181.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 & INF A&B AMP PRB", "code_information": [{"code": "87636", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 363.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 25 MCG/.25ML IM", "code_information": [{"code": "91321", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 3MCG TRS-SUC IM", "code_information": [{"code": "91318", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 50 MCG/0.5ML IM", "code_information": [{"code": "91322", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 5MCG/0.5ML IM", "code_information": [{"code": "91304", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2&INF A&B&RSV AMP PRB", "code_information": [{"code": "87637", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 363.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 571.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 205.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCV2 VAC 10MCG TRS-SUC IM", "code_information": [{"code": "91319", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCV2 VAC 30MCG TRS-SUC IM", "code_information": [{"code": "91320", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SATISFY WITH CARE", "code_information": [{"code": "G0916", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SAW BLADE 5.5MM X 18.5MM X 4MM OSCILLATING SS", "code_information": [{"code": "5023162R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE 9MM OSCILLATING", "code_information": [{"code": "OSB-9S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW CUT 3.5 MID/ 3.2 PROX HAMMEROTE CORRECTION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NX-3532K-SC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1473.0, "discounted_cash": 515.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW MICRO 0.36IN X 9MM OSCILLATING SAGITTAL PRECISION THIN", "code_information": [{"code": "2296003105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SBRT DELIVERY", "code_information": [{"code": "77373", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 9064.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2935.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5765.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9064.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9064.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9064.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBRT MANAGEMENT", "code_information": [{"code": "77435", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2861.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4498.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4498.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4498.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS HIGH 50", "code_information": [{"code": "99233", "type": "CPT"}], "standard_charges": [{"minimum": 465.65, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 465.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 731.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 731.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 731.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS MODERATE 35", "code_information": [{"code": "99232", "type": "CPT"}], "standard_charges": [{"minimum": 325.81, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 325.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 511.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 511.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 511.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS SF/LOW 25", "code_information": [{"code": "99231", "type": "CPT"}], "standard_charges": [{"minimum": 176.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NB EM PER DAY HOSP", "code_information": [{"code": "99462", "type": "CPT"}], "standard_charges": [{"minimum": 189.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 189.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE LOW MDM 20", "code_information": [{"code": "99308", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE MODERATE MDM 30", "code_information": [{"code": "99309", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE SF MDM 10", "code_information": [{"code": "99307", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ PSYC COLLAB CARE MGMT", "code_information": [{"code": "99493", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQT PLMT DRUG ELUT OC INS", "code_information": [{"code": "445T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 4382.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC DIS P-SELECTIN WHL BLOOD", "code_information": [{"code": "122U", "type": "CPT"}], "standard_charges": [{"minimum": 14.05, "maximum": 757.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 757.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 757.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC DIS VCAM-1 WHOLE BLOOD", "code_information": [{"code": "121U", "type": "CPT"}], "standard_charges": [{"minimum": 14.05, "maximum": 733.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 733.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 733.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC GNOTYP ERMAP EXONS 4 12", "code_information": [{"code": "199U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 395.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC HM ST 1-2 10MM LTLA RTMD 71423037", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71423037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4200.0, "discounted_cash": 1470.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SC HM ST 3-4 10MM LTLA RTMD 71423038", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4450.0, "discounted_cash": 1557.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SC HM ST 3-4 15MM LTMD RTLA 71423042", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3269.0, "discounted_cash": 1144.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SC THER INFUSION ADDL HR", "code_information": [{"code": "96370", "type": "CPT"}], "standard_charges": [{"minimum": 69.94, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 69.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 109.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 109.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 109.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION RESET PUMP", "code_information": [{"code": "96371", "type": "CPT"}], "standard_charges": [{"minimum": 266.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION UP TO 1 HR", "code_information": [{"code": "96369", "type": "CPT"}], "standard_charges": [{"minimum": 745.38, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 745.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1171.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1171.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1171.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCALP COOL 1ST MEAS&CALBRJ", "code_information": [{"code": "662T", "type": "CPT"}], "standard_charges": [{"minimum": 149.23, "maximum": 234.51, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 234.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 234.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 234.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCALP COOL PLMT MNTR RMVL", "code_information": [{"code": "663T", "type": "CPT"}], "standard_charges": [{"minimum": 28.62, "maximum": 44.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCALPEL GREAT RELEASE MTP RELEASE SN29", "code_information": [{"code": "SN29", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 941.5, "discounted_cash": 329.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SCALPEL OPTHALMIC 2.6MM FEATHER ROUND TUNNEL", "code_information": [{"code": "P-7726B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCEW NON-LOCKING 2.7X20MM MF-NL-2720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-NL-2720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 422.0, "discounted_cash": 147.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCHLEIN POSITIONING KITS", "code_information": [{"code": "NON081647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.09, "discounted_cash": 25.58, "setting": "both", "billing_class": "facility"}]}, {"description": "SCISSOR ENDOPTH CURVED 5MM-ORDR QTY6 5DCS", "code_information": [{"code": "5DCS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.9, "discounted_cash": 28.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SCISSOR HIRZONTAL CRVD 25G DISP", "code_information": [{"code": "1286.MD05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 226.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCISSOR VERTICAL 25G 90DEG DISP", "code_information": [{"code": "1286.ED05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 226.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCISSORS CRVD 5MM REP", "code_information": [{"code": "5DCSR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCISSORS CURVED 25GA REVOLUTION DSP 705.52P", "code_information": [{"code": "705.52P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCLERAL REINFORCEMENT WITH GRAFT 67255", "code_information": [{"code": "67255", "type": "CPT"}, {"code": "1482073", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCLERAL REINFORCEMENT WITHOUT GRAFT 67250", "code_information": [{"code": "67250", "type": "CPT"}, {"code": "1482074", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCLEROTX FLUID COLLECTION", "code_information": [{"code": "49185", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCOLIOSIS DNA ALYS", "code_information": [{"code": "4M", "type": "CPT"}], "standard_charges": [{"minimum": 201.45, "maximum": 316.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 201.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 316.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 316.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 316.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCORPION NEEDLE STERILE", "code_information": [{"code": "AR-1399ON", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCP KIT KNEE 11GA X 120 MM 5CC SIDE-DELIVERY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "414.502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 2590.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCR C/V CYTO, AUTOMATED SYS", "code_information": [{"code": "G0147", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 60.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO, AUTOSYS, RESCR", "code_information": [{"code": "G0148", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 128.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 128.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 128.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 128.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 46.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 46.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,AUTOSYS AND MD", "code_information": [{"code": "G0141", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 130.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,THINLAYER,RESCR", "code_information": [{"code": "G0143", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 108.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 108.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 108.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 108.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,THINLAYER,RESCR", "code_information": [{"code": "G0144", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 176.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 112.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 176.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 176.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 176.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 63.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 63.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,THINLAYER,RESCR", "code_information": [{"code": "G0145", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 106.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 40.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 67.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR DEP NEG, NO PLAN REQD", "code_information": [{"code": "G8510", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR DEP POS, NO PLAN DOC RNG", "code_information": [{"code": "G8511", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR FOR DEP NOT CPT DOC RSN", "code_information": [{"code": "G8433", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR MAMMO BI INCL CAD", "code_information": [{"code": "77067", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 434.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 683.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 683.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 683.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 222.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 236.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR T8 S-T EVOS 2.7MM X 42MM LCK 72412742", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 286.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCR T8 S-T EVOS 2.7MM X 44MM LCK 72412744", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCR UNHEAL ETOH W/COUNSEL", "code_information": [{"code": "G9621", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCRAPER MEMBRANE 25G CURVED DSP", "code_information": [{"code": "338.25P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 430.08, "discounted_cash": 150.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRAPER MEMBRANE 27G CURVED DSP", "code_information": [{"code": "338.27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRAPER OPHTH 23GA MEMBRANE CRVD", "code_information": [{"code": "338.23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREEN C/V THIN LAYER BY MD", "code_information": [{"code": "G0124", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 130.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREEN CERV/VAG THIN LAYER", "code_information": [{"code": "G0123", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 81.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 81.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 81.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 81.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREEN HLTHY ETOH USE", "code_information": [{"code": "G2197", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREEN PAP BY TECH W MD SUPV", "code_information": [{"code": "P3000", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 60.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREEN UNHLTHY ETOH USE", "code_information": [{"code": "G2196", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREENING PAP SMEAR BY PHYS", "code_information": [{"code": "P3001", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 130.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 130.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREENING SLEEP DISORDERS", "code_information": [{"code": "D9957", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 0.3MM X 26MM CANNULATED DARTFIRE EDGE D0130026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0130026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 934.0, "discounted_cash": 326.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 0.3MM X 36MM CANNULATED DARTFIRE EDGE D0130036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0130036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 934.0, "discounted_cash": 326.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 0.8MM X 150MM A-5040.01/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5040.01/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.2MM X 8MM HAND BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-12008E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.3 LCKNG SLF-TPNG T4 SD RECESS 04.111.520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.111.520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2338.0, "discounted_cash": 818.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.5 X 7MM VLP TITANIUM CORTEX T4 SELF-TAPPING 74401507", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74401507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.5 X 9 NON LOCKING SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7440-1509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 114.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.5MM X 6MM VLP TI LOCKING T4 SELF TAPPING 74411506", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74411506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 658.0, "discounted_cash": 230.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.5MM X 6MM VLP TITANIUM CORTEX T4 SELF-TAPPING 74401506", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74401506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.5MM X 7MM VLP LOCKING T4 SELF-TAPPING 74411507", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74411507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 658.0, "discounted_cash": 230.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.5MM X 8MM VLP 74401508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74401508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.5MM X 8MM VLP TITANIUM LOCKING T4 SELF-TAPPING 74411508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74411508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 658.0, "discounted_cash": 230.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.5MM X 9MM VLP TITANIUM LOCKING T4 SELF-TAPPING 74411509", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74411509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.6MM X 26MM FUSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "334-2026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 558.26, "discounted_cash": 195.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.7 X 10MM BONE 662610", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.7 X 12MM BONE 662612", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.7 X 13MM BONE 662613", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.7 X 18MM BONE 662618", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 1.7X8MM LOCKING 662508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 112.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 10MM HEX NOT DNE-6000-036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-6000-036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 11 X 30MM BC IF VENTED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4030C-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.56, "discounted_cash": 223.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 11.5MM X 50MM 44115-50-ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44115-50-ST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5000.0, "discounted_cash": 1750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 14 MM 2.7 LOCKING LCBS2.7-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LCBS2.7-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 14MM VARIABLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207-4214V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 LOCKING 12MM 657612", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 154.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 LOCKING 14MM 657614", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 158.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 LOCKING 16MM T6 657616", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 158.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 LOCKING 18MM T6 657618", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 158.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 LOCKING 22MM T6 657622", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 158.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 MM X 12MM A-5411.12/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5411.12/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 314.0, "discounted_cash": 109.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 NANO ACUTRAK BONE 30MM 3050-20030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3050-20030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2578.0, "discounted_cash": 902.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 NON-LOCKING 14MM 657714", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 SPEEDTIP C SNAP 13M HD61 PKG A-5417.13/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5417.13/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 781.0, "discounted_cash": 273.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 10 HEADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DLN20010S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 10 MM ORTHOLOC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52011-20010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 67.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 12 MM ORTHOLOC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52011-20012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 67.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 12MM SNAP OFF TWIST OFF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018485", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 14MM CORTICAL AR-18720-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-18720-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 14MM HEADED CANNULATED 319-2014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-2014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 14MM HEADED COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N20014S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 16MM HEADED COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N20016S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 17MM COMPRESSION MM T7 S20 ST017", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S20 ST017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 18MM HEADED COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N20018S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 20MM HEADED COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N20020S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 81.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0-C DIAM 2.0 LG 15MM T7 S20 ST015", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S20 ST015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 10MM LOCKING 657610", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 466.0, "discounted_cash": 163.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 10MM NON-LOCKING 657710", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 10MM T7 IBS S20 ST010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S20 ST010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 11MM LOCKING PLATE PS0-053-2011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS0-053-2011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 435.0, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 11MM T7 IBS S20 ST011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S20 ST011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 11MM VLP TITANIUM CORTEX T6 SELF-TAPPING 74402011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74402011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 12MM COMPRESSION T7 S20 ST012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S20 ST012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 13MM MINI MONSTER CANNULATED HEADLESS SHORT THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-520-013S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 855.0, "discounted_cash": 299.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 13MM T6 S-T 74412013", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74412013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 692.0, "discounted_cash": 242.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 14MM VLP TITANIUM LOCKING T6 SELF-TAPPING 74402014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74402014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 14MM VLP TITANIUM LOCKING T6 SELF-TAPPING 74412014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74412014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 15MM LOCKING PLATE PS0-053-2015", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS0-053-2015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 435.0, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 8MM LOCKING 657608", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 466.0, "discounted_cash": 163.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 8MM LOCKING PLATE PS0-053-2008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS0-053-2008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 435.0, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 8MM NON-LOCKING 657708", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 8MM VLP TITANIUM LOCKING T6 SELF-TAPPING 74412008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74412008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 9MM VLP TATANIUM CORTEX T6 SELF-TAPPING 74402009", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74402009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MM X 9MM VLP TITANIUM LOCKING T6 SELF-TAPPING 74412009", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74412009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MMX10MM LOCKING 657609", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 466.0, "discounted_cash": 163.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MMX11MM NON LOCKING 657711", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MMX12MM HEADED CANNULATED PART THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS903012-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1503.0, "discounted_cash": 526.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MMX14MM HEADED CANNULATED PART THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS903014-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1503.0, "discounted_cash": 526.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MMX16MM HEADED CANNULATED PART THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS903016-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1503.0, "discounted_cash": 526.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0MMX1MM LCOKING 657611", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 158.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0X12MM SPEEDTIP C-SNAP HD6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5417.12/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.0X20MM CANNULATED TC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC-2020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 81.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.2 X 20MM CANULATED COMPR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5780.20/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 162.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.2MM X 10MM CANNULATED COMPRESS A-5780.10/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5780.10/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 626.0, "discounted_cash": 219.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.2MM X 11MM SNAP OFF S22ST011B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S22ST011B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1288.0, "discounted_cash": 450.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.2MM X 12MM COMPRESSION CANNULATED A-5780.12/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5780.12/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1252.0, "discounted_cash": 438.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.2MM X 8MM NON-LOCKING 307-22-008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-22-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 16MM CRUCIFORM NON-TOGGLING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-N2316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 20MM CRUCIFORM NON-TOGGLING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-N2320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.5, "discounted_cash": 52.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 22MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-T2322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.76, "discounted_cash": 76.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 22MM CRUCIFORM NON-TOGGLING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-N2322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.5, "discounted_cash": 52.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 24MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-T2324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.76, "discounted_cash": 76.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 26MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-T2326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 581.0, "discounted_cash": 203.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23228E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 28MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-T2328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 30MM MICROCAN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "35-23.030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 865.0, "discounted_cash": 302.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 36MM MICROCAN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "35-23.036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 865.0, "discounted_cash": 302.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 8MM BONE 663808", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3MM X 10MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P35-23-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3MM X 14MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P35-23-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3MM X 14MM COMPRESSIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC010014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3MM X 16MM COMPRESSIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC010016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1197.0, "discounted_cash": 418.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3MM X 18MM COMPRESSIVE SC010018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC010018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1197.0, "discounted_cash": 418.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3MM X 20MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "35.23.020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3MM X 30MM COMPRESSION NEXIS SC010030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC010030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1197.0, "discounted_cash": 418.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3X12MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TRX2.3-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3X14MM CORTICAL TRIMED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TRX2.3-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3X16MM CORTICAL (TRIMED)", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TRX2.3-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 10MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSL2410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 12MM LOCKING MFSL2412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSL2412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 12MM LOCKING SB SB-LK-2412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB-LK-2412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 12MM NON LOCKING MFSN2412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSN2412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 14MM NON LOCKING MFSN2414", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSN2414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 16 LOCKING 656016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 143.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 18MM LOCKING SB SB-LK-2418", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB-LK-2418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 20 LOCKING 656020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 143.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 24MM N2424", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "N2424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 32MM N2432", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "N2432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 8MM LOCKING MFSL2408", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSL2408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 541.0, "discounted_cash": 189.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM TI LOCKING SCR SLF-TPNG WITH STARDRIVE RECESS 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 10MM SPIDER HEX L 072410", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 230.0, "discounted_cash": 80.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 12MM NON-LOCKING POLYLCOK SB-NL-2412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB-NL-2412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 12MM SPIDER HEX L 072412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 230.0, "discounted_cash": 80.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 14MM SPIDER HEX L 072414", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 215.0, "discounted_cash": 75.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 14MM TIGER CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210-24-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 16MM 201-24-016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201-24-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 16MM LOCKING SB SB-LK-2416", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB-LK-2416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 16MM TIGER CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210-24-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 20MM LCK SCR T7 S-T 72412420", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 478.0, "discounted_cash": 167.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 22MM NON-LOCKING POLYLOCK SB-NL-2422", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB-NL-2422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 6MM 72412406", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 6MM VLP TITANIUM CORTEX T7 SELF-TAPPING 74402406", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74402406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 7MM LCK SCR T7 S-T 72412407", "code_information": [{"code": "C1714", "type": "HCPCS"}, {"code": "72412407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 8MM LOCKING SB SB-LK-2408", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB-LK-2408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 8MM SPIDER HEX 072408", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 215.0, "discounted_cash": 75.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 9MM EVOS CTX T7 S-T 72402409N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402409N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4MM X 9MM LCK SCR T7 S-T 72412409", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 478.0, "discounted_cash": 167.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4X22MM GRIDLOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-24-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.4X24MM LOW PROFILE LOCKING TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724V-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 10MM CORTICAL A-5700.10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 80.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 10MM MINI-MONSTER SHOR THREADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-125-010S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 613.0, "discounted_cash": 214.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 12MM MINI-MONSTER SHOR THREADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-125-012S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 13MM MINI-MONSTER SHORT THREADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-125-013S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 13MM PEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP13000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 49.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 14MM COLAG 2 P67 ST214", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 896.0, "discounted_cash": 313.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 14MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N25014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 159.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 14MM MINI-MONSTER SHORT THREADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-125-014S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 15 LAG S25-15T-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25-15T-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 15MM MINI-MONSTER SHOR THREADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-125-015S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 16MM COLAG 2 P67 ST216", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 901.0, "discounted_cash": 315.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 16MM MINI-MONSTER SHORT THREADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-125-016S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 18MM MINI-MONSTER SHORT THREADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-125-018S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 20MM MINI-MONSTER SHORT THREADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-125-020S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 24 FX-HD-2524", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX-HD-2524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1710.0, "discounted_cash": 598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 30MM CANNULATED IC2530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IC2530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 430.0, "discounted_cash": 150.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 32MM HEADED COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N25032S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM FEMALE HEX 25MM LENGHT 42-5099-025-25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "42-5099-025-25", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 12MM CANN SHT 9ZB25212", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9ZB25212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 14MM FULL 25214", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "25214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 14MM FULLY THREADED FT25-14S-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FT25-14S-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 605.0, "discounted_cash": 211.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 14MM HD CANN SHT 9ZB25214", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9ZB25214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 14MM IBS COMPRESSION 2.5C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25 ST014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 14MM LOCKING HD7 A-5755.14/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5755.14/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 16MM CANNULATED CREED F2-0825-016S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "F2-0825-016S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1316.0, "discounted_cash": 460.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 16MM FULL THREAD 25216", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "25216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 16MM FULLY THREADED FT25-16S-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FT25-16S-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 605.0, "discounted_cash": 211.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 16MM HD CANN SHT 9ZB25216", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9ZB25216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 18MM CANNULATED CREED F2-0825-018S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "F2-0825-018S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1316.0, "discounted_cash": 460.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 18MM FRACTURE AND CORRECTION COLAG P67 ST218", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 901.0, "discounted_cash": 315.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 20MM FRACTURE AND CORRECTION COLAG P67 ST220", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 24MM 25224", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "25224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 24MM HEADED CANNULATED PARTIALLY THREADED OS905024-NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS905024-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 41.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 28MM HD7 LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.28/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 119.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 30MM 25230", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "25230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 34MM D0125034", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0125034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 38MM D0125038", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0125038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 38MM M1-25338", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "M1-25338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 850.0, "discounted_cash": 297.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 4.3MM CANNULATED INSTRUMENT SET F4-2540-000S", "code_information": [{"code": "F4-2540-000S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3199.0, "discounted_cash": 1119.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MM X 40MM D0125040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0125040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MMX12MM HEADED CANNULATED PART THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS905012-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1503.0, "discounted_cash": 526.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5MMX18MM HEALDESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N25018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 159.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5X15MM LAG FULLY THREADED FT25-15S-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FT25-15S-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 605.0, "discounted_cash": 211.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5X17MM LAG FULLY THREADED FT25-17S-11F", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FT25-17S-11F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 605.0, "discounted_cash": 211.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5X26MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP26000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.6 X 2.4 X 12 TS HAMMER TOE IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204-24-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3698.0, "discounted_cash": 1294.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 10MM RECON NON-LOCKING TNR27-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR27-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 12 CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71803012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 12 MM BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-27012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 14 LOCKING TLR27-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR27-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 16 NON LAG LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "342-2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 271.0, "discounted_cash": 94.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 18 NON-LOCKING 541418", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "541418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 18MM LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "131227118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 18MM LOCKING 308-27-018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-27-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 20 NON LAG LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "342-2720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 271.0, "discounted_cash": 94.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 20MM RECON LOCKING TLR27-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR27-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 22MM LOCKING 308-27-022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-27-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 22MM RECON LOCKING TLR27-22", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR27-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 24MM LOCKING BIOMET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 201.6, "discounted_cash": 70.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 24MM TLR27-24", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR27-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 24MM TNR27-24", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR27-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 24MMM LOCKING 308-27-024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-27-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 26MM LOCKING 308-27-026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-27-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 26MM LOCKING BIOMET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 201.6, "discounted_cash": 70.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 40MM EVOS LOCKING SELF TAPPING T8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412740N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 55MM PERI LOCK CORTEX S-T T20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73822355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7M X 20MM TNR27-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR27-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 10MM ARSENAL 307-27-010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-27-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 10MM ARSENAL LOCKING 308-27-010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-27-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 10MM EVOS LCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412710N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 459.0, "discounted_cash": 160.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 10MM SNAP OFF TWIST OFF 110018500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 11MM CORTICAL 3041-23011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3041-23011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 11MM EVOS CTX T8 S-T 72402711N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402711N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 11MM EVOS LCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412711N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 12MM CORTICAL 3041-23012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3041-23012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 12MM EVOS CTX T8 S-T 72402712N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402712N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 12MM GRIDLOCK ANKLE LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-27-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 12MM NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "342-2712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 12MM NON-LOCKING 304-27-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-27-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 12MM POLYAX LOCKING MINI MFSL2712", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSL2712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 13MM EVOS LCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412713N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 14MM FLEX THREAD FIBULA NAIL ZERO PROFILE LOCKING 8426-14-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8426-14-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 14MM GRIDLOCK ANKLE LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-27-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 14MM MULTI-THREAD LOCKING MTLS-27140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-27140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 410.0, "discounted_cash": 143.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 14MM NON-LOCKING MINI MFSN2714", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSN2714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 14MM POLYAX LOCKING MINI MFSL2714", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSL2714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 15MM CORTICAL 3041-23015", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3041-23015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 16MM FLEX THREAD FIBULA NAIL ZERO PROFILE LOCKING 8426-16-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8426-16-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.0, "discounted_cash": 127.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 16MM POLYAX LOCKING MINI MFSL2716", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSL2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 16MM SNAP-OFF S27 ST016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S27 ST016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 18MM FLEX-THREAD INTERLOCKING CORTEX 8426-18-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8426-18-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 18MM MULTI-THREAD LOCKING MTLS-27180-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-27180-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 410.0, "discounted_cash": 143.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 18MM PERI CONICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2359-018-26", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 32.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 19MM CTX SCR T8 S-T 72402719", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 20MM EVOS LCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 22MM EVOS CORTEX T8 SELF-TAPPING 72402722", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 22MM EVOS LCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 24MM EVOS CORTEX T8 SELF-TAPPING 72402724", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 26MM TAPPER THREADED LOCKING MF-LK-2726", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-LK-2726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 28MM LOCKING 308-27-028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-27-028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 30MM EVOS LOCKING SELF-TAPPING T8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412730N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 286.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 30MM TLR27-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR27-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 36MM EVOS LOCKING SELF-TAPPING T8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412736N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 286.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 48MM COMPRESSION MTNL-27480-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-27480-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 50MM EVOS CTX T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402750N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 55MM EVOS CTX T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402755N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 55MM EVOS LCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412755N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 60MM EVOS LCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412760N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 286.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 7MM EVOS LCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7242707N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 7MM EVOS LOCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412707N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 170.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 8MM ARSENAL LOCKING 308-27-008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-27-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MM X 8MM EVOS CTX T8 S-T 72402708", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MMX12MM EVOS CTX SCR T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MMX13MM EVOS CTX SCR T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MMX13MM EVOS LCK SCR T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 170.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MMX18MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27622E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MMX18MM NON LOCKING 307-27-018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-27-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MMX20MM LOCKING 308-27-020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-27-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MMX24MM LOCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MMX26MM NON LOCKING 307-27-026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-27-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MMX28MM LOCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 534.0, "discounted_cash": 186.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MMX32MM LOCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7MMX40MM LOCK T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X10MM RECON LOCKING TLR27-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR27-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X12MM NON LOCKING (ORTHOHELIX)", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MXM-011-27-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X12MM RECON LOCKING TLR27-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR27-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X12MM RECON NON-LOCKING TNR27-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR27-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X12MM RECON NON-LOCKING TRN27-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TRN27-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X14MM RECON NON-LOCKING TNR27-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR27-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X14MM RECON NON-LOCKING TRN27-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TRN27-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X16MM NON LOCKING (ORTHOHELIX)", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MXM-011-27-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X16MM RECON LOCKING TLR27-16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR27-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X16MM RECON NON-LOCKING TNR27-16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR27-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X18MM RECON LOCKING TLR27-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR27-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X18MM TNR27-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR27-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X22MM LOCKING (BIOMET)", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "131227122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7X26 MM TLR27-26", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR27-26", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.8 X 12MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5800.12/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 63.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.8MM X 50MM LOCKING BLUE A-5801.50/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5801.50/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.8MM X 50MM TRILOCK HD7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.50/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.8MM X 60MM TRILOCK HD7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.60/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.MM X 12MM SNAP OFF SC040012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC040012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 20 X 20MM FUSE FORCE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS-2020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5140.0, "discounted_cash": 1799.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 20.0MM CRUCIFORM FUSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ATF-200-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1366.0, "discounted_cash": 478.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 22MM 2.0 NANO ACUTRAK 3 BONE 3050-20022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3050-20022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2732.0, "discounted_cash": 956.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 23.0 X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "35.23-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 24MM 2.0 NANO ACUTRAK 3 BONE 3050-20024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3050-20024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2732.0, "discounted_cash": 956.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 24MM FUSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ATF-240-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 767.0, "discounted_cash": 268.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 25 X 22 FUSE FORCE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS-2522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4917.0, "discounted_cash": 1720.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 25MM FP-1225", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP-1225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 432.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 26MM 2.0 NANO ACUTRAK 3 BONE 3050-20026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3050-20026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2938.0, "discounted_cash": 1028.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 26MM ALTIVATE TORX REVERSE 506-04-126", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "506-04-126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 95.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 28MM 2.0 NANO ACUTRAK 3\u00c2\u00ae BONE 3050-20028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3050-20028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2732.0, "discounted_cash": 956.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2MM X 11MM SNAP OFF SC040011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC040011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1197.0, "discounted_cash": 418.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2MM X 18MM TIGER HEADLESS 202-20-018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202-20-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 MM X 14MM CANNULATED 300-30-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-30-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 12MM NON-LOCK HEXALOBE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 14MM NON-LOCKING V30 ST214", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V30 ST214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 16 CORTICAL P43 ST016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P43 ST016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 20MM 57S03020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S03020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 22 LOCKING P43 ST122", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P43 ST122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 22MM HV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HVS03022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 980.0, "discounted_cash": 343.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 22MM MICA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S03022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 24 HEADLESS IH3024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH3024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 24 LAG S30-24T-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S30-24T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 26 LAG S30-26T-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S30-26T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 26MM REVCON RSN3026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RSN3026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1986.0, "discounted_cash": 695.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 30MM MINI MONSTER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-130-030S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 30MM T10 CH30130T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CH30130T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 950.0, "discounted_cash": 332.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 34MM CANNULATED COMPR HD10 A-5880.34/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5880.34/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 758.0, "discounted_cash": 265.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 36MM N3036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "N3036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 40.0MM COLAG 2 P67 ST340", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 10MM COLINK LOCKING P43 ST110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P43 ST110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 650.0, "discounted_cash": 227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 12MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "300-30-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 12MM COLINK LOCKING P43 ST112", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P43 ST112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 12MM TIGER 210-30-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210-30-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 12MM TIGER CANN 201-30-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201-30-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 14MM COLINK LOCKING P43 ST114", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P43 ST114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 14MM FULLY THREADED FT30-14S-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FT30-14S-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 605.0, "discounted_cash": 211.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 15MM FULLY THREADED FT30-15S-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FT30-15S-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 605.0, "discounted_cash": 211.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 16MM COLINK LOCKING P43 ST116", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P43 ST116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 650.0, "discounted_cash": 227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 16MM FULLY THREADED FT30-16S-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FT30-16S-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 605.0, "discounted_cash": 211.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 16MM HEADLESS CANNULATED SCREW PARTIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS908016-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1503.0, "discounted_cash": 526.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 16MM LOCKING PLATE V30 ST316", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V30 ST316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 130.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 16MM TIGER CANN 201-30-016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201-30-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 17MM FULLY THRD SS FT30-17S-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FT30-17S-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 605.0, "discounted_cash": 211.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 18MM CANNULATED FULL THREAD CH30218T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CH30218T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 18MM CORTICAL HYBRID MTP AR-9933HY-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9933HY-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 18MM FULLY THRD. SS FT30-18S-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FT30-18S-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 605.0, "discounted_cash": 211.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 18MM HEADLESS CANNULATED 71103318S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71103318S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1946.0, "discounted_cash": 681.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 18MM MOTOBAND POLYAXIAL LOCKING 15PL-3018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15PL-3018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 20MM COLINK LOCKING P43 ST120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P43 ST120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 22MM HEADLESS CANNULATED 71103322S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71103322S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1946.0, "discounted_cash": 681.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 24MM COLINK LOCKING P43 ST124", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P43 ST124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 979.0, "discounted_cash": 342.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 24MM HD FX-HD-3024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX-HD-3024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1710.0, "discounted_cash": 598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 24MM LOCKING PLATE V30 ST324", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V30 ST324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 30MM COLAG FRACTURE AND CORRECTION P67 ST330", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1190.0, "discounted_cash": 416.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 34MM FRACTURE AND CORRECTION COLAG P67 ST334", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1226.0, "discounted_cash": 429.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 38MM CANNULATED COMPRESSION SHORT THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5880.38/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 904.0, "discounted_cash": 316.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 38MM COLAG 2 P67 ST338", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1190.0, "discounted_cash": 416.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MM X 40MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 358.0, "discounted_cash": 125.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MMX12MM CORTICAL AR-9933-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9933-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0MMX20MM NON LOCKI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSS3020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 65.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0X16MM CORTICAL MTP TI LP AR-9933-16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9933-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0X18MM NON LOCKING T8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSS3018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.0, "discounted_cash": 127.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0X20MM CORTICAL MTP TI LP AR-9933-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9933-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.0X24MM BONE HEADLESS ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71103324S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1028.0, "discounted_cash": 359.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.2MM X 32MM HEX CORTICAL HEX3.2-32", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HEX3.2-32", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.2X12MM HEX CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HEX3.2-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.2X14MM HEX CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HEX3.2-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.2X16MM CORTICAL LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LAG3.2-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.2X16MM HEX CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HEX3.2-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.2X18MM LAG CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LAG3.2-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 MM / CORTEX TI 3.5 / L12MM 661412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 10MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COL-3100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 261.0, "discounted_cash": 91.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 12 P50-453-3512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 12MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COL-3120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 261.0, "discounted_cash": 91.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COL-3140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 261.0, "discounted_cash": 91.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14MM CRUCIFORM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-3140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14MM LOCKING 308-35-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-35-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14MM STOL 5301-3514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5301-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14MM TRILOCK A-5950.14/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5950.14/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16 LOCKING MF-LK-3516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-LK-3516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COL-3160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 261.0, "discounted_cash": 91.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16MM STERILE COLINK AFX LOCKING P73 ST116", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P73ST116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16MM STERILE COLINK AFX LOW-PRO CORTICAL P73 ST016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P73 ST016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18 LOCKING MPSN3518", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSN3518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18 LOCKING TLR35-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR35-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18 MM LOCKING HEXALOBE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18MM CRUCIFORM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-3180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18MM STERILE COLINK AFX LOCKING P73 ST118", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P73ST118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18MM TNR35-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR35-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 20 LOCKING P73 ST120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P73 ST120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 20 LOCKING TLR35-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR35-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 22 LOCKING TLR35-22", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR35-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24 LOCKING V35 ST324", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V35 ST324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24MM STERILE COLINK AFX LOW-PRO CORTICAL P73 ST024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P73 ST024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1123.0, "discounted_cash": 393.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 26 MM NON-LOCKING HEXALOBE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.26, "discounted_cash": 43.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 26 NL P73 ST026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P73 ST026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30MM R3CON NON LOCKING PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 680.0, "discounted_cash": 238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 32MM CANN FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "205.232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 381.0, "discounted_cash": 133.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 32MM DARCO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCN353232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 579.0, "discounted_cash": 202.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 34MM R3CON NON LOCKING PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 46 TI MTLS-35460-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35460-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 344.0, "discounted_cash": 120.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM CANNULATED W/ DRILL CANN 2.5MM FPS OS200325", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS200325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1153.0, "discounted_cash": 403.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM CORTEX TI 3.5MM/L28MM 661428", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM CORTEX TI 3.8/L18MM 661418", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 10MM EVOS CTX S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403510N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 10MM EVOS LCK S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413510N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 10MM EVOS SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 10MM LOCKING 72413510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 968.0, "discounted_cash": 338.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 10MM PERI W/2.7MM HEAD SLEF-TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2348-010-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 10MM TAPPER THREADED LOCKING MF-LK-3510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-LK-3510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 11MM EVOS CTX S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403511N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 11MM EVOS LCK S-T 72413511N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413511N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 12MM C-C BIASED ANGLE SCREW 66-3712", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "66-3712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 113.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 12MM EVOS CTX S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403512N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 12MM EVOS CTX SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 12MM GRIDLOCK ANKLE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-35-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 12NON-LOCKING SHAFT PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PRCST3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 13MM EVOS CTX S-T 72403513N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403513N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 14MM 3601-03514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3601-03514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 14MM EVOS CTX S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403514N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 14MM GRIDLOCK NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-35-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 14MM LOCKING HEXLOBE 30-0234", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 14MM POLYAXIAL SCREW 95-3514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "95-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2575.0, "discounted_cash": 901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 14MM SELF DRILLING VARIABLE 6608-3514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6608-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 15MM EVOS CTX S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403515N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 16MM C-C BIASED ANGLE SCREW 66-3716", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "66-3716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 113.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 16MM EVOS CTX S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403516N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 16MM GRIDLOCK NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-35-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 16MM LOCKING - STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 134.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 16MM LOCKING 72413516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 968.0, "discounted_cash": 338.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 16MM NON LOCKING 304-35-016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-35-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 16MM TNR35-16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR35-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 17MM EVOS CTX SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 18MM EVOS CTX SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 18MM LOCKING 15LK-3518", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15LK-3518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 18MM LOCKING 72413518", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 968.0, "discounted_cash": 338.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 18MM NON LOCKING 304-35-018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-35-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 19MM EVOS CTX S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403519N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 20MM EVOS CTX S-T 72403520N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403520N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 20MM EVOS LCK S-T 72413520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 677.6, "discounted_cash": 237.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 20MM GRIDLOCK ANKLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-35-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 20MM GRIDLOCK NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-35-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 22MM EVOS CTX S-T 72403522N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403522N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 22MM LOCKING MOTOBAND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15LK-3522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 22MM TNR35-22", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR35-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 24MM EVOS CTX S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403524N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 24MM EVOS LCK S-T 72413524", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 24MM FREEFIX COMPRESSION TI FFC-35240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-35240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 112.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 26MM EVOS LCK S-T 72413526", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 26MM TLR35-26", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR35-26", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 28MM COMPRESSION MF-NL-3528", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-NL-3528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 28MM EVOS CTX S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403528N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 28MM FREEFIX COMPRESSION TI FFC-35280-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-35280-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 112.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 28MM LOCKING MOTOBAND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15LK-3528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 30MM EVOS CTX S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403530N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 34MM FREEFIX COMPRESSION TI FFC-35340-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-35340-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 112.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 35MM TNR35-35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR35-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 36MM CANNULATED DIN350365", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DIN350365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 123.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 38MM CANNULATED DIN350385", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DIN350385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 123.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 38MM CTX SCR S-T 72403538", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 159.8, "discounted_cash": 55.93, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 40MM MINI ACUTRACK BONE 3052-35040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3052-35040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2482.0, "discounted_cash": 868.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 40MM R3CON NON-LOCKING PLATE P50-453-3540", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 46MM COMPRESSION MTNL-27140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-27140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 46MM EVOS LCK S-T 72413546N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413546N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 48MM EVOS LCK S-T 72413548", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 48MM HEX HEAD 00-5901-035-48", "code_information": [{"code": "-5901-035-48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 50MM 8428-50-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8428-50-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 305.0, "discounted_cash": 106.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 50MM R3CON NON-LOCKING PLATE P50-453-3550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 55MM CTX EVOS 72403555", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 55MM EVOS LCK S-T 72413555N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413555N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 60MM EVOS LCK S-T 72413560N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413560N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 65MM LOCKING EVOS 72413565", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 583.8, "discounted_cash": 204.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X 8MM CTX SCR S-T 72403508", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 95.1, "discounted_cash": 33.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MM X13MM EVOS CTX SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 95.1, "discounted_cash": 33.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX12MM EVOS LCK SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 968.0, "discounted_cash": 338.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX14MM 307-35-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-35-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 183.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX14MM EVOS CTX SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX15MM EVOS LCK SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 968.0, "discounted_cash": 338.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX16MM EVOS CTX SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX16MM PERI-LOC T20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 406.0, "discounted_cash": 142.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX20MM CORTEX SELF TAPPING 72403520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX28MM PERI-LOC T20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 200.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX34MM CORTICAL SELF TAPPING 72403534", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX50MM CORTICAL SELF TAPPING 72403550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX70MM CORTICAL SEFL TAPPING 72403570", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 47.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5MMX8MM LOCKING HEX 30-0232", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0232 Screw", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 527.0, "discounted_cash": 184.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5X 32 NON-LOCKING MF-NL-3532", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-NL-3532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5X10MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5X13MM SELF-TAP VARIABLE ACP 18008215", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18008215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5X15MM SELF-DRILL VARIABLE ACP 18008115", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18008115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5X16 LOCK P50-353-3516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 680.0, "discounted_cash": 238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5X20 LOCK P50-353-3520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 680.0, "discounted_cash": 238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5X24MM NON LOCKING S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.26, "discounted_cash": 43.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5X28MM PERI LOCK CORTEX S-T T20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73824028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5X32 MM OF1073532S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1073532S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2430.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.5X36MM PERI LOCK CORTEX S-T T20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7382-4036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.6 X 28 PT SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "629628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1498.0, "discounted_cash": 524.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.6X28MM 626928", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 475.0, "discounted_cash": 166.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.75X34MM CANNULATED FULLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-7000-34FT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.7MM X 24MM MTLS-37240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-37240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 137.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.7MM X 28MM METAPHYSEAL COMPRESSION MTC-37280-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTC-37280-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 292.8, "discounted_cash": 102.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.7MM X 28MM METAPHYSEAL MTLS-37280-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-37280-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 137.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.7MMX30MM TI MTLS-37300-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-37300-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 137.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.7MMX36MM TI MTLS-37360-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-37360-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 137.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.7MMX40MM TI MTLS-37400-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-37400-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 137.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 3.MM X 30MM PROSTEP MICA 57S03030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S03030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 30.0MM MINI ACUTRAK 2 BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-M30-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1681.0, "discounted_cash": 588.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 30MM ALTIVATE REVERSE TORX PERIPHERAL 506-04-130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "506-04-130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 95.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 34MM LOCKING SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "28.30.034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 35MM LOCKING REDAPT 71354506", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71354506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 36MM X3.6 HEADLESS IH3036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH3036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 38MM ALTIVATE REVERSE TORX PERIPHERAL 506-04-138", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "506-04-138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 95.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 38MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "28.30.038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4 X 13 ATT-4X13 2SN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ATT-4X13 2SN", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1110.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4 X 24MM HEADLESS COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 722.0, "discounted_cash": 252.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4 X 28 MM LOCKING FT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1896-4028S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 595.0, "discounted_cash": 208.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4 X 48MM PROSTEP MICA 57S04048", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S04048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4 X 54MM PROSTEP MICA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S04054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 HEADED CCS LONG THREAD 38/15MM A-8116.38/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-8116.38/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 HEADED CCS LONG THREAD 44/18MM A-8116.44/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-8116.44/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 HEADED SHORT THREAD 46/09MM A-8115.46/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-8115.46/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 133.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14 LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-40-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16MM FIXED 236-1-34016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "236-1-34016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 24MM COLAG 2 P67 ST424", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 894.0, "discounted_cash": 312.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 26MM COLAG 2 P67 ST426", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1190.0, "discounted_cash": 416.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 28 COLAG P67 ST428", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1226.0, "discounted_cash": 429.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 30.0MM STERILE COLAG 2 P67 ST430", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 724.0, "discounted_cash": 253.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 30MM FIBER COMPRESSION OF1024030S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1024030S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2430.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 30MM PARTIALLY THREADED CANCELLOUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 32 COLAG P67 ST432", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1230.0, "discounted_cash": 430.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 32MM CANNULATED 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604632S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 32MM EVOS OSTEOPENIA T8 PARTIALLY THREADED 72434032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 182.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 32MM HEADED COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N40032S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 336.0, "discounted_cash": 117.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 34 MM LOCKING SLF-TAPPING (02-204-034)", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222.676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 34MM FRACTURE AND CORRECTION COLAG2 P67 ST434", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 362.0, "discounted_cash": 126.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 35MM ORTHOHELIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSS-011-40-0354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 204.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 36MM FIBER COMPRESSION OF1024036S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1024036S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2430.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 36MM FRACTURE AND CORRECTION COLAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1226.0, "discounted_cash": 429.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 38MM COLAG 2 P67 ST438", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 724.0, "discounted_cash": 253.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 40MM FIBER COMPRESSION OF1024040S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1024040S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4728.0, "discounted_cash": 1654.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 40MM FULLY THREADED CANCELLOUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 145.0, "discounted_cash": 50.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 40MM H.D. CANNULATED FX-HD-4042", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX-HD-4042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1710.0, "discounted_cash": 598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 46MM CANNULATED LONG THREAD 3006-40046", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3006-40046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 432.26, "discounted_cash": 151.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 50MM RSA4050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RSA4050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5570.0, "discounted_cash": 1949.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 56MM REVCON ANCHOR RSA4056", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RSA4056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5960.0, "discounted_cash": 2086.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 70MM ORTHOHELIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSS-011-40-0705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1461.0, "discounted_cash": 511.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM FULLY THREADED - SHORT (32MM/36MM) SK37", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK37", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 956.0, "discounted_cash": 334.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM HEAD LENGTH 36MM IC4036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IC4036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM VARIABLE ANGLE SELF-TAPPING SINGLE LEAD 14MM 236-1-14014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "236-1-14014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 10MM C-C BIASED ANGLE SCREW 66-3810", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "66-3810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 10MM EVOS OST T8 FT 72424010N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424010N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 393.0, "discounted_cash": 137.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 12MM ARSENAL LOCKING 308-40-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-40-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 12MM EVOS OST T8 FT 72424012N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424012N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 12MM GIBRALT POLYAXIAL 05-000-20-4012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-000-20-4012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 12MM OZARK SELF-TAP 8801-04012CA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8801-04012CA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 14MM ANGLE COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "fcs 614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 14MM ARSENAL LOCKING 308-40-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-40-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 14MM EVOS OST T8 FT 72424014N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424014N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 14MM GRIDLOCK ANKLE LOCKING 305-40-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-40-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 14MM VARIABLE APV4014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "APV4014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 14MM VARIABLE SELF-DRILLING CBAB40014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CBAB40014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 16MM 308-40-016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-40-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 16MM EVOS OST T8 FT 72424016N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424016N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 16MM GRIDLOCK ANKLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-40-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 16MM PRIMARY SEMI-CONSTRAINED SELF-TAPPING 19-4516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "19-4516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 16MM SELF DRILLING VARIABLE 6608-4016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6608-4016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 18MM EVOS OST T8 FT 72424018N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424018N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 18MM GRIDLOCK ANKLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-40-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 20MM EVOS OST T8 FT 72424020N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424020N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 22MM GRIDLOCK 310-40-022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "310-40-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 26MM EVOS OST T8 PT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434026N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 26MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "28.30.126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 51.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 26MM T8 FULLY THREADED 72424026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 28MM 76344028SH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "76344028SH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1224.6, "discounted_cash": 428.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 28MM EVOS OST T8 PT 72434028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 30MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "28.30.030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 32MM HEDLESS COMPRESSION 658032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 935.0, "discounted_cash": 327.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 34MM EVOS OST T8 PT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434034N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 34MM H.D. CANNULATED FX-HD-4034", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX-HD-4034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1710.0, "discounted_cash": 598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 36MM EVOS OST T8 PT 72434036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 36MM GRIDLOCK ANKLE 304-40-036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-40-036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 38MM MICA 57S04038", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S04038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 40MM CANNULATED 1/3 THD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-1147-040-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 40MM CANNULATED 3006-40040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3006-40040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 432.26, "discounted_cash": 151.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 42MM MICA 57S04042", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S04042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 44MM HEADLESS N4044", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "N4044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 44MM SYNDESMONIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "306-40-044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 46MM SF4046", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SF4046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 504.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 48MM TIGER 200-40-048", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 52MM RSA4052", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RSA4052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5960.0, "discounted_cash": 2086.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 54MM TIGER 200-40-054", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM X 60MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604660S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MM/L34MM HEADLESS COMPRESSION 658034", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 722.0, "discounted_cash": 252.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MMX 10MM GRIDLOCK ANKLE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-40-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MMX 12MM GRIDLOCK ANKLE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-40-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MMX22MM NON-LOCK 301-40-022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "301-40-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MMX42MM PARTIALLY THREADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1664.0, "discounted_cash": 582.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0MMX55MM EVOS OST SCR T8 FT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0X 22MM P67 ST422", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1190.0, "discounted_cash": 416.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0X14MM CONSTRAINED SELF DRILL 19-5514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "19-5514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0X14MM SEMICONSTRAINED SELF DRILL 19-6514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "19-6514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0X16 SEMI CONSTRAINED SELF DRILL 19-6516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "19-6516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0X46MM REVCON ANCHO RSA4046", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RSA4046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5960.0, "discounted_cash": 2086.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.2 X 40 HEADLESS F42-42T-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "F42-42T-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1070.0, "discounted_cash": 374.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.2MM X 55MM R3CON NON-LOCKING GORILLA PLATING SYSTEM P50-453-4255", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-4255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 117.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.3MM X 30MM HEADLESS COMPRESSION F1-1040-030S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "F1-1040-030S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1790.0, "discounted_cash": 626.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.4 LOCKING 661044", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5 45MM SHORT THREAD TIGER CANNULATED 200-45-045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-45-045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 16MM VARIBLE 236-1-14516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "236-1-14516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 30MM HEADED CANNULATED SHORT THREAD MONSTER P20-145-030S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-145-030S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 40 CANNULATED EXINN924540", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINN924540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3968.0, "discounted_cash": 1388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 42 NON-LOCKING 661742", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 37.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 50 MM JONES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5601-4550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2592.0, "discounted_cash": 907.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 50MM INNATE EXINN924550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINN924550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 56MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "340656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM TI CORTEX SCREW SELF-TAPPING 46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "414.846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 14MM VARIABLE APV4514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "APV4514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 16MM VARIABLE APV4516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "APV4516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 2.2MM X 5MMTENOTAC FEMALE IMPLANT SHORT P42-122-0050-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P42-122-0050-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1053.0, "discounted_cash": 368.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 26MM FREEFIX COMPRESSION TI FFC-45260-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-45260-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 28MM FREEFIX COMPRESSION TI FFC-45280-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-45280-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 30MM 72504530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72504530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 53.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 30MM FREEFIX COMPRESSION TI FC-45300-TSF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FC-45300-TSF", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 30MM FREEFIX COMPRESSION TI FFC-45300-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-45300-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 32MM HEADLESS 202-45-032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202-45-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 34MM 72504534", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72504534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 53.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 36MM HEADLESS 202-45-036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202-45-036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 38MM SHORT 200-45-038", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-45-038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 40M SHORT THREADED TIGER 200-45-040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-45-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 40MM E5111-04540", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-04540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 40MM JONES CANNULATED JF45-40T-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JF45-40T-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2668.0, "discounted_cash": 933.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 40MM JONES FRACTURE P60ST440", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P60ST440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3790.0, "discounted_cash": 1326.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 44MM HEADED SHORT P20-145-44S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-145-44S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 46MM HEADED SHORT P20-145-46S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-145-46S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 55MM INNATE STAINLESS STEEL BONE S EXINN924555", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINN924555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X 60MM HEADLESS N4560", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "N4560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1300.0, "discounted_cash": 455.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5MM X45MM LTTCS 200-45-145", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-45-145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5X26MM CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "340626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5X28MM CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "340628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5X70MM OF1084570S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1084570S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3170.0, "discounted_cash": 1109.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7 X 28MM PARTIALLY THREADED EVOS OSTEOPENIA 72434728", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 95.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 10MM EVOS OST FT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424710N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 12MM EVOS OST FT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424712N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 317.0, "discounted_cash": 110.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 14MM EVOS OST F-T 72424714", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 502.0, "discounted_cash": 175.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 14MM EVOS OST FT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424714N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 22MM EVOS OST F-T 72424722", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 95.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 26MM ACUTRAK 30-0626", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1910.0, "discounted_cash": 668.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 26MM EVOS OST SCR F-T 72424726", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 317.0, "discounted_cash": 110.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 28MM ACUTRACK 30-0628", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1910.0, "discounted_cash": 668.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 28MM EVOS OST F-T 72424728", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 32MM EVOS OST FT 72424732N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424732N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 42MM OST SCR F-T EVOS 72424742", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 358.0, "discounted_cash": 125.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 50MM EVOS OST FT 72424750N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424750N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 317.0, "discounted_cash": 110.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 60MM EVOS OST PT 72434760N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434760N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MM X 65MM EVOS OSTEOPENIA FULLY THREADED 72424765", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424765", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 341.6, "discounted_cash": 119.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MMX55MM EVOS OST F-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 292.6, "discounted_cash": 102.41, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.7MMX60MM EVOS OST SCR FT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4MM LOCKING 4.0MM/L32MM 661032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4MM LOCKING 4.0MM/L40MM 661040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4MM LOCKING 4.0MM/L50MM 661050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 152.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4MM X 32MM DYNANAIL MINI HEADLESS 2600-04-4332", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2600-04-4332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4MM X 32MM FULLY THREADED MICA 57S34032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S34032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4MM X 35MM BEVELED FT AR-8740BV-36", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740BV-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 573.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4MM X 56MM PROSTEP MICA 57S04056", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S04056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4X13MM SELF TAPPING FIXED SCREW 7804213", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7804213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 110.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4X13MM SELF TAPPING VARIABLE SCREW 7803113", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7803113", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 110.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4X17MM SELF TAPPING FIXED SCREW 7804217", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7804217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 110.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5 X 14MM LP PRESTIGE 6972450", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6972450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7000.0, "discounted_cash": 2450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0 VAL SCREOPTILINK SLF-TPNG SD 46 42.231.246", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "42.231.246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 171.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 25MM SCARLET ALT SJT-LS 50 25-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SJT-LS 50 25-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 27.5MM TRIGEN LOW PROFILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71645027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.5, "discounted_cash": 169.58, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 30MM SA ALIF 61-50-25-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "61-50-25-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 34MM CANCELLOUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71755034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 225.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 36MM CANCELLOUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71755036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 225.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 40 MM FIXOS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 756.0, "discounted_cash": 264.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 40MM CANCELLOUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71755040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 225.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 42MM CANCELLOUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71755042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 849.0, "discounted_cash": 297.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 44 MM JFX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2262.0, "discounted_cash": 791.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 55MM COLAG P65 ST555", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P65 ST555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1382.0, "discounted_cash": 483.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 22MM FULLY THREADED FT30-22S-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FT30-22S-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 162.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 30MM VAL OPTILINK SLF-TPNG STRDRV 42.231.230", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "42.231.230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 171.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 32MM CANNULATED PARTIAL THREAD 110007638", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 136.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 32MM VAL OPTILINK SLF-TPNG STRDRV 42.231.232", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "42.231.232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 171.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 34MM HEADED CANNULATED PARTIALLY THREADED OS911034-NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS911034-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 34MM VAL OPTILINK SLF-TPNG STRDRV 42.231.234", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "42.231.234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 171.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 38MM HEADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS912038-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 42MM HEADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS912042-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 44MM OSTEOPENIA P-L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 45MM P-T OSTEOPENIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 50MM NON STERILE PERFORM REVERSED PERIPHERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 57.5MM TRIGEN LOW PROFILE 71645057", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71645057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1042.0, "discounted_cash": 364.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 65MM VAL SLF-TPNG STRDRV 42.231.265", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "42.231.265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 171.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 75MM LOW PROFILE TRIGEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71645075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 828.0, "discounted_cash": 289.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 75MM TI CANNULATED CONICAL 04.205.275", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.205.275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 423.0, "discounted_cash": 148.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MM X 75MM VAL OPTILINK SLF-TPNG STRDRV 42.231.275", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "42.231.275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 171.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0MMX34MM REVERSED PERIPHERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.0X50MM LARGE CMPR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8750-50H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 979.0, "discounted_cash": 342.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 25MM AXTI5525", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AXTI5525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 30MM AXTI5530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AXTI5530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 55MM PREASSEMBLED CREO THREADED 5119.1557", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5119.1557", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2163.0, "discounted_cash": 757.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 70MM LONG THREAD TIGER CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-70-070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5MM / 6.0MM SOLERA VOYAGER 6540530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6540530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5MM VARIABLE ANGLE 30MM 163.63", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "163.63", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5MM X 30MM SS 205-55-030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "205-55-030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1270.0, "discounted_cash": 444.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5MM X 35MM LUMBAR 63-55-35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "63-55-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5MM X 35MM MODULAR BONE SELF-TAPPING CANNULATED 77-8535", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "77-8535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5MM X 35MM SS 205-55-035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "205-55-035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1270.0, "discounted_cash": 444.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5MM X 40MM MODULAR BONE SELF-TAPPING CANNULATED 77-8540", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "77-8540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5MM X 75MM HEADLESS N5575", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "N5575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1300.0, "discounted_cash": 455.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5MMX50MM INVICTUS CORTICAL CANCELLOUS POLYAXIAL 15001-055-050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15001-055-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5X40MM POLYAXIAL EXTENDED TAB FENESTRATED E5111-05540", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-05540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5X50MM LONG THREAD LARGE CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206-55-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5.5X50MM POLYAXIAL EXTENDED TAB FENESTRATED E5111-05550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-05550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 50 X 3.5 MM LOCKING SELF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121.121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5MM X 10MM TENODESIS PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CM-9505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 797.0, "discounted_cash": 278.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5MM X 55MM 5560127055FS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5560127055FS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2700.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5X30 CROSSING P32-450-030F", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P32-450-030F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 774.0, "discounted_cash": 270.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5X32.5MM LOCKING STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1896-5032S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 441.0, "discounted_cash": 154.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5X40MM PIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1891-5040S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 492.0, "discounted_cash": 172.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 5X80 LOCKING STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1896-5080S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 158.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.0MM X 38MM LOCKING SPL-60380-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPL-60380-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 166.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 35 CENTRAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45MM POLYAXIAL E356545", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E356545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50MM CANNULATED COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NCS-6050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 827.0, "discounted_cash": 289.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM LOW PROFILE HEX 7030-6525", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7030-6525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM REVERSED CTR PERFORM DWJ125", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM X 15MM G7 ACETABULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10000996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM X 15MM LOW PROFILE HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7030-6515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM X 20MM G7 ACETABULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10000997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM X 25MM G7 ACETABULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10000998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM X 40MM CANNULATED 0602-65040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "602-65040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM X 45MM POLYAXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "55065-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM X 45MM TILOCK 2 MIS EXTENDED TAB SCREW G741-65-45", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "G741-65-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM X 50MM CANNULATED MIS PEDICLE SYSTEM 0602-6550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "602-6550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM X 50MM OVERWATCH MIS POLY EXTENDED TAB CANNULATED 108-ET-6550C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "108-ET-6550C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM X 50MM POLYAXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "55065-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5MM X 55MM 15001-065-055", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15001-065-055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6.5X 20MM BONE 940-00-020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "940-00-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6MM X 12MM BOLT TENODESIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CM-9506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 797.0, "discounted_cash": 278.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 6MM X 3.0 HBS SDST PKG 20519", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 790.0, "discounted_cash": 276.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0 HEADED CCS SHORT THREAD 55/13MM A-8415.55/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-8415.55/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 928.0, "discounted_cash": 324.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 55 20MM THREAD LENGTH PERI OP ORTHO SMALL JOINTS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-170-055M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1261.0, "discounted_cash": 441.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 60MM STTCS SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "205-70-060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 70MM LONG THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MDS-90-70-010L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 931.0, "discounted_cash": 325.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 70MM LONG THREAD SCREW MSD-010-70-070L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD-010-70-070L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 75MM LONG THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD-010-70-75L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 883.0, "discounted_cash": 309.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 85 LONG THREAD CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206-70-085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1535.0, "discounted_cash": 537.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0MM X 55MM LONG 206-70-055", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206-70-055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1270.0, "discounted_cash": 444.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0MM X 65MM SHORT THREAD HEADED 205-70-030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "205-70-030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0MM X 82MM HEADED FULLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-170-082F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0MM X 85MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1564.0, "discounted_cash": 547.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0MM X 85MM CANNULATED FULL THREAD STAINLESS STEEL 71129085", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71129085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1137.0, "discounted_cash": 397.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0MM X 90MM CANNULATED FULL THREAD STAINLESS STEEL 71129090", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71129090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1137.0, "discounted_cash": 397.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.0MM X 90MM LONG 206-70-090", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206-70-090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.5MMX40MM XIA 3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482317540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1632.0, "discounted_cash": 571.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7.5X4.5MM 15025-075-045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15025-075-045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7MM X 50MM 5560127050FS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5560127050FS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2700.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 7X23MM MILAGRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1082.0, "discounted_cash": 378.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 8.0 X 40MM 508-80-040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "508-80-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3982.0, "discounted_cash": 1393.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ACUTRACK II MICRO 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-C24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1681.0, "discounted_cash": 588.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ACUTWIST 24MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AI-0024-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 376.26, "discounted_cash": 131.69, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AEQUALIS PERFORM REVERSED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1092.0, "discounted_cash": 382.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AIRLOCK 3DEG 16MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP013016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 711.0, "discounted_cash": 248.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AIRLOCK 3MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP013018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 711.0, "discounted_cash": 248.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ALIGN RADIAL STEM 10MM X 0MM ALN-RHI-200", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ALN-RHI-200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4841.0, "discounted_cash": 1694.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANCHOR AVS 3.5 X 10MM ANCHOR-C SELF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48325310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANCHOR AVS 3.5 X 8MM ANCHOR-C SELF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48325308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANCHOR REVCON 4.0MMX 54MM RSA4054", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RSA4054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5570.0, "discounted_cash": 1949.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANCHOR-C 3.5 X 12MM SELF TAPPING SCREW 48325312", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48325312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANCHOR-C 3.5 X 14MM SELF TAPPING SCREW 48325314", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48325314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANCHOR-C 4.0 X 12MM SELF TAPPING SCREW 48325412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48325412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANGLE VARIABLE LKG 2.3MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-2314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.0, "discounted_cash": 223.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANGLED LOCKING 2.0 X 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-2008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANIS III 4.0MM X 50MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 196.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANKLE 2.7MM X 14MM NON-LOCKING 304-27-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-27-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANKLE 3.5MM X 22MM NON-LOCKING 304-35-022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-35-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ANTERIOR LUMBAR 5.5MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10155-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1401.0, "discounted_cash": 490.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AOS 2.7 X 12 MM NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8083-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 451.0, "discounted_cash": 157.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AOS 2.7 X 26 MM NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8083-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 451.0, "discounted_cash": 157.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AOS 3.5 X 44 MM HEADLESS CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8081-044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 698.0, "discounted_cash": 244.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW APTUS 1.2 X 6MM CORTEX BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5100.06/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW APTUS 16 X 2.2MM COMPRESSION CANNULATED HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5780.16/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 904.0, "discounted_cash": 316.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW APTUS 2.2 X 17MM COMPRESSION CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5780.17", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 904.0, "discounted_cash": 316.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW APTUS 2.5 X 12MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.12/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 63.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW APTUS 2.5 X 12MM CORTICAL HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.12/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW APTUS 2.5 X 14MM CORTICAL HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.14/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW APTUS 2.5 X 16MM CORTICAL HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.16/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW APTUS 2.5 X 18MM CORTICAL HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.18/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW APTUS 2.5 X 20MM CORTICAL HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.20/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW APTUS 3.0 X 15MM COMPRESSION CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5880.15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 904.0, "discounted_cash": 316.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW APTUS 3.0 X 22MM CANNULATED COMPRESSION HEXADRIVE 10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5880.22/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 758.0, "discounted_cash": 265.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARESENAL 2.2X12MM 307-22-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-22-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 2.2MM X 10MM 307-22-010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-22-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 2.2MM X 12MM LOCKING 308-22-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-22-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 3.5MM X 16MM LOCKING 308-35-016 308-35-016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-35-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 3.5MM X 16MM NONLOCKING 307-35-016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-35-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 3.5MM X 18MM 307-35-018 307-35-018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-35-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 3.5MM X 18MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-35-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 3.5MM X 20MM 307-35-020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-35-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 3.5MM X 24MM 307-35-024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-35-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 3.5MM X 26MM 307-35-026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-35-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 3.5MM X 28MM 307-35-028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-35-028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 3.5MM X 30MM 307-35-030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-35-030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL 3.5MM X 32MM 307-35-032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-35-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL LOCKING 3.5 X 26MM 308-35-026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-35-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL NON-LOCKING 2.7 X 14MM 307-27-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-27-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL NONLOCKING 2.7 X 24MM 307-27-024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-27-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENAL NONLOCKING 2.7X28MM 307-27-028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-27-028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ASNIS 2MM X 9MM MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20109S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ASNIS 5.0 X 70MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "601770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ASNIS CANULATED 6.5X80 326080S 326080S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "326080S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 566.0, "discounted_cash": 198.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ASNIS III 4MM X 44MM CANNULATED PARTIALLY THREADED STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604644S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ASNIS III 5.0MM X 40MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "601640S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 448.0, "discounted_cash": 156.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ASNIS III 5.0MM X 50MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "601650S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 398.0, "discounted_cash": 139.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ASNIS III 6.5MM X 60MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "602660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 635.0, "discounted_cash": 222.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ASNIS III 6.5MM X 70MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "602670", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 654.0, "discounted_cash": 228.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ASNIS III 6.5MM X 75MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "602675S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 654.0, "discounted_cash": 228.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ASNIS III 6.5MM X 85MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "602685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 231.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ASTURA SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBAA00000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AVID PLATE 3.5X12MM TI LKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ASL35-12T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AVID PLATE3.5X14MM TI LKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ASL35-14T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXOS 4.5 X 24MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXOS 4.5 X 26MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXOS 4.5 X 30MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXOS 4.5 X 32MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 1.0MM X 42MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 3 3.5MM X 20MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 3 3.5MM X 22MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 3 3.5MM X 24MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 3 3.5MM X 26MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 3 3.5MM X 30MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 3 3.5MM X 34MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 3 3.5MM X 36MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 3 3.5MM X 38MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 3 3.5MM X 50MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 3 4MM X 24MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 3.5 X 16MM CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 4.0MM X 26MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 4.5 X 18MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 4.5 X 20MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 4.5 X 22MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 4.5 X 28MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 4.5 X 34MM CORTEX LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 5.0 X 20MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 5.0 X 26MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS 5.0 X 28 MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AXSOS CORTEX 3.5 X 85MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661485", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BG LOCKING 2.0MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-053-2012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BG LOCKING 2.0MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-053-2014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BIO-COMP 11 X 28MM INTERF RD DELTATPR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8028C-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BIOCOMP 8 X 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110004599", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 574.0, "discounted_cash": 200.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BIODRIVE 3.0MM MICRO CANNULATED COUNTERSINK", "code_information": [{"code": "FR300B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 928.0, "discounted_cash": 324.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BIODUR 2.7 X 16MM CANCELLOUS LOCKING ST PT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4828-016-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BIODUR 2.7 X 18MM CANCELLOUS LOCKING ST PT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4828-018-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BIODUR 2.7 X 26MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4828-026-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BIODUR 2.7 X 48MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4828-048-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BIODUR 3.5 X 18MM 108C ALLOY LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2359-018-38", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 57.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BIOSURE 9MM X 25MM REGENESORB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72204404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 416.0, "discounted_cash": 145.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BLUE 2.5MM X 30MM HD7 LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.30/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BLUE 2.8MM X 14MM TRILOCK HD7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.14/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BLUE 2.8MM X 24MM TRILOCK HD7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.24/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BLUE 2.8MM X 55MM TRILOCK HD7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.55/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BLUNT TIP 4 X 30MM CANN LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5051-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BLUNT TIP 4 X 38MM CANN LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5051-38", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BN 25MM REDAPT LCK 71354504", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71354504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.2MM X 3MM CROSS PIN SELF DRILLING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "50-12903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 233.0, "discounted_cash": 81.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.2MM X 4MM SLF DRILLING NON STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "50-12904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 242.0, "discounted_cash": 84.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.5MM X 10MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-20-510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.5MM X 11MM CORTICAL HEXADRIVE 4 IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5200.11/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.5MM X 12MM CORTICAL HEXADRIVE 4 IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5200.12/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.5MM X 13MM CORTICAL HEXADRIVE 4 IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5200.13/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.5MM X 14MM CORTICAL HEXADRIVE 4 IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5200.14/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.5MM X 18MM CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.818.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.5MM X 18MM CORTICAL HEXADRIVE 4 IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5200.18/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.5MM X 24MM CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.824.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.5MM X 7MM CORTICAL HEXADRIVE 4 IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5200.07/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.5MM X 8MM NON STRL HND IMP NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-20-508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.6MM X 12MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "330-1612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 222.26, "discounted_cash": 77.79, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.6MM X 9MM FULLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "331-1609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.76, "discounted_cash": 42.27, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7 X 7MM 662607", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7 X 9MM 662609", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 10MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17010E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 10MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17010E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 11MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17011E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 11MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17011E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 12MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17012E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 12MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17012E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 13MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17013E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 13MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17013E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 14MM CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17014E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 14MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17014E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 15MM CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17015E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 16MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17016E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 18MM CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17018E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 18MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17018E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17020E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 22MM CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17022E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 22MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17022E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 24MM CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17024E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 24MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17024E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 5MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17005E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 5MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17005E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 6MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17006E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 6MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17006E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 7MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17007E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 7MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17007E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 211.0, "discounted_cash": 73.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 8MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17008E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 8MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17008E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 9MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-17009E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.7MM X 9MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-17009E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.9MM X 10MM EMERGENCY CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-19010E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.9MM X 12MM EMERGENCY CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-19012E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.9MM X 5MM EMERGENCY CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-19005E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 1.9MM X 8MM EMERGENCY CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-19008E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM LEN 2.4 MSM 4MM HEAD CORTEX T8 STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.76", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM LEN 2.7 DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.81", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM VAR ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "102-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM X 2.5MM CORTICAL HEXADRIVE 7 SELF TAPPING TITANIUM IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.10/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM X 20MM KNEE BIOCOMPOSITE BIPHASIC CALCIUM PHOSPHATE AND POLY L L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1586RC-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM X 20MM REVERSE THREAD POLY L LACTIC ACID FOR SOFT TISSUE GRAFT F", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1586LB-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM X 20MM TIBL FEMRL POLY L LACTIC ACID FOR SOFT TISSUE GRAFT FXTN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1586RB-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM X 23MM TAPERED MILAGRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM X 23MMINTERFERENCE KNEE POLYLACTIC CO GLYCOLIC ACID COMPOSITE MI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 861.0, "discounted_cash": 301.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM X 25MMINTERFERENCE COMPOSITCP 60 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "905259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 657.0, "discounted_cash": 229.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM X 3.5MM HEAD 6MM SOCKET 2.5MM CORTEX HEXAGONAL ORTHO SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.81", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM X 3.5MM T20 CLAVICLE SCREW SET LOCKED PLATING SYS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 358.0, "discounted_cash": 125.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM X 30MMINTERFERENCE KNEE POLYLACTIC CO GLYCOLIC ACID COMPOSITE MI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 861.0, "discounted_cash": 301.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 10MM X 50MM SLOTTED HYDROXYAPATITE SILOK IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "139.506S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9785.0, "discounted_cash": 3424.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 11MM X 1.5MM CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.811.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 11MM X 2.5MM CORTICAL HEXADRIVE 7 SELF TAPPING TITANIUM IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.11/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 12MM LEN 2.4 DIA 4MM HEAD CORTEX T8 STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 12MM LEN 2.7 DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 12MM X 2.7MM CORTEX T15 PERI LOC SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73823012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 12MM X 3.5MM CORTEX SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-1312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 12MM X 3.5MM T20 PERI LOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 200.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 13MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS13000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 13MM X 1.5MM CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.813.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 13MM X 2.4MM RECESS 13MM HEAD 4MM CORTEX T8 STARDRV SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.763", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 13MM X 2.5MM CORTICAL HEXADRIVE 7 SELF TAPPING TITANIUM IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.13/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 80.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 14MM LEN 2.3 DIA CANNULATED LAG SLF DRILLING CORT 0.034IN GUIDE WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-13120T-14C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 291.0, "discounted_cash": 101.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 14MM LEN 2.4 DIA 4MM HEAD CORTEX T8 STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 14MM LEN 2.7 DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 14MM SLF DRILLING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IM71059-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 14MM X 2.5MM CORTICAL HEXADRIVE 7 SELF TAPPING TITANIUM IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.14/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 284.0, "discounted_cash": 99.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 14MM X 2.7MM HEAD 3.5 T8 STARDRV ORTHO SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 14MM X 3.5MM 6MM HEAD SOCKET 2.5MM CORTEX HEXAGONAL ORTHO SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.94, "discounted_cash": 19.23, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 14MM X 3.5MM CORTICAL IMPLANT LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "816135014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 14MM X 3.5MM X 6MM SLF TAPPING HEXAGONAL SOCKET CORTEX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "404.814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 14MM X 4MM X 6MM FULLY THREADED HEXAGONAL SOCKET CANCELLOUS TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "406.014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 15MM SPHERICAL HEAD R3 REFLECTION IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71332515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 244.0, "discounted_cash": 85.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 15MM X 2.5MM CORTICAL HEXADRIVE 7 SELF TAPPING TITANIUM IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.15/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 16MM LEN 2.4 M DIA 2.4MM HEAD CORTEX T8 STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.766", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 16MM LEN 2.7 DIA 5MM HEAD CORTEX HEXAGONAL SOCKET SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 18MM LEN 2.7 DIA 5MM HEAD CORTEX HEXAGONAL SOCKET SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 18MM LEN 3.5 DIA CORTEX HEXAGONAL SOCKET SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "404.818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 18MM X 3.5MM CORTEX SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-1318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 7MM X 46MM LCKNG VAR ANGLE T8 STARDRV RECESS SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 119.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 STEP IMPLANT 2.6MM X 2.4MM X 8MM HAMMER TOE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204-24-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3698.0, "discounted_cash": 1294.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 X 10MM CORTEX MODULAR HND SYS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.810.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.5, "discounted_cash": 14.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 X 11MM CORTEX MODULAR HND SYS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.811.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 X 12MM CORTEX MODULAR HND SYS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.812.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 X 13MM CORTEX MODULAR HND SYS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.813.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 X 14MM CORTEX MODULAR HND SYS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.814.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 X 16MM CORTEX MODULAR HND SYS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.816.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 X 18MM CORTEX MODULAR HND SYS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.818.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 X 20MM CORTEX MODULAR HND SYS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.820.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 X 22MM CORTEX MODULAR HND SYS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.822.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2 X 24MM CORTEX MODULAR HND SYS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.824.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2. 7MM X 18MM LOCKING VAR ANGLE T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 362.3, "discounted_cash": 126.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0 X 12 QFX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71102282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 682.0, "discounted_cash": 238.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0 X 12MM Q FIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71102282S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 682.0, "discounted_cash": 238.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0 X 13MM SNAP OFF SYS NEXFIX TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NSO-2013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 682.0, "discounted_cash": 238.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0 X 15MM CANNULATED MICRO IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0 X 28MM INFRAME IMPLANT EXINF922028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINF922028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3968.0, "discounted_cash": 1388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0 X 30MM INFRAME IMPLANT EXINF922030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINF922030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0MM X 10.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4001-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0MM X 12.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4001-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0MM X 14MM TWIST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SFT-2014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 414.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0MM X 15.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4001-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0MM X 16.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4001-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0MM X 20.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4001-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.0MM X 24MM CORTEX CRUCIFORM RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.2MM X 22MM CROSSLOCK SMOOTH PEG DIST RADIUS PLATING SYS DVR LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3 X 12MM BIODRIVE MICRO", "code_information": [{"code": "V2312B", "type": "CDM"}], "standard_charges": [{"gross_charge": 849.0, "discounted_cash": 297.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3 X 14MM BIODRIVE MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V2314B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 917.0, "discounted_cash": 320.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3 X 16MM BIODRIVE MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V2316B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 917.0, "discounted_cash": 320.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3 X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23224E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM 11MM VARIAX T6 NONSTERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM 9MM VARIAX T6 NONSTERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23010E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 10MM CROSS PIN SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52-23010E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 10MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23010E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 11MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23011E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 172.0, "discounted_cash": 60.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 11MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23011E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23012E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 12MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23612E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 351.0, "discounted_cash": 122.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 12MM T7 VARIAX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23212E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 293.0, "discounted_cash": 102.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 13MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23013E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 13MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23013E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 13MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23014E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 14.0MM CROSS PIN SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52-23014E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 311.0, "discounted_cash": 108.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 14MM CT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23214E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 14MM IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23614E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 14MM ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23014E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 14MM THREADED LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-T2314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.76, "discounted_cash": 76.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 15MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23015E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 16MM CORTICAL LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-T2316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.76, "discounted_cash": 76.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 16MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23616E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 16MM LCKNG CT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23216E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 16MM LCKNG ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23016E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 16MM TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52-23616E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 18.0MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23218E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 18MM CORT VAR ANGLE VOLAR DIST RADIUS PLATING SYS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-2318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.0, "discounted_cash": 223.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 18MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23618E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 351.0, "discounted_cash": 122.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 18MM LCKNG ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23018E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 18MM TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52-23618E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 20.0MM CROSS PIN SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52-23020E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 311.0, "discounted_cash": 108.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23220E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 20MM CORTICAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-13123-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 192.0, "discounted_cash": 67.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 20MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23620E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 20MM LCKNG ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23020E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 20MM THREADED IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-T2320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.76, "discounted_cash": 76.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23222E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 22MM CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23022E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 22MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 22MM LCKNG STR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23022E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 22MM TI LCKNG ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23622E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 24MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23024E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 24MM DISTAL RADIAL FULLY THREADED T7 DRIVE VARIAX TITANIUM STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23624E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 26MM CORTICAL NON TOGGLING THREADED NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-N2326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.5, "discounted_cash": 52.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 26MM CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23026E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 26MM CROSS PIN SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23026E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 26MM DISTAL RADIAL FULLY THREADED T7 DRIVE VARIAX TITANIUM STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23626E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 6MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23006E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 8MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23008E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 8MM ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23008E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 9MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23009E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 32.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.3MM X 9MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-23009E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4 X 10 MM SELF TAPPING TI 401.510.96", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.510.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4 X 12 MM SELF TAPPING TI 401.512.96", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.512.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM 28MM CORTEX ORTHO SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.528.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 201.0, "discounted_cash": 70.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM 60MM VAR ANGLE STARDRV RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.210.160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 10MM LOCKING STAR DRIVE SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.210.110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 10MM LOW PROFILE CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 10MM STARDRV T8 SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.81", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 10MM VAR ANGLE STARDRV TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.210.110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 11MM 4.5MM HEAD DIA CRUCIFORM RECESS CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.511.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 12MM 3.5MM HEAD T8 STARDRV SLF TAP SS IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 238.0, "discounted_cash": 83.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 12MM LOCKING STAR DRIVE SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.210.112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 12MM LOW PROFILE CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 12MM STARDRV T8 SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 303.4, "discounted_cash": 106.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 12MM VAR ANGLE STARDRV LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.210.112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 13MM CRUCIFORM RECESS CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.513.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 14MM 3.5MM HEAD T8 STARDRV SLF TAP SS IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 238.0, "discounted_cash": 83.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 14MM CANNULATED CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "306-2414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 14MM CANNULATED HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-2414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 711.0, "discounted_cash": 248.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 14MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-2414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 127.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 14MM CORTEX LOW PROFILE TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 438.0, "discounted_cash": 153.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 14MM CRUCIFORM RECESS CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.514.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 14MM X 3.5MM STARDRV T8 SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 303.4, "discounted_cash": 106.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 16MM CANNULATED HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-2416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 16MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "306-2416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 16MM CANNULATED LAG ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-2416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 127.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 16MM CANNULATED TIGER IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 16MM CRUCIFORM RECESS CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.516.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 16MM HEAD 3.5MM T8 STARDRV ORTHO SLF TAP SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 569.0, "discounted_cash": 199.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 16MM LOCKING STAR DRIVE SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.210.116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 16MM X 3.5MM STARDRV T8 SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 303.4, "discounted_cash": 106.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 18MM CANNULATED HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-2418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 18MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-2418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 422.0, "discounted_cash": 147.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 18MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 18MM CRUCIFORM RECESS CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.518.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 18MM HEAD 3.5MM T8 STARDRV ORTHO SLF TAP SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 238.0, "discounted_cash": 83.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 18MM LOCKING VAR ANGLE T8 STARDRV RECESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.210.118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 18MM VAR ANGLE W/ STARDRV RECESS TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.210.118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 18MM X 3.5MM STARDRV T8 SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 20MM 4.5MM HEAD DIA CRUCIFORM RECESS CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.520.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 20MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 20MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-2420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 20MM LOCKING VAR ANGLE T8 STARDRV RECESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.210.120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 20MM STARDRV SLF TAP SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.82", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 229.0, "discounted_cash": 80.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 20MM VAR ANGLE STARDRV TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.210.120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 20MM X 3.5MM STARDRV T8 SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.82", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 303.4, "discounted_cash": 106.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 22MM COMPRESSION HEADLESS CANNULATED LNG THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.226.322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 784.0, "discounted_cash": 274.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 22MM CRUCIFORM RECESS CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.522.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 22MM HEAD 3.5MM T8 STARDRV ORTHO SLF TAP SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 275.0, "discounted_cash": 96.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 22MM X 3.5MM STARDRV T8 SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19.6, "discounted_cash": 6.86, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 24MM 3.5MM HEAD T8 STARDRV SLF TAP SS IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 24MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 24MM CORTEX ORTHO SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.524.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 24MM LOCKING VAR ANGLE T8 STARDRV RECESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.210.124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 24MM LOW PROFILE CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 24MM X 3.5MM STARDRV T8 SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 26MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 26MM CORTEX W/ T8 STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 26MM LOCKING STAR DRIVE SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.210.126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 26MM LOW PROFILE CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724-26", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 28MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 28MM CORTEX T8 STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.778", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 28MM LOCKING STAR DRIVE SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.210.128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 116.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 28MM T8 STARDRV RECESS SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 30MM 4.5MM HEAD CORTEX CRUCIFORM RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.530.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 30MM CORTEX T8 STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.78", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 44.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 30MM T8 STARDRV RECESS SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.83", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 265.0, "discounted_cash": 92.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 6MM 4.5MM HEAD DIA CRUICIFORM RECESS CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.506.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 6MM CORTEX T8 STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 6MM T8 STARDRV RECESS SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.806", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 7MM 4.5MM HEAD DIA CRUCIFORM RECESS CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.507.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 8MM 3.5MM HEAD T8 STARDRV SLF TAP SS IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 284.0, "discounted_cash": 99.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 8MM 4.5MM HEAD DIA CRUCIFORM RECESS CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.508.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 8MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 8MM CORTEX T8 STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.758", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 8MM T8 STARDRV RECESS SLF TAP TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.4MM X 9MM 4.5MM HEAD DIA CRUCIFORM RECESS CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.509.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 207.0, "discounted_cash": 72.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5 X 16 MM NL CORTEX GOLD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.16/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 284.0, "discounted_cash": 99.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5 X 26MM LOCKING ARTHRODESIS TRILOCK HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.26/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 10MM EMERGENCY CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-25010E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 10MM PEG IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP10000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 12MM EMERGENCY CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-25012E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 12MM FIXOS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SV12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 923.0, "discounted_cash": 323.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 14MM CANNINTERNAL FXTN SYS LOW PROFILE TI6 METASURG TI STRL I", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC-2514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 14MM CANNULATED COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SV14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 907.0, "discounted_cash": 317.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 14MM HEADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IC2514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 14MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP14000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 16.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4002-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 16MM BLUE LAG IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25-16T-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 16MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC-2516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 16MM CANNULATED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DIN25016S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 16MM CORTICAL MULTI DIRECTIONAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-11-116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 16MM HEADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IC2516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 18MM BLUE LAG IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25-18T-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 516.0, "discounted_cash": 180.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 18MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC2518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 18MM CORTICAL MULTI DIRECTIONAL THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-11-118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 18MM FULLY THREADED PEG LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 18MM PEG NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP18000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 20MM PEG FULLY THREADED LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 22MM PEG IMP NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP22000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 24MM PEG NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP24000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 50.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 28MM LAG CANNULATED TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25-28T-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 28MM PEG NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP28000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 30.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4002-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 30MM COMPRESSION HEADLESS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SV30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 907.0, "discounted_cash": 317.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 6MM EMERGENCY CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-25006E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 8MM EMERGENCY CROSS PIN SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-25008E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.5MM X 8MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.6MM X 5MM SPINAL CENTERPIECE TITANIUM STERILE IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "853-465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.6MM X 7MM SPINAL CENTERPIECE TITANIUM STERILE IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "853-467", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7 MM X 14MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52-27614E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7 X 10 MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8087-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2876.0, "discounted_cash": 1006.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7 X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-27010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7 X 10MM VA LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7 X 12 MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8087-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1438.0, "discounted_cash": 503.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7 X 12MM CORTICAL LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8163-27-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 213.0, "discounted_cash": 74.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7 X 14MM CORTICAL LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8163-27-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 213.0, "discounted_cash": 74.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7 X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27220E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7 X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.75MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1896-5027S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 158.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM 24MM T8 METAPHYSEAL STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM THREAD CONTOUR VPS 2.7MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC2718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 10.0MM VAR ANGLE TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.211.010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 10MM GRN STNADARD IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-2710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 10MM LOCKING VAR ANGLE T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 10MM LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827L-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 10MM METAPHYSEAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 10MM T7 LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-27610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 406.0, "discounted_cash": 142.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 10MM T8 CORTEX SLF TAPPING STARDRV RECESS TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.87", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12.0MM VAR ANGLE TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.211.012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12MM CORTEX SELF TAPPING IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12MM DVR CROSSLOCK LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 72.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12MM FOR DIST RADIUS LOCKING PLATE SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27212E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12MM LCKNG TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52-27612E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12MM LCKNG VAR ANGLE T8 STARDRV RECESS SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27612E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 351.0, "discounted_cash": 122.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12MM LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827L-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12MM T8 CORTEX SLF TAPPING STARDRV RECESS TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 12MM T8 FULL THREAD LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 14MM CORTEX SELF TAPPING IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 14MM CROSSLOCK DISTAL RADIUS PLATING SYSTEM DVR LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 14MM FOR DIST RADIUS LOCKING PLATE SYS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27214E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 293.0, "discounted_cash": 102.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 14MM LCKNG VAR ANGLE T8 STARDRV RECESS SLF TAP SS 02.211.014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 14MM LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827L-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 14MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 14MM STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-2714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 14MM T8 CORTEX SLF TAPPING STARDRV RECESS TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 14MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52-27014E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 311.0, "discounted_cash": 108.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 15MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16.0MM VAR ANGLE TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.211.016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM FOR DIST RADIUS LOCKING PLATE SYS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27216E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27616E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM LCKNG VAR ANGLE T8 STARDRV RECESS SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827L-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM METAPHYSEAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM METAPHYSEAL S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 81.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM MULTIDIRECTIONAL CROSSLOCK DIST RADIUS PLATING SYS DVR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 313.0, "discounted_cash": 109.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM SELF TAPPING TITANIUM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM SQUARE IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 201.6, "discounted_cash": 70.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 16MM T8 CORTEX SLF TAPPING STARDRV RECESS TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.876", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 18.0MM VAR ANGLE TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.211.018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 18MM CROSSLOCK DIST RADIUS PLATING SYS DVR LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 18MM GRN STANDARD FPS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-2718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 18MM LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827L-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 18MM T8 CORTEX SLF TAPPING STARDRV RECESS TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.878", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 20MM LCKNG VAR ANGLE T8 STARDRV RECESS SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 20MM LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827L-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 20MM METAPHYSEAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 81.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 20MM STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-2720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 20MM T7 LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-27620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 20MM T8 CORTEX STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.88", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 22 M LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827L-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 22MM CORTEX SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 22MM CROSSLOCK DISTAL RADIUS PLATING SYSTEM DVR LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 22MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 22MM LCKNG VAR ANGLE T8 STARDRV RECESS SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 22MM METAPHYSEAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 22MM NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27222E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 146.0, "discounted_cash": 51.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 22MM T7 LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-27622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 22MM T8 CORTEX STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.882", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 22MM VAR ANGLE W/ T8 STARDRV RECESS SLF TAP TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.211.022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27224E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 293.0, "discounted_cash": 102.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 24MM LCKNG VAR ANGLE T8 STARDRV RECESS SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 354.0, "discounted_cash": 123.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 24MM LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827L-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 24MM T8 CORTEX STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 24MM VAR ANGLE W/ T8 STARDRV RECESS SLF TAP TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.211.024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27226E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 101.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 26MM CORTEX SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 26MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 26MM LOCKING VAR ANGLE T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 26MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 26MM T7 VARIAX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-27026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 26MM T8 CORTEX STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 26MM VAR ANGLE W/ T8 STARDRV RECESS SLF TAP TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.211.026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 28MM CORTEX SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71823028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 28MM METAPHYSEAL T8 STAR DRIVE RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 123.14, "discounted_cash": 43.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 28MM T8 CORTEX STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 30MM LOCKING VAR ANGLE T8 STARDRV RECESS SLF TAP 02.211.030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 30MM METAPHYSEAL T8 STAR DRIVE RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 30MM T7 VARIAX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-27030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 30MM T8 CORTEX STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.89", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC2732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 34MM METAPHYSEAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 36MM METAPHYSEAL T8 STAR DRIVE RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 36MM VAR ANGLE W/ T8 STARDRV RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 119.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 40MM LCKNG VAR ANGLE T8 STARDRV RECESS SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 44MM VAR ANGLE W/ T8 STARDRV RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 119.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 46.0MM VAR ANGLE TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.211.046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 50MM LOCKING VAR ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 70MM T10 F-T LOCK STARDRIVE VARIAX FOOT PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7MM X 8MM LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827L-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7X20MM LOCKING FULL THREAD(2) 656320", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 143.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7X22MM LOCKING FULL THREAD 656322", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 143.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2.7X22MM LOCKING FULL THREAD 657322", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 20MM LEN 2.4 DIA 4MM HEAD CORTEX T8 STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.77", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 20MM MINI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-M20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1681.0, "discounted_cash": 588.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 20MM SPHERICAL HEAD REFLECTION IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71332520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 20MM X 2.5MM CORTICAL HEXADRIVE 7 SELF TAPPING TITANIUM IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.20/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 80.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 20MM X 3.5MM CORTEX SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-1320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 20MM X2.7MM HEAD 3.5MM T8 STARDRV ORTHO SLF TAP SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 22MM 2.7 DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 22MM CORTEX NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.22/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 22MM FRS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P3022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 22MM LEN 2.4 DIA 4MM HEAD CORTEX T8 STARDRV RECESS SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 22MM LEN 2.7 DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 22MM LEN 3.5 DIA CORTEX HEXAGONAL SOCKET SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "404.822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 22MM MINI ACUTRAK 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-M22-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1889.0, "discounted_cash": 661.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 22MM X 2.7MM HEAD 3.5 T8 STARDRV ORTHO SLF TAP SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 23MM COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "VDV223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 23MM X 10MM KNEEINTERFERENCE DISPOSABLE SHEATH POLY L LACTIC ACID AND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1400C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 692.0, "discounted_cash": 242.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 23MM X 8MM BIOINTERFERENCE DISPOSABLE SHEATH POLY L LACTIC ACID AND B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1380C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 183.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 24MM X 3.5MM 6MM HEAD 2.5 SOCKET CORTEX HEXAGONAL ORTHO SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 25MM ACTBLR CANCELLOUS UNIVERSAL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71336562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 25MM SPHERICAL HEAD REFLECTION IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71332525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 290.4, "discounted_cash": 101.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 26MM 2.4MM DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.526.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 26MM LEN 2MM DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.826.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM 16MM AUTOFX SS ORTH CANN CMPR TWN PTCH MOD T7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "141-2016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 541.0, "discounted_cash": 189.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM 18MM APTUS TRI-LOCK TIT FOOT HAND ELBOW WRIST CORTICAL HEX 6 LOCK A-5450.18/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5450.18/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 10MM BLUE TRILOCK HEXADRIVE 6 IMPLANT LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5450.10/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 10MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 10MM CORTICAL IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "322-2010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 10MM STANDARD IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-2010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 11MM TWIST IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SFT-2011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 414.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 11MM TWIST OFF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WS11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 754.0, "discounted_cash": 263.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 12MM 5MM CANNULATED ASNIS MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 12MM BLUE TRILOCK HEXADRIVE 6 IMPLANT LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5450.12/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 12MM CANNULATED PARTIALLY THREADED QUICKFIX TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8720-12PT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 303.52, "discounted_cash": 106.23, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 12MM STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-2012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 12MM TWIST OFF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WS12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 754.0, "discounted_cash": 263.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 13MM MICRO CANNULATED ASNIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20113", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 606.0, "discounted_cash": 212.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 13MM TWIST OFF FIXOS IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WS13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1077.0, "discounted_cash": 376.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 14MM 6MM CANNULATED ASNIS MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 14MM BLUE HND TRILOCK HEXADRIVE 6 TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5450.14/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 14MM HEADED DART FIRE TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DIN20014S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 14MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-2014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 14MM MICRO CANNULATED ASNIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20114s", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 14MM STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-2014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 15MM 6MM CANNULATED ASNIS MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 16MM 7MM ASNIS MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 16MM CANNULATED PARTIALLY THREADED QUICKFIX TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8720-16PT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 16MM CORTICAL LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "322-2016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 16MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-2016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 266.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 16MM STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-2016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 18MM CANNULATED ASNIS MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 18MM CANNULATED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DIN200185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 18MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-20-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 20MM HEADED DART FIRE IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DIN20020S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 20MM HEADLESS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "141-2020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 884.0, "discounted_cash": 309.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 20MM IMP NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IFS-203020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 247.0, "discounted_cash": 86.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 22MM BLUE HND TRILOCK HEXADRIVE 6 TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5450.22/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 22MM HEADLESS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "141-2022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 884.0, "discounted_cash": 309.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 22MM IMP NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IFS-203022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 247.0, "discounted_cash": 86.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 22MM X 5MM FULL THREAD CANNULATED ASNIS TI STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20122S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 24MM BLUE HND TRILOCK HEXADRIVE 6 TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5450.24/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 24MM CANNULATED HEADLESS EXTREMIFIX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-2024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 657.0, "discounted_cash": 229.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 24MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-2024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 26MM DIGITAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-2026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 26MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-2026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 657.0, "discounted_cash": 229.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 28MM CANNULATED HEADLESS EXTREMIFIX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-2028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 657.0, "discounted_cash": 229.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 6MM STARDRV RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.876", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 32.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 8MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-2008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 2MM X 8MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-20-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0 X 22MM HEADLESS COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V30228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 849.0, "discounted_cash": 297.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0 X 26 MM CANN SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-130-026s", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0 X 32MM COMPRESSION DART-FIRE CANN ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N30032S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0 X 36MM COMPRESSION DART-FIRE CANN ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N30036S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 10MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4F01-2010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 12MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4F01-1012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 428.0, "discounted_cash": 149.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 14MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4F01-1014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 428.0, "discounted_cash": 149.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 16MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4F01-1016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 428.0, "discounted_cash": 149.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 16MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4F01-2016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 18MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4F01-1018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 441.0, "discounted_cash": 154.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 20.0MM X 5.0MM FULLY THREADED CANNULATED FOR HAND ASNS MICRO TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-30120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 22MM CANN SLF DRILLING LNG THREAD SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 24.0MM X 6.0MM FULLY THREADED CANNULATED FOR HAND ASNS MICRO TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-30124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 26.0MM X 6.0MM FULLY THREADED CANNULATED FOR HAND ASNS MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-30126S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 28.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4003-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 381.0, "discounted_cash": 133.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 28.0MM X 6.0MM FULLY THREADED CANNULATED FOR HAND ASNS MICRO TITANIUM STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-30128S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 28MM CANNULATED TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC3028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 30.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4003-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 381.0, "discounted_cash": 133.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 34.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4003-34", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 381.0, "discounted_cash": 133.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 36.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4003-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 381.0, "discounted_cash": 133.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 40.0MM X 6.0MM FULLY THREADED CANNULATED FOR HAND ASNS MICRO TITANIUM STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-30140S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.0MM X 8MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4F01-1008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 428.0, "discounted_cash": 149.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.2MM X 14MM IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LCBS3.2-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5 X 10MM CORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS100000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 42.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5 X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 49.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5 X 18MM CHROME MULTIDIRECTIONAL LOCKING SELF TAPPING COBALT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8163-35-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 110.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5 X 28MM CORTICAL LOW PROFILE STAINLESS STEEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5 X 40MM AXOS CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.50MM X 34.0MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4004-34", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM 10MM VAR ANGLE STARDRV SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.127.110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM 2.5MM 12MM ORTHOLOC FULL THREAD MIDFOOT CORTICAL LOW PROFILE HEAD SELF TAP BRONZE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM 36MM STAINLESS STEEL T15 SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE MEDIAL C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.127.136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM 46MM VAR ANGLE STARDRV SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.127.146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM 54MM VAR ANGLE STARDRV SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.127.154", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM 60MM VAR ANGLE STARDRV SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.127.160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM 65MM CONICAL FULLY THREADED SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 337.0, "discounted_cash": 117.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM 70MM CONICAL FULLY THREADED SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 337.0, "discounted_cash": 117.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM 70MM VAR ANGLE STARDRV SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.127.170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM 75MM VAR ANGLE STARDRV SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.127.175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM 80MM VAR ANGLE STARDRV SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.127.180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4F01-1010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 441.0, "discounted_cash": 154.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM CORTEX SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM CORTICAL DVRA PLATE SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS10000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 42.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM CORTICAL LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8161-35-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM HEXALOBE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 651.0, "discounted_cash": 227.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM HEXALOBE NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.26, "discounted_cash": 43.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM LOW PROFILE CORTICAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM ORTHO HELIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-011-35-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM PERILOC VLP SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 301.0, "discounted_cash": 105.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM T10 LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 10MM T10 NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 184.0, "discounted_cash": 64.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 112MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-011-35-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM 6MM HEAD DIA CORTEX SM 2.5 MM HEXAGONAL SOCKET SLF TAP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM CORTEX PERI LOC VLP SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM CORTEX T20 SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7382-4012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM CORTICAL DVRA PLATE SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS12000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-021-35-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM LOW PROFILE CORTICAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835L-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM LOW PROFILE TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935L-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 87.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM LOW PROFILE TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 130.08, "discounted_cash": 45.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM T10 ANKLE FRACTURE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 758.0, "discounted_cash": 265.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 12MM T10 NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM CORTEX T 15 STAR DRIVE ACCESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.200.014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 23.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM CORTEX T20 SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7382-4014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS14000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM CORTICAL PERILOC SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM CORTICAL SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM HEXALOBE THREADED LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM IMP ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3601-13514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM LCKNG ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-021-35-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 467.0, "discounted_cash": 163.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM LOW PROFILE CORTICAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM LOW PROFILE MIDFOOT TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935L-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 87.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835L-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM LOW PROFILE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 130.08, "discounted_cash": 45.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-011-35-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 467.0, "discounted_cash": 163.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM PERILOC VLP SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 282.0, "discounted_cash": 98.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM SLF TAP LCKNG ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM T10 ANKLE FRACTURE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 413.0, "discounted_cash": 144.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 14MM T10 NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 15MM CORTICAL DVRA PLATE SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS15000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-011-35-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM 6MM HEAD DIA CORTEX SM 2.5 MM HEXAGONAL SOCKET SLF TAP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM 6MM THREAD SHAFT SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM CORTEX SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM CORTEX STAR DRIVE SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.200.016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 23.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS16000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 42.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM CORTICAL LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "816135016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM CORTICAL LOW PROFILE ANATOMIC LOCKED PLATE SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-18-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 32.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM CORTICAL SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM FIXED ANGLE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-021-35-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM HEXALOBE THREADED LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM LOCKING LRG FRAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM LOW PROFILE CORTICAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM LOW PROFILE SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835L-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM LOW PROFILEFT ANKLE TI LCKNG DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935L-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 87.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM PERILOC VLP SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 376.0, "discounted_cash": 131.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM SLF TAP LCKNG TM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM T10 ANKLE FRACTURE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 16MM T10 NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18.0MM LOW PROFILE CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.206.218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM 16MM THREAD SHAFT SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM 6MM HEAD DIA CORTEX SM 2.5 MM HEXAGONAL SOCKET SLF TAP S 204.818", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM COMPRESSION CANNULATED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS18A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 907.0, "discounted_cash": 317.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM CORTEX PERI LOC VLP SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM CORTEX STAR DRIVE SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.200.018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM CORTICAL LOW PROFILE ANATOMIC LOCKED PLATE SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-18-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 161.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM CORTICAL SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM HEXALOBE NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-021-35-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM LCKNG CORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "37351-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM LOW PROFILE CORTICAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM PERILOC VLP SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM SLF TAP LCKNG STRDRV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 18MM T10 NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 184.0, "discounted_cash": 64.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM 6 THREAD SHAFT SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM COMPRESSION CANNULATED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS20A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 907.0, "discounted_cash": 317.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM CORTEX T20 SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73824020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM CORTICAL LOW PROFILE IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-18-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 32.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM CORTICAL SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM HEXALOBE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM HEXALOBE THREADED NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.26, "discounted_cash": 43.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM LOW PROFILE AR-8835-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM LOW PROFILEFT ANKLE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935L-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 87.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM MAXLOCK EXTREME IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-021-35-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 467.0, "discounted_cash": 163.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM PERILOC VLP SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM T10 NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM T20 CORTICAL PERILOC SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73824022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 20MM T20 PERILOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 200.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 22MM 6MM HEAD DIA CORTEX SM 2.5 MM HEXAGONAL SOCKET SLF TAP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 22MM 6MM THREAD SHAFT SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 22MM CORTEX SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 22MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 22MM HEXALOBE CORTICAL THREADED NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.26, "discounted_cash": 43.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 22MM NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4F01-2022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 397.0, "discounted_cash": 138.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 22MM SLF TAP IMP LCKNG ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 358.0, "discounted_cash": 125.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 22MM SLF TAP LCKNG STRDRV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.0, "discounted_cash": 76.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 22MM T10 NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 22MM T15 STARDRV RECESS THREADED CONICAL HEAD SLF TAP TI LCKN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "412.107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 310.0, "discounted_cash": 108.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 24MM 10MM THREAD SHAFT SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 24MM CORTEX HEXAGONAL SOCKET SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "404.824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 24MM CORTEX T20 SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73824024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 24MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 24MM LCKNG ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-021-35-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 467.0, "discounted_cash": 163.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 24MM LOW PROFILE CORTICAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 24MM LOW PROFILE TI IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935L-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 87.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 24MM NON LCKNG ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-011-35-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 24MM PURPLE CORTICAL IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8161-35-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 24MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 24MM T20 PERILOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 406.0, "discounted_cash": 142.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM 10MM THREAD SHAFT SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM 6MM HEAD DIA CORTEX SM 2.5 MM HEXAGONAL SOCKET SLF TAP S 204.826", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.94, "discounted_cash": 19.23, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM CORTEX HEXAGONAL SOCKET SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "404.826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM CORTEX SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-1324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM CORTICAL IMP NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8150-37-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM CORTICAL LCKNG ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8161-35-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM CORTICAL PERI LOC SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-1326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM HEXALOBE IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM LOW PROFILE CORTICAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-26", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM LOW PROFILE FOR MIDFOOT PLATING MODULE TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935L-26", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 87.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 310.0, "discounted_cash": 108.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 26MM T10 NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 184.0, "discounted_cash": 64.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 28MM 10MM SHAFT SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 28MM 6MM HEAD DIA CORTEX SM 2.5 MM HEXAGONAL SOCKET SLF TAP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.94, "discounted_cash": 19.23, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 28MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 28MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 50.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 30MM 10MM THREAD SHAFT HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.23", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 30MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 30MM LOW PROFILE CORTICAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 30MM PERI LOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 30MM SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 200.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 30MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 32MM 12 THREAD SHAFT SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 32MM 6MM HEAD DIA CORTEX SM 2.5 MM HEXAGONAL SOCKET SLF TAP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 32MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3112-035-0325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 575.0, "discounted_cash": 201.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 32MM CORTICAL LOW PROFILE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935-32", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 354.0, "discounted_cash": 123.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 32MM CORTICAL PERI LOC SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 32MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 32MM SLF TAP LCKNG STRDRV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 34MM 12MM THREAD SHAFT SM HEXAGONAL SHAFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 34MM CANNULATED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DIN350345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 123.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 34MM CORTICAL LOW PROFILE SS NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-34", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 34MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 34MM LOW PROFILE CORTICAL TI DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935-34", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 169.0, "discounted_cash": 59.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 34MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.113", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 310.0, "discounted_cash": 108.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 34MM T20 PERILOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 200.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 35MM HEAD 5MM T15 STARDRV ORTHO FOR THREADED HOLE 2.8 MM SLF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 36MM 10MM THREAD SHAFT SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 36MM 6MM HEAD DIA CORTEX SM 2.5 MM HEXAGONAL SOCKET SLF TAP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 36MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3112-035-0365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 575.0, "discounted_cash": 201.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 36MM CORTICAL LOW PROFILE NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 36MM CORTICAL PERILOC SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 36MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 36MM PERILOC IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 36MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 301.0, "discounted_cash": 105.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 38MM 12MM THREAD SHAFT SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 38MM 6MM HEAD DIA CORTEX SM 2.5 MM HEXAGONAL SOCKET SLF TAP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 38MM CORTEX PERI LOC VLP SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 38MM LOW PROFILE TI LCKNG DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935L-38", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 87.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 38MM PERILOC IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 38MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 38MM T20 PERILOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 200.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 40MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 40MM LOW PROFILE CORTICAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 40MM PERILOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 367.0, "discounted_cash": 128.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 40MM SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 200.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 40MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 301.0, "discounted_cash": 105.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 42MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 42MM T10 NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 44MM CORTEX PERI LOC VLP SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 367.0, "discounted_cash": 128.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 44MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 45MM SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 200.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 45MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 301.0, "discounted_cash": 105.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 45MM VAR ANGLE STARDRV SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.127.145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 46MM PERI LOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 48MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 50MM CORTEX PERI LOC VLP SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 367.0, "discounted_cash": 128.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 50MM CORTICAL PERI LOC SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 50MM NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 50MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 301.0, "discounted_cash": 105.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 52MM SLF TAP SS LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 103.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 55MM 5MM .8MM THREAD PITCH STARDRV SLF TAP SS IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.968.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 55MM CORTEX PERI LOC VLP SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 55MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 55MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 301.0, "discounted_cash": 105.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 55MM T20 PERILOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 60MM SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 301.0, "discounted_cash": 105.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 60MM T20 PERILOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7382-5060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 70MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 70MM T10 F-T LOCK STARDRIVE VARIAX FOOT PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 80MM CORTEX PERI LOC VLP SLF TAP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 8MM HEXALOBE IMP NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 8MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-021-35-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.5MM X 8MM SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.6MM 32MM ANCHORAGE T8 LAG CROSS PLATE 626932", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626932", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 475.0, "discounted_cash": 166.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.75MM X 34MM CANNULATED PARTIAL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-7000-34", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 589.0, "discounted_cash": 206.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.75MM X 36MM CANNULATED SHOULDER FULLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-7000-36FT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.75MM X 38MM CANNULATED FULLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-7000-38FT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 589.0, "discounted_cash": 206.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.75MM X 42MM CANNULATED SHOULDER PARTIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-7000-42", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 589.0, "discounted_cash": 206.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.7MM X 16MM BIOCOMPOSITE COMPRESSION STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5025B-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1164.0, "discounted_cash": 407.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.85MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3601-13812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3.85MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3601-13814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 30MM HEADED", "code_information": [{"code": "5983-40-33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 257.0, "discounted_cash": 89.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 30MM LEN 2MM DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.830.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 30MM MICRO ACUTRAK 2 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "at2-c30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2070.0, "discounted_cash": 724.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 30MM REDAPT LOCK 71354505", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71354505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 30MM STANDARD HEADLESS COMPRESSION ACUTRAK 2 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1765.0, "discounted_cash": 617.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 30MM X 3.5MM 6MM HEAD SOCKET 2. 5MM CORTEX HEXAGONAL ORTHO SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.83", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 30MM X 6MM TO 7MM TAPERED KNEE BIOCRYL TRICALCIUM PHOSPHATE BIOINTRAF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "254622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 731.0, "discounted_cash": 255.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 30MM X 6MM TO 8MM TAPERED KNEE BIOCRYL TRICALCIUM PHOSPHATE BIOINTRAF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "254660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 731.0, "discounted_cash": 255.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 30MM X 7MM TO 9MM TAPERED KNEE BIOCRYL TRICALCIUM PHOSPHATE BIOINTRAF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "254624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 746.0, "discounted_cash": 261.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 30MM X 8MM TO 10MM TAPERED KNEE BIOCRYL TRICALCIUM PHOSPHATE BIOINTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "254625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 746.0, "discounted_cash": 261.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 32MM LEN 2.4 DIAMTER CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.532.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 32MM LEN 2MM DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.828.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 32MM X 14MM X 4MM CANN PARTIALLY THREADED SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 976.0, "discounted_cash": 341.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 34MM STANDARD NON STERILE ACUTRAK 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-S34-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2070.0, "discounted_cash": 724.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 34MM X 3.5MM 6MM HEAD SOCKET 2.5MM CORTEX HEXAGONAL ORTHO SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 35MM SPHERICAL HEAD REFLECTION IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71332535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 35MM X 12MMINTERFERENCE DELTA TAPERED POLY L LACTIC ACID BIPHASIC CAL", "code_information": [{"code": "AR-1227S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM 4MM 100MM X 20MM SLF DRILLING SCHANZ SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 661.0, "discounted_cash": 231.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM 4MM X 18MM CANNULATED ASNIS MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-30118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM OR 4MM X 20MM X 80MM SELDRILL SCANZ THREADED SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "294.771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 10MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-3010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 14MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-3014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 14MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 14MM CANNULATED TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC-3014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 14MM LAG IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S30-14T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 14MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSL3014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 14MM T8 IMP NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSS3014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 65.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 15MM 4MM CANNULATED ASNIS MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-30115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 15MM 4MM HEADLESS CANNULATED SLF DRILLING COMPR SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "441.361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 432.0, "discounted_cash": 151.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 16MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 16MM CANNULATED TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC3016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 16MM CORTICAL IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 16MM T8 IMP NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSS3016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 65.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 18MM CANNULATED HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-3018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 18MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-3018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 18MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 18MM FULLY THREADED CANCELLOUS SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8830-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 75.88, "discounted_cash": 26.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 18MM HEXALOBE NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 18MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSL3018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 528.0, "discounted_cash": 184.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 20MM CANNULATED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC-3020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 20MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-3020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 20MM CANNULATED TIGER HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202-30-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 20MM GRIDLOCK LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-30-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 22MM CANCELLOUS LOW PROFILE SS NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8830-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 75.88, "discounted_cash": 26.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 22MM CANNULATED TI6 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC-3022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 22MM GRIDLOCK LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-30-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 24MM CANCELLOUS LOW PROFILE SS NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8830-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 24MM CANNULATED TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC3024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 24MM COMPRESSION HEADLESS LNG THREAD W/ T8 STARDRV RECESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.226.124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 807.0, "discounted_cash": 282.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 24MM FUSION RECONSTRUCTION FRS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P1024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 24MM GRIDLOCK LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-30-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 24MM IMP NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSS3024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 394.0, "discounted_cash": 137.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 26MM CANNULATED HEADED DART FIRE STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DIN30026S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 516.0, "discounted_cash": 180.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 26MM CANNULATED HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-3026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 26MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-3026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 127.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 26MM FUSION RECONSTRUCTION FRS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P1026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 28MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-3028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 28MM FUSION RECONSTRUCTION FRS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P1028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 30MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-3030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 30MM CANNULATED TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC3030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 34MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-3034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 36MM CANNULATED HEADLESS EXTREMIFIX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-3036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 36MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-3036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 38MM CANCELLOUS PARTIALLY THREADED QUICKFIX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8730-38PT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MM X 42MM PARTIALLY THREADED CANCELLOUS QUICKFIX TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8730-42PT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MMX 12MM CANCELLOUS LOW PROFILE SS NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8830-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MMX 16MM CANCELLOUS LOW PROFILE SS NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8830-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 75.88, "discounted_cash": 26.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 3MMX 20MM CANCELLOUS LOW PROFILE SS NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8830-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4 X 30MM CANNULATED SHRT THREAD QUICK FIX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-30PTS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0 X 14MM 0201-4014F", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201-4014F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM 30.0MM THREADED 100.00 MM SLF DRILLING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "294.776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 12MM NON-BIASED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48558412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 28MM SELFTAP CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7175-4028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 32.0MM CANNULATED ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4005-32", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 336.0, "discounted_cash": 117.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 36.0MM FULLY THREADED CANCELLOUS PROXIMAL HUMERAL HEX UNIFLX STAINLESS STEEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "345436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 40.0MM THREADED 125.0 MM SLF DRILLING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "294.777", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 40.0MM W/ T25 STARDRV RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.204.040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 42MM CANN LOW PROFILE SHRT THREAD PARTIALLY THREADED QUICKFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-42PTS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 46MM 15MM CANN PARTIALLY THREADED SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1616.0, "discounted_cash": 565.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 50.0MM HUMERAL FEMORAL TIBIAL T15 DRIVER AXSOS SELF TAPPING STAINLESS STEEL LOCKI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "371550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 60MM CANNULATED PART THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1123.0, "discounted_cash": 393.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 80MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.0MM X 85MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5 X 25MM TRIGEN STAINLESS STEEL INTERNAL CAPTURED LOW PROFILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71645425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 779.0, "discounted_cash": 272.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5 X 35 LOCKING TORN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWD0035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5 X 50 CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JC4550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2163.0, "discounted_cash": 757.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM 38MM TI CORT NS AXSOS 3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 37.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 14MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 22MM CORTICAL PERI LOC IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73826022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 23MM BASEPLATE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWD023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 24MM CORTICAL PERI LOC IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73826024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 26MM COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "VDV226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 29MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWD029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 30.0MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "340630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 30MM CORTICAL PERI LOC IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73826030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 32MM BASEPLATE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWD032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 32MM CORTICAL SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "340632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 35MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWD035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 369MM T25 PERILOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73827036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 36MM CORTEX PERI LOC SLF TAP IMP NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73826036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 36MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "340636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 40MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.84", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 40MM CORT LOW PROFILE SLF DRILLING CANNULATED PARTIALLY THREA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8945-40PT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 40MM PERI LOC SLF TAP IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73827040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 41MM BASEPLATE LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWD041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 42MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 42MM X 6.5MM HEAD 14MM THREAD CANN SLF DRILLING SHRT THREAD S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 44MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 45MM LOW PROFILE CORTICAL SLF DRILLING CANNULATED LAG PARTIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8945-45PT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 46MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 48MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 50.0MM CORTICAL HEX DRIVER AXSOS STAINLESS STEEL STERILE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "340650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 50MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.85", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 50MM CORT LOW PROFILE SLF DRILLING CANNULATED LAG PARTIALLY T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8945-50PT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 52MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 52MM CANN SLF DRILLING FULLY THREADED HEXAGONAL SOCKET SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 407.0, "discounted_cash": 142.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 54MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 56MM 6.5MM HEAD CANN SLF DRILLING FULLY THREADED 1HEXAGONAL S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 407.0, "discounted_cash": 142.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 56MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 58MM CORTEX W/ LG HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.858", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 60MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.86", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 62MM 8MM HEAD CORTEX HEXAGONAL SOCKET 3.5 MM SLF TAP SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.862", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 64MM CORTEX W/ LG HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.864", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 66MM CORTEX SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214.866", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.5MM X 66MM T25 PERI LOC LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73827066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4.7MM X 45MM HEADLESS COMPRESSION SCREW SYS NON STRL ACUTRAK 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2093.0, "discounted_cash": 732.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 40MM SPHERICAL HEAD REFLECTION IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71332540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 40MM X 14MM X 4MM CANN PARTIALLY THREADED SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1616.0, "discounted_cash": 565.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 40MM X 3.5MM HEAD 6MM SOCKET 2.5MM CORTEX HEXAGONAL ORTHO SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.84", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 40MM X 4MM X 6MM HEXAGONAL SOCKET CANC PARTIALLY THREADED TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "407.04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 44MM 4.0 STANDARD ACUTRAK 3053-40044", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3053-40044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2482.0, "discounted_cash": 868.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 45MM X 3.5MM 6MM HEAD 2.5MM SOCKET CORTEX HEXAGONAL SLF TAP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 48MM HEADED MIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-5983-040-48", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 50.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM 12MM OZARK SPINE CERVICAL SELF START FIX ANGLE NONSTERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8801-14012DA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM 28MM FORINTRAMEDULLARY NAILS TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.005.418S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 186.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM 28MM T25 STARDRV FORINTRAMEDULLARY NAILS TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.005.418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM 34MM T25 STARDRV TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.005.424S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 186.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM 36MM ASNIS CANNULATED NONSTERILE JONES FRACTURE FIXATION SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2237.0, "discounted_cash": 782.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM 38MM T25 STARDRV LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.005.428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM 38MM T25 STARDRV TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.005.428S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 186.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM CANNULATED COUNTERSINK AO COUPLING ASNIS III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "702473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 632.0, "discounted_cash": 221.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 10MM 5MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 10MM 5MM THREAD CANCELLOUS SM HEXAGONAL SOCKET ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 10MM BIOCOMPOSITE BIO TENODESIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1540BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1016.0, "discounted_cash": 355.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 10MM CANCELLOUS LOW PROFILE SS NON LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 12MM CANCELLOUS FULLY THREADED SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 12MM CANCELLOUS LOW PROFILE SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 12MM FIXED CERVICAL SPIDER IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "N60000145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 214.0, "discounted_cash": 74.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 14MM 5MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 14MM CANCELLOUS FULLY THREADED SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 16MM 5MM HEAD 8MM THREAD CANCELLOUS W/ HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 16MM 6MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 16MM CANCELLOUS FULLY THREADED SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 16MM LOW PROFILE CANCELLOUS SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 18MM 5MM HEAD 8MM THREAD CANCELLOUS W/ HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 18MM 7MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 18MM CANCELLOUS FULLY THREADED W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 18MM LOW PROFILE CANCELLOUS SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 20MM 8MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 20MM CANCELLOUS FULLY THREADED W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 20MM LOW PROFILE CANCELLOUS SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 20MM LOW PROFILE FOR MIDFOOT PLATING MODULE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8940-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 22MM 9MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 22MM CANCELLOUS FULLY THREADED W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 22MM CORTICAL SLF TAP TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71754022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 22MM LOW PROFILE CANCELLOUS SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 24MM 10MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 24MM CANCELLOUS FULLY THREADED W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 24MM CORTICAL SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71754024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 698.0, "discounted_cash": 244.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 24MM LAG IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S40-24T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 26MM 12MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 26MM CANCELLOUS FULLY THREADED W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 26MM CANNINTERNAL FXTN SYS LOW PROFILE TI6 METASURG TI STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC4026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 26MM LOW PROFILE FOR MIDFOOT PLATING MODULE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8940-26", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 28MM 14MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 28MM CANCELLOUS FULLY THREADED W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 28MM CANN LOW PROFILE FULLY THREADED T15 HEXALOBE DRIVE SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8940-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 28MM CANNULATED CANCELLOUS SHRT THREAD QUICKFIX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-28PTS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 28MMINTERNAL FXTN SYS CANNULATED TI6 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC4028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 30MM 14MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 30MM CANCELLOUS FULLY THREADED W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 30MM CANN PARTICALLY THREADED SS STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1123.0, "discounted_cash": 393.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 30MM CANNULATED TI6 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC4030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 30MM LOW PROFILE CANNULATED LNG THREAD SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840CL-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 30MM LOW PROFILE CANNULATED SHRT THREAD SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840C-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 32MM CANNULATED HEADLESS EXTREMIFIX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-4032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 32MM HEADED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DIN40032S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 336.0, "discounted_cash": 117.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 32MM LAG IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S40-32T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 236.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 32MMINTERNAL FXTN SYS CANNULATED TI6 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC4032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 34MM 14MM CANN PARTIALLY THREADED FIXTN SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1616.0, "discounted_cash": 565.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 34MM CANC CANNULATED SHRT THREAD PARTIALLY THREADED QUICKFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-34PTS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 34MM CANNULATED ASNIS III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 34MM CANNULATED ASNIS III STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604634S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 34MM CANNULATED HEADLESS EXTREMIFIX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-4034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 34MM CANNULATED TI6 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC4034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 34MM LCKNG FOR USE W/ LOCKING COMPRESSION PLATES SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.204.034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 34MM LOW PROFILE FOR MIDFOOT PLATING MODULE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8940-34", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 35MM 14MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16.6, "discounted_cash": 5.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 35MM CANNULATED LNG THREADED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD-010-40-35L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 196.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 36MM 14MM CANN PARTIALLY THREADED FIXTN SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1123.0, "discounted_cash": 393.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 36MM CANNULATED CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840C-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 36MM CANNULATED LOW PROFILE LNG THREAD SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840CL-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.72, "discounted_cash": 125.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 36MM CANNULATED PARTIALLY THREADED TITANIUM ASNIS III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604636S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 36MM LOW PROFILE FOR MIDFOOT PLATING MODULE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8940-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 37.5MM LNG THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD-010-40-375L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 38MM CANN LOW PROFILE SHRT THREAD PARTIALLY THREADED QUICKFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-38PTS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.72, "discounted_cash": 125.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 38MM CANNULATED HEADLESS EXTREMIFIX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-4038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 38MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-4038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 38MM CANNULATED PARTIALLY THREADED TITANIUM ASNIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 38MM LOW PROFILE FOR MIDFOOT PLATING MODULE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8940-38", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 40MM 14MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 40MM CANCELLOUS FULLY THREADED W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 40MM CANN LOW PROFILE SHRT THREAD PARTIALLY THREADED QUICKFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-40PTS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 40MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "325040S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 40MM CANNULATED HEADLESS EXTREMIFIX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "317-4040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 40MM CANNULATED LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-4040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 422.0, "discounted_cash": 147.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 40MM CANNULATED LOW PROFILE LNG THREAD SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840CL-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 40MM CANNULATED PARTIALLY THREADED ASNIS II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 196.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 40MM LAG IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S40-40T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 40MM LOW PROFILE CANNULATED SHRT THREAD SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840C-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 42MM ASNIS CANNULATED JONES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2750.0, "discounted_cash": 962.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 42MMINTERNAL FXTN SYS TI6 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC4042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 44MM 15MM CANN PARTIALLY THREADED FIXTN SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1314.0, "discounted_cash": 459.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 44MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "325044S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 44MM CANNULATED PARTIALLY THREADED ASNIS III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604644", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 45MM 15MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 45MM CANCELLOUS FULLY THREADED W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 45MM CANNULATED LOW PROFILE LNG THREAD SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840CL-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 46MM CANC CANN SHRT THREAD PARTIALLY THREADED QUICKFIX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-46PTS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.72, "discounted_cash": 125.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 46MM CANNULATED LOW PROFILE LNG THREAD SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840CL-46", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 48MM CANN LOW PROFILE SHRT THREAD PARTIALLY THREADED QUICKFIX T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-48PTS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 48MM CANN PARTICALLY THREADED SS STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1616.0, "discounted_cash": 565.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 50MM 15MM CANN PARTIALLY THREADED FIXTN SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1616.0, "discounted_cash": 565.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 50MM 15MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 50MM ALPS LOCKING SM FRAGMENT SYS CANN CANCELLOUS STANDARD HEAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14376-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 50MM CANCELLOUS FULLY THREADED W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 50MM CANN SLF DRILLING SHRT THREAD 2.5 MM HEXAGONAL SOCKET SLF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.65", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 166.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 50MM CANNULATED LOW PROFILE LNG THREAD SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840CL-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 50MM CANNULATED PARTIALLY THREADED TITANIUM ASNIS III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604650S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 54MM CANN PARTICALLY THREADED SS STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1123.0, "discounted_cash": 393.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 55MM 15MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 56MM CANN PARTICALLY THREADED SS STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1314.0, "discounted_cash": 459.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 60MM 15MM THREAD CANCELLOUS SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206.06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X 60MM LOW PROFILE CANNULATED SHRT THREAD SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8840C-60", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MM X10MM CANCELLOUS PARTIALLY THREADED SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MMX 32MM CANNULATED ASNIS III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4MMX 50MM CANNULATED ASNIS III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 407.0, "discounted_cash": 142.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 4X35MM CANCELLOUS FULLY THREADED W/ SM HEX SOCKET 207.035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5. MM X 14MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "506-03-114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0 MM X 18 MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "506-03-118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0 MM X 22 MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "506-03-122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0 MM X 25 MM RSP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "506-03-126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0 MM X 30 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "506-03-130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0 MM X 34 MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "506-03-134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0 MM X 38 MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "506-03-138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0MM X 36.0MM W/ T25 SRATDRIVE RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0MM X 38.0MM W/ T25 SRATDRIVE RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 354.0, "discounted_cash": 123.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0MM X 40.0MM W/ T25 SRATDRIVE RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 354.0, "discounted_cash": 123.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0MM X 48.0MM W/ T25 SRATDRIVE RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 123.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0MM X 55.0MM CANNULATED CONICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.205.255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 425.0, "discounted_cash": 148.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0MM X 55.0MM W/ T25 SRATDRIVE RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0MM X 65.0MM CANNULATED LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.205.065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0MM X 65.0MM W/ T25 SRATDRIVE RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0MM X 80.0MM CANNULATED CONICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.205.280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 425.0, "discounted_cash": 148.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.0MM X 80.0MM LCKNG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "2.205.080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM 45MM EVEREST SPINE POLYAXIAL EXTEND TAB FENESTRATE NONSTERILE LATEX FREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-05545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 10MM TENODESIS PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1655PS-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 294.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 15MM BIOCOMPOSITE BIO TENODESIS STRL IMP DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1555BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1016.0, "discounted_cash": 355.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10155-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1401.0, "discounted_cash": 490.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 25MM AX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX5525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 40MM 16MM CANN PARTIALLY THREADED SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71125040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 40MM LOW PROFILE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8955-40PT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 919.0, "discounted_cash": 321.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 46MM 16MM THREAD CANNULATED SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71125046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1454.0, "discounted_cash": 508.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 48MM 16MM THREAD CANNULATED SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71125048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 50MM 16MM THREAD CANNULATED SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71125050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1454.0, "discounted_cash": 508.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 50MM CANNULATED SHRT THREADED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD-010-55-0555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 694.0, "discounted_cash": 242.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 52MM 16MM THREAD CANNULATED SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71125052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 915.0, "discounted_cash": 320.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 60MM 16MM THREAD CANNULATED SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71125060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 80MM 32MM THREAD CANNULATED SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71124080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1257.0, "discounted_cash": 439.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 85MM 32MM THREAD CANNULATED SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71124085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1257.0, "discounted_cash": 439.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5.5MM X 8MM GRAFT DIA 4.5MM TO 5.5MM TENODESIS PEEK STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1655PS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 294.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM 34MM T25 STARDRV TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.005.424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM HEADLESS CANNULATED COUNTERSINK DART FIRE IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSDS1050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 14MM OSTEOPENIA FULLY THREADED PERI LOC VLP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71822014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 18MM OSTEOPENIA FULLY THREADED PERI LOC VLP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71822018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 24MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-405024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 28MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-405028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 487.0, "discounted_cash": 170.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 30MM LOW PROFILE TRIGEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7164-5030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1042.0, "discounted_cash": 364.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 32.5MM LOW PROFILE TRIGEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71645032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 878.0, "discounted_cash": 307.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 34MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-405034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 35MM LOW PROFILE TRIGEN IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7164-5035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1042.0, "discounted_cash": 364.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 36MM DOUBLE LEAD THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-405036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 487.0, "discounted_cash": 170.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 37MM FULL THREAD LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1896-5037S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 606.0, "discounted_cash": 212.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 40MM LOW PROFILE TRIGEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7164-5040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 977.2, "discounted_cash": 342.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 40MM OSTEOPENIA PARTIALLY THREADED PERI LOC VLP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 44MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-405044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1896-5045S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 441.0, "discounted_cash": 154.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 45MM LOW PROFILE TRIGEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71645045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 977.2, "discounted_cash": 342.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 50MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.205.050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 50MM LOW PROFILE TRIGEN IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71645050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 5MM LEGION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71421731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2048.0, "discounted_cash": 716.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 60MM X 175MM SELDRILL SCHANZ THREADED SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "294.785", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 65MM LOW PROFILE TRIGEN IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71645065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 70MM CANNULATED LOCKING SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.205.070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 70MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-405070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 70MM LOW PROFILE TRIGEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7164-5070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 828.0, "discounted_cash": 289.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 75MM CANNULATED LOCKING SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.205.075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 547.0, "discounted_cash": 191.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 80MM CORTICAL 14-405080", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-405080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 487.0, "discounted_cash": 170.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 80MM SLF DRILLING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "294.786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 142.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 90MM CANNULATED CONICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.205.290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 154.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 90MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.205.090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5MM X 95MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.205.095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 5X25MM NON STERILE 232-12-50-250", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "232-12-50-250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.25MM X 15MM GRAFT DIA 5MM TO 6MMFT TENODESIS PEEK STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1562PS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 649.0, "discounted_cash": 227.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.25MM X 15MM TENODESIS BIOCOMPOSITE IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1562BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1016.0, "discounted_cash": 355.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM 15MM HIP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-55-015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM 35MM EVEREST SPINE POLYAXIAL EXTEND TAB FENESTRATE NONSTERILE LATEX FREE E5111-0653", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-06535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM 40MM EVEREST SPINE POLYAXIAL EXTEND TAB FENESTRATE NONSTERILE E5111-06540", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-06540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM 50MM EVEREST SPINE POLYAXIAL EXTEND TAB FENESTRATE NONSTERILE E5111-06550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-06550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM 55MM EVEREST SPINE POLYAXIAL EXTEND TAB FENESTRATE NONSTERILE LATEX FREE E5111-0655", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-06555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM SZ 25MM HIP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-55-025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 110MM 16MM THREAD CANCELLOUS W/ LG HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "216.11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 110MM 32MM THREAD CANCELLOUS W/ LG HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "217.11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 20MM CANCELLOUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2030-6520-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 184.0, "discounted_cash": 64.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 25.0MM CANCELLOUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2030-6525-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 25MM LOW PROFILE CANCELLOUS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 192.96, "discounted_cash": 67.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 30MM CANCELLOUS LOW PROFILE KNEE STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 183.0, "discounted_cash": 64.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 30MM SPHERICAL HEAD DOME HOLE REFLECTION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71332530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 35MM CANCELLOUS FULLY THREADED W/ LG HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "218.035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 35MM LOW PROFILE CANCELLOUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 40MM COMPRESSION CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NCS-6040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 827.0, "discounted_cash": 289.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 40MM POLYAXIAL XIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482316540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 45MM 32MM THREAD CANCELLOUS W/ LG HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "217.045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 45MM CANCELLOUS SPHERICAL HEAD REFLECTION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71332545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 45MM CANNULATED SS STRL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121629", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1323.0, "discounted_cash": 463.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 45MM XIA 3 TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482316545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 50MM CANNULATED 16MM THRD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007741", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 595.0, "discounted_cash": 208.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 50MM CANNULATED SS STRL IMP UNIV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 50MM VERT POLYAXIAL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482316550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1391.0, "discounted_cash": 486.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 55MM VERT POLYAXIAL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482316555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 60MM 20MM CANN PARTIALLY THREADED SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 778.0, "discounted_cash": 272.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 65MM CANCELLOUS CANNULATED TIMAX IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14196-65", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 65MM CANNULATED SS STRL IMP ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121633", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 70MM 20MM CANN PARTIALLY THREADED SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 70MM 32MM CANNULATED W/ 4 MM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "208.436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 652.0, "discounted_cash": 228.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 70MM 32MM THREAD CANCELLOUS W/ LG HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "217.07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 80MM 32MM THREAD CANCELLOUS W/ LG HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "217.08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5MM X 85MM 32MM THREAD CANCELLOUS W/ LG HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "217.085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.7MM X 70MM 28MM THREAD LOW PROFILE CANNULATED LAG TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8967-2870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 737.0, "discounted_cash": 257.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6.7MM X 80MM 28MM THREAD LAG LOW PROFILE TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8967-2880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 737.0, "discounted_cash": 257.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6MM 3MM X 34MM CANNULATED ASNIS MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-30134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2348.0, "discounted_cash": 821.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6MM LEN 2MM DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.806.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6MM X 1.5MM CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.806.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6MM X 23MMINTERFERENCE TAPERED TIP ORTHO BIOCOMPOSITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1360C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 6MMX30MM AXSOS 3 TATINUM FULL THREADED CANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "608030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7.0 X 65MM LONG THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206-70-065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1308.0, "discounted_cash": 457.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7.0 X 70MM LONG THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206-70-070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1270.0, "discounted_cash": 444.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7.3MM X 130MM CANNULATED FULLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "209.73", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 606.0, "discounted_cash": 212.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7.3MM X 30MM CANNULATED FULLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "209.63", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 606.0, "discounted_cash": 212.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7.3MM X 40MM CANNULATED FULLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "209.64", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 606.0, "discounted_cash": 212.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7.5MM 35MM EVEREST SPINE POLYAXIAL EXTEND TAB FENESTRATE NONSTERILE LATEX FREE E5111-0753", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-07535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7.5MM 40MM EVEREST SPINE POLYAXIAL EXTEND TAB FENESTRATE NONSTERILE LATEX FREE E5111-0754", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-07540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7.5MM 45MM EVEREST SPINE POLYAXIAL EXTEND TAB FENESTRATE NONSTERILE LATEX FREE E5111-0754", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-07545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7.5MM 50MM EVEREST SPINE POLYAXIAL EXTEND TAB FENESTRATE NONSTERILE LATEX FREE E5111-0755", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-07550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7MM LEN 2MM DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.807.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7MM X 1.5MM CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.807.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7MM X 23MMINTERFERENCE POLY L D LACTIC ACID BIPHASIC CALCIUM PHOSPHAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1370C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 183.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7MM X 55MM CANNULATED SHRT THREADED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSS-011-70-55S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 883.0, "discounted_cash": 309.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 7MM X 55MM CANNULATED SHRT THREADED IMP ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD-010-70-55-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 883.0, "discounted_cash": 309.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 8MM LEN 2MM DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.808.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 8MM X 12MM GRAFT DIA 5.5MM TO 8MMFT ANKLE TENODESIS PEEK STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1680PS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 682.92, "discounted_cash": 239.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 8MM X 2.5MM CORTICAL HEXADRIVE 7 SELF TAPPING TITANIUM IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.08/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 8MM X 20MM REVERSE THREAD POLY L LACTIC ACID FOR SOFT TISSUE GRAFT FX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1586LB-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 8MM X 23MM TAPERED MILAGRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1114.0, "discounted_cash": 389.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 8MM X 23MMINTERFERENCE KNEE POLYLACTIC CO GLYCOLIC ACID COMPOSITE MIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 861.0, "discounted_cash": 301.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 8MM X 28MM FULLY THREADEDINTERFERENCE POLY L D LACTIC ACID BIPHASIC C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1380TC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 8MM X 8MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "306-2408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 9MM LEN 2MM DIA CORTEX SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.809.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 9MM X 20MM KNEE BIOCOMPOSITE BIPHASIC CALCIUM PHOSPHATE AND POLY L LA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1586RC-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 9MM X 20MM REVERSE THREAD POLY L LACTIC ACID FOR SOFT TISSUE GRAFT FX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1586LB-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 208.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 9MM X 23MM TAPERED MILAGRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 930.0, "discounted_cash": 325.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 9MM X 23MMINTERFERENCE KNEE POLY L D LACTIC ACID BIPHASIC CALCIUM PHO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1390C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 183.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 9MM X 23MMINTERFERENCE KNEE POLYLACTIC CO GLYCOLIC ACID COMPOSITE OR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 861.0, "discounted_cash": 301.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE 9MM X 25MM ROUND HEADINTERFERENCE COMPOSITCP 60 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "905256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 657.0, "discounted_cash": 229.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ACUTRACK II MICRO 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-C22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1889.0, "discounted_cash": 661.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ACUTRACK II MICRO26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-C26", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2150.0, "discounted_cash": 752.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ANCHORAGE 3.5MM X 12MM METATARSOPHALANGEAL LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSL3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ANCHORAGE 3.5MM X 14MM METATARSOPHALANGEAL LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSL3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ANCHORAGE 3.5MM X 16MM METATARSOPHALANGEAL LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSL3516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ANCHORAGE 3.5MM X 16MM NONLOCKING T8 DRIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSS3516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ANCHORAGE 3.5MM X 18MM METATARSOPHALANGEAL LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSL3518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 574.0, "discounted_cash": 200.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ANCHORAGE 3.5MM X 18MM NONLOCKING T8 DRIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSS3518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 65.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ANCHORAGE 3.5MM X 28MM NONLOCKING T8 DRIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSS3528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 205.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ASNIS III 4.0MM X 28MM FT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ASNIS III CANNULATED PT TI 4MM X 55MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604655S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE AXS SELF-DRILLING 1.2 X 3MM 5P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "56-12903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 193.0, "discounted_cash": 67.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE AXSOS 4 X 34MM LOCKING NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANCELLOUS 6.5MM X 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "456525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 672.0, "discounted_cash": 235.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED ASIII 4.0MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED HEADLESS MINI 2.5 X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH2524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED HEADLESS MINI 2.5 X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH2526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 2.0MM X 10.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 545.0, "discounted_cash": 190.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 2.0MM X 14.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 508.0, "discounted_cash": 177.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 2.4MM X 12.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 2.4MM X 14.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 2.4MM X 16.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 508.0, "discounted_cash": 177.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 2.4MM X 26.0MM", "code_information": [{"code": "CSP-126", "type": "CDM"}], "standard_charges": [{"gross_charge": 508.0, "discounted_cash": 177.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 3.0MM X 26.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 3.0MM X 28.0MM", "code_information": [{"code": "CSP-228", "type": "CDM"}], "standard_charges": [{"gross_charge": 529.0, "discounted_cash": 185.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 3.0MM X 30.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 3.0MM X 34.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 3.5MM X 28.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 3.5MM X 32.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 3.5MM X 34.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED PT 3.5MM X 36.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP-336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED TIGER 3MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED TIGER 3MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED TIGER 3MM X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED TIGER 3MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED TIGER 3MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED TIGER 3MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED TIGER 3MM X 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED TIGER 3MM X 34MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED TIGER 3MM X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED TIGER 3MM X 38MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CANNULATED TIGER 3MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE COMPRESSION 1.75MM X 2.5MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SV18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 754.0, "discounted_cash": 263.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE COMPRESSION 3.0 MM X 30 MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5880.30/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 656.0, "discounted_cash": 229.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE COMPRESSION CANNULATED FIXOS SELF TAPPING 4.0MM X 44MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MV44A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1046.0, "discounted_cash": 366.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE COMPRESSION CANNULATED FIXOS SELF TAPPING 4.0MM X 46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MV46A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1046.0, "discounted_cash": 366.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CORTEX 2.8MM X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5800.45/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 80.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CORTEX 2.8MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5800.50/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 80.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CORTEX GOLD 1.5MM X10MM A-5200.10/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5200.10/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CORTICAL 3.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "815037020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CORTICAL LOCKING 3.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "816135012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CORTICAL LOCKING 3.5MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "816135018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CORTICAL LOCKING 3.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "816135020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CORTICAL LOCKING 3.5MM X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "816135024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CORTICAL NON-LOCKING 3.5MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "815037026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE COUNTERSINK 2.7 X 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "320-2735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 731.0, "discounted_cash": 255.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CROSS PIN SELF TAP 2.3MM X 15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23015E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE CROSS PIN SELF TAP 2.3MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-23016E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 172.0, "discounted_cash": 60.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE EXPLOR IMP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11-210099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE EXTRA SNGL DISCOVERY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "114993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE GRAVITY NEEDLE DRIVER 86PP00N0", "code_information": [{"code": "86PP00N0", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1070.62, "discounted_cash": 374.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE GRIDLOCK LOCKING 3.0MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "301-30-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE GRIDLOCK LOCKING 3MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-30-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE GRIDLOCK LOCKING 3MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-30-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE GRIDLOCK LOCKING 4.0MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-40-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE GRIDLOCK LOCKING 4.0MM X 18MM 302-40-018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-40-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE GRIDLOCK LOCKING 4.0MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-40-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE GRIDLOCK LOCKING 4.0MM X 22MM 302-40-022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-40-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE GRIDLOCK LOCKING 4.0MM X 24MM 302-40-024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-40-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE GRIDLOCK LOCKING 4.0MM X 26MM 302-40-026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-40-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE HAND 1.2MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-12010E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE HEADED 7.5MM X 65MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCN756562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1261.0, "discounted_cash": 441.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE HEADED DART FIRE 3MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N30028S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 517.0, "discounted_cash": 180.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE HUMERAL BODY IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BSW-0920-021-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 382.0, "discounted_cash": 133.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE IMPLANTS RAPID COMPRESSION SK51", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK51", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6254.0, "discounted_cash": 2188.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE INFRAME IMPLANT 2.0 MM X 26MM EXINF922026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINF922026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3968.0, "discounted_cash": 1388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 2.7 X 10MM EVOS FULLY THREADED SELF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7241-2710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 490.8, "discounted_cash": 171.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 2.7 X 12MM EVOS FULLY THREADED SELF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7241-2712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 286.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 2.7 X 14MM EVOS FULLY THREADED SELF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7241-2714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 286.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 2.7 X 15MM FULLY THREADED SELF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7241-2715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 2.7 X 16MM EVOS FULLY THREADED SELF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7241-2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 286.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 2.7 X 18MM FULLY THREADED SELF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7241-2718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 286.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 2.7 X 38MM EVOS FULLY THREADED SELF TAPPING 72412738", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 534.0, "discounted_cash": 186.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 2.7 X 8MM EVOS FULLY THREADED SELF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7241-2708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 3.5MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-021-35-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 3.5MM X 12MM SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 197.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 3MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSL3016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 5.5MM X 45MM SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "205-55-045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1270.0, "discounted_cash": 444.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING 5.5MM X 50MM SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "205-55-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING T8 FULL THREAD 2.4 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 422.0, "discounted_cash": 147.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOCKING T8 FULL THREAD 2.4 X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE LOW PROFILE LOCKING CORTICAL TITANIUM 3.5MM X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935L-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 87.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE MONSTER CANNULATED 20MM MEDIUM THREAD 7.0 X 65MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-170-065M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1261.0, "discounted_cash": 441.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE MULTI DIRECTIONAL LOCKING 3.5MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "816335010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 110.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE NON LOCKING T10 3.5 X 44MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE ONE SIZE DTRAX SPINAL SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PD-32-301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE POLYAXIAL XIA 7.0MM X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482317045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1632.0, "discounted_cash": 571.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE SELF DRILLING 4.2 X 14MM HYPER-C ANTERIOR CERVICAL 0201-4214V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201-4214V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE SELF DRILLING 4.2 X 16MM VARIABLE 0201-4216V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201-4216V", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE SELF TAP 3.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614812 STRYKR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE SELF- TAPPING 2.7MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC2720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE SELF-TAPPING 2.7MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE SELF-TAPPING 2.7MM X 17MM LOCKING T8 STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7241-2717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 459.0, "discounted_cash": 160.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE SELF-TAPPING 2.7MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE SHANK 6.5X45MM 20-SDS-6545", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-SDS-6545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T10 12 X 3.5MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T10 16 X 3.5MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T10 18 X 3.5MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T5 1.7MM / L14MM 662614", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T6 2.0MM L13MM 657713", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 257.0, "discounted_cash": 89.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T6 2.0MM X L 12MM 657712", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 2.4 X 26MM LOCKING FULL TREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 422.0, "discounted_cash": 147.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 2.4MM X 18MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 96.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 2.7 X 24MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 81.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 2.7MM X12MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 83.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 2.7MM X14MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 2.7MM X14MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 435.0, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 2.7MM X16MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 401.0, "discounted_cash": 140.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 2.7MM X18MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 143.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 2.7MM X24MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 FULL THREAD 2.4 X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 FULL THREAD 2.4 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 FULL THREAD 2.7 X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 81.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 FULL THREAD 2.7 X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 81.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 FULL THREAD 2.7 X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 FULL THREAD 2.7 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 FULL THREAD 2.7 X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 81.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE T8 FULL THRED 2.7 X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 401.0, "discounted_cash": 140.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE TITANIUM PARTIAL THREAD LOW PROFILE 6.0 X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9060-50PT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2340.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE TWIST OFF 2.7X12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 989.0, "discounted_cash": 346.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE YUKON SPINE OCCIPITOCERVICOTHORACIC POLYAXIAL NONSTERILE 6.5MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7601-03516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONETWIST OFF 2 X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BUTRESS 5.5MM X 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PP-1225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CAN 4.0MM X 36MM 207.636 207636", "code_information": [{"code": "207636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANC 12MM LEN 4MM DIA 6MM HEAD FULLY THREADED HEXAGONAL SOCKET 2.5 MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "406.012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANC 4.0 X 28MM PERI LOCK T20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 145.0, "discounted_cash": 50.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANC LOCKING 6.5 X 41MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "340-65-41", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANCELLOUS 35MM X 4MM HEAD DIA 6MM HEXAGONAL SOCKET 2.5 MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "407.035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANCELLOUS 4 X 14MM 307-40-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-40-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANCELLOUS 4.0MM X 46MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "607346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANCELLOUS 4.0MM X 48MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "607348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANCELLOUS BONE 30MM X 6.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2030-6530-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANCELLOUS FT 3 X 14MM AR-8830-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8830-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 75.88, "discounted_cash": 26.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANCELLOUS FULL 4.0X12 58934012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58934012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANCELLOUS FULL 4.0X16 58934016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58934016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANCELLOUS FULL 4.0X35 58934035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58934035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 73.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 2.5 X 20MM LEOS HLESS 76342520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "76342520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1021.8, "discounted_cash": 357.63, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 2.5MM X 22MM LEOS HLESS 76342522", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "76342522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1021.8, "discounted_cash": 357.63, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 2.5MM X 30MM HEADLESSTH25-30T-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TH25-30T-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2008.0, "discounted_cash": 702.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 2.5MM X 46MM LEOS HLESS 76342546", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "76342546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1021.8, "discounted_cash": 357.63, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 2.5X14MM OS905014-NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS905014-NS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1432.0, "discounted_cash": 501.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 2.7MM X 40MM 72402740", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 184.7, "discounted_cash": 64.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 3.5 X 24MM LEOS 76343524", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "76343524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.72, "discounted_cash": 402.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4.0 X 28MM FX-HD-4028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX-HD-4028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 10MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.61", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 135.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 12MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 135.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 14MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 135.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 16MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 16MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 135.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 18MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 18MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 135.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 20MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.72", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 20MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.62", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 135.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 22MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 22MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 135.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 24MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 24MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 26MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 26MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 28MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 152.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 28MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 30MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.73", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 30MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.63", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 479.0, "discounted_cash": 167.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 32MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 32MM SLF DRILLING SLF-TAP SHRT THREAD W/ 2.5 MM HEXAGONAL SOCKE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 479.0, "discounted_cash": 167.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 34MM SLF DRILLING SLF-TAP LNG THREAD W/ 2.5 MM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 479.0, "discounted_cash": 167.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 34MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 479.0, "discounted_cash": 167.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 36MM SLF DRILLING SLF-TAP LNG THREAD W/ 2.5 MM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 403.0, "discounted_cash": 141.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 36MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 38MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 38MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 462.02, "discounted_cash": 161.71, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 40MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.74", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 40MM SLF DRILLING SLF-TAP SHRT THREAD W/ 2.5 MM HEXAGONAL SOCKE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.64", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 166.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 42MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 166.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 42MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 44MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 152.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 44MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.644", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 46MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 46MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 173.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 48MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.748", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 48MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 135.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 50MM SLF DRILLING SLF-TAP LNG THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.75", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 4MM X 52MM SLF DRILLING SLF-TAP SHRT THREAD W/ SM HEXAGONAL SOCKET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207.652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 366.0, "discounted_cash": 128.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN 6.5MM X 70MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "606070S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 726.0, "discounted_cash": 254.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN ASNIS III 4.0 X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604626S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN ASNIS III 4.0 X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604630S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 196.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN COMP FIXOS 2.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SV20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 907.0, "discounted_cash": 317.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN HOOK PLATE 4.0 X 45MM MPSH4045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSH4045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 414.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN INT WITH DISPOSABLE SHEATH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1390E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN MAXTORQUE 4.0 X 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD-010-40-035L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 204.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN MAXTORQUE 7.0 X 75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD-010-70-075L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 883.0, "discounted_cash": 309.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN TIGER 2.0MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-20-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN TIGER 2.0MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-20-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN TIGER 2.0MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-20-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN TIGER 2.0MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-20-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN. 4.0 X 38MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 929.0, "discounted_cash": 325.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 1.8MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "35-18-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 1.8MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P35-18-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.0 MM X 14 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3-4001-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.0MM X 10.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 508.0, "discounted_cash": 177.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.0MM X 12.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.0MM X 14.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.0MM X 16.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.0MM X 18.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 508.0, "discounted_cash": 177.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.0MM X 24.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.3MM X 12MM P35-23-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P35-23-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.3MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "35-23-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.4MM X 16.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 100.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.4MM X 18.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 508.0, "discounted_cash": 177.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.4MM X 26.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 508.0, "discounted_cash": 177.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2.5MM X 24MM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TC2524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 2MM COUNTERSINK ADAPTIVE OPTICS COUPLING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45-20007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 294.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0 X 30MM PARTIAL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0 X 32MM PARTIAL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0 X 34MM PARTIAL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0 X 36MM PARTIAL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0MM X 22.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0MM X 22MM P67 ST322", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0MM X 24.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0MM X 28.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71103230S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1077.0, "discounted_cash": 376.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0MM X 36MM P67 ST336", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1190.0, "discounted_cash": 416.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0MM X 38MM 40-30238S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-30238S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.0MM X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71103245S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1077.0, "discounted_cash": 376.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.5 X 16MM SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-135-016S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.5MM X 30MM SELF DRILL/TAP OS326930", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS326930", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1014.0, "discounted_cash": 354.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.5MM X 32.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 569.0, "discounted_cash": 199.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 3.5MM X 36.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 305.0, "discounted_cash": 106.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4 X 40MM MINI MONSTER SHORT THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-140-040L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4.0 X 30MM 201-40-030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201-40-030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 640.0, "discounted_cash": 224.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4.0 X 42MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604642S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 407.0, "discounted_cash": 142.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4.0 X 44 IH4044", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH4044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4.0MM X 30MM 339-4030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "339-4030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4.0MM X 32.0MM PATRIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSP 432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4.0MM X 36MM 339-4036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "339-4036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4.0MM X 38MM FUZEFIX MINI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX-HD-4038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1710.0, "discounted_cash": 598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4.0MM X 42MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N40042S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 123.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4.0MM X 44MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1147-44-41", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4.0MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX-HD-4050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1710.0, "discounted_cash": 598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 40MM x 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5051-32", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 4MM x 34MM BLUNT TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5051-34", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 5.0MM X 40MM PARTIAL THREAD 110007646", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 136.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 6.5 X 80MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "602680S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 654.0, "discounted_cash": 228.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 6.5MM X 40MM POLY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "G741-65-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 6.5MM X 45MM MIS PEDICLE 0602-65045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "602-65045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 6.5MM X 80MM FT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007861", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 594.0, "discounted_cash": 207.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 7.0MM X 55MM HEADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-170-0555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1483.0, "discounted_cash": 519.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED 75MM 20MM 6.5MM CANNULATED SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED ASNIS MICRO TI 10MM X 5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20120S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED ASNIS MICRO TITANIUM 24MM X 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED COMPRESSION 3.0MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5881.30/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 656.0, "discounted_cash": 229.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED COMPRESSION 3.2X24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-30424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 262.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED DARTFIRE EDGE 3MM X 32MM D0130032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0130032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 934.0, "discounted_cash": 326.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED DARTFIRE EDGE 3MM X 42MM D0130042", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0130042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 934.0, "discounted_cash": 326.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED DARTFIRE EDGE D0325032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0325032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED EXTENDED TAB POLY RDC 7.5MMX50MM KODIAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15025-075-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED HEADED 3.0MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IC3018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED HEADED 3MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S30-12T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED HEADLESS 3.0MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH3022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 740.0, "discounted_cash": 259.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED LONG BLADE 6.5MM X 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482804635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED LONG BLADE 6.5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482804640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED PARTIAL THREADED 3.75MM X 36MM AR-7000-36", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-7000-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 589.0, "discounted_cash": 206.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED TI P-T LOPRO S-T 4.0 X 70MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604670", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANNULATED TIGER 3.0 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANULATED COOMPR 23MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5880.23/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 656.0, "discounted_cash": 229.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANULATED EXTREMFIX 7.3MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-7070", "type": "CDM"}, {"code": "277", "type": "RC"}], "standard_charges": [{"gross_charge": 1215.0, "discounted_cash": 425.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CAP SCREW 95-2003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "95-2003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CAYMAN 7.0MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1201-17026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1141.0, "discounted_cash": 399.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CAYMAN 7.0MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1201-17028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1141.0, "discounted_cash": 399.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 20MM UNIVERSAL GLENOID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9165-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CENTRAL ALLOY 6.5MM X 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "115397", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CERVICAL TI SELF-TAPPING 3.5X12 MM 3601-13512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3601-13512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CERVICAL TI SELF-TAPPING 3.5X16 MM 3601-13516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3601-13516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CERVICAL TI SELF-TAPPING 3.85X16 MM 3601-13816", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3601-13816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COLAG 2 3.0X32MM P67 ST332", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 362.0, "discounted_cash": 126.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COLAG 2 4.0 X 42.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1190.0, "discounted_cash": 416.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COLAG 5.0MM X 70MM P65 ST570", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P65 ST570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2012.0, "discounted_cash": 704.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COLAG 6.7MM X 80MM P65 ST680", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P65 ST680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2588.0, "discounted_cash": 905.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COLAG 6.7MM X 80MM P65 ST880", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P65 ST880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2012.0, "discounted_cash": 704.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COLAG 6.7MMX 77.5MM P65 ST677", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P65 ST677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2588.0, "discounted_cash": 905.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COLINK\u00c2\u00ae LOCKING \u00c3\u02dc3.0 X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P43 ST118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMP 2.5 X 16MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMP CANN FIXOS 3.5 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS22A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 907.0, "discounted_cash": 317.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMP HEADLESS 2.5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH2540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMP HEADLESS 3.0MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH3026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 941.0, "discounted_cash": 329.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPOSITE TIBIAL FIXATION 8MM X 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110004609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 574.0, "discounted_cash": 200.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPR 5.0 X 42MM FT LG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8750-42H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 979.0, "discounted_cash": 342.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPR FT 5.0 LG X 46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8750-46H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1399.0, "discounted_cash": 489.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPR FT SCRW 3.5 MINI 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8730-36H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPREHENSIVE CENTRAL HEX 6.5MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "115396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.4 X 14MM VAR ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS-414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.4 X 16MM VAR ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS-416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.4 X 16MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.4 X 18 HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.226.318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 784.0, "discounted_cash": 274.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.4 X 18MM MAX VPC VAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "233230018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1627.0, "discounted_cash": 569.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.5 X 14MM CANNULATED TWIN PITCH AUTOFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "141-2514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 884.0, "discounted_cash": 309.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.5 X 18MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.5 X 22MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.5 X 24MM CANNULATED TWIN PITCH AUTOFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "141-2524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 884.0, "discounted_cash": 309.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.5 X 26MM CANNULATED TWIN PITCH AUTOFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "141-2526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 884.0, "discounted_cash": 309.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.5 X 26MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.5 X 28MM CANNULATED TWIN PITCH AUTOFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "141-2528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 884.0, "discounted_cash": 309.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.7 X 10MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 143.0, "discounted_cash": 50.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.7 X 12MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 2.7 X 20MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 143.0, "discounted_cash": 50.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 28MM X 3MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P1208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.0MM X 1800 CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5880.18/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 758.0, "discounted_cash": 265.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.2 X 26MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58-30426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 262.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.5 X 10MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.5 X 12MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.5 X 14MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.5 X 18MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.5 X 22MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.5 X 24MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.5 X 26MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.5 X 28MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.5 X 30MM OF1073530S", "code_information": [{"code": "OF1073530S", "type": "CDM"}], "standard_charges": [{"gross_charge": 2430.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.5 X 30MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FCS 530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 3.5MM X 28MM FT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8730-28H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 869.0, "discounted_cash": 304.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 4.0 X 26MM OF1024026S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1024026S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2430.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 4.0 X 38MM OF1024038S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1024038S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2430.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 4.0 X 46MM OF1024046S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1024046S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4728.0, "discounted_cash": 1654.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 4.0MM X 52MM OSSIOFIBER OF1024052S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1024052S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4728.0, "discounted_cash": 1654.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 4.0MMX24MM STD AR-8740-24H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-24H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 4MM X 32MM PS050032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS050032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1811.0, "discounted_cash": 633.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION 7.0 X 90MM HEADLESS SHORT THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1564.0, "discounted_cash": 547.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1818-0001S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FIXOS CANNULATED 2.5MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SV16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 907.0, "discounted_cash": 317.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FREEFIX 3.5 X 18MM FFC-35180-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-35180-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 112.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FREEFIX 3.5 X 20MM FFC-35200-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-35200-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 112.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FREEFIX 3.5 X 22MM FFC-35220-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-35220-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 311.0, "discounted_cash": 108.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FT MICRO TI 2.5MM X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8725-24H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 758.8, "discounted_cash": 265.58, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FT MICRO TI 2.5MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8725-26H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 758.8, "discounted_cash": 265.58, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FT MINI 3.6MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8730-16H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FT STD LENGTH 4.0MM X 42MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-42H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FT STD LENGTH 4.0MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-50H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FT STD LENGTH4.0MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-30H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FT STD LENGTH4.0MM X 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-32H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FT STD LENGTH4.0MM X 34MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-34H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION FT2.5MM X 28MM MICRO TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8725-28H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1168.0, "discounted_cash": 408.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION HEADLESS 4.0MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 722.0, "discounted_cash": 252.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION HEADLESS 4.0MM X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 935.0, "discounted_cash": 327.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION HEADLESS 4.0MM X 44MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 935.0, "discounted_cash": 327.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION HEADLESS STANDARD 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-S24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2070.0, "discounted_cash": 724.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION HEADLESS STANDARD 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-S28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1889.0, "discounted_cash": 661.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION HEADLESS STANDARD 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-S30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1765.0, "discounted_cash": 617.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION HEADLESS STANDARD 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-S32", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1889.0, "discounted_cash": 661.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION HEADLESS STANDARD 34MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-S34", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2070.0, "discounted_cash": 724.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORT 2.7 X 12MM SELF TAP SMALL HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4827-012-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORT 2.7 X 14MM SELF-TAP SMALL HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4827-014-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORT 2.7 X 16MM SELF-TAP SMALL HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4827-016-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORT 2.7MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC2714-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTES 2.7 MM / T8 / L16 MM 541716", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "541716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 63.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 1.55MM X 10MM CRUCIFORM HEAD SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.810.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 1.5MM CRUCIFORM HEAD SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.808.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 1.5MM X 12MM CRUCIFORM RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 32.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 1.5MM X 12MM SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.812.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 1.5MM X 14MM SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.814.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 1.5MM X 16MM SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.816.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 1.5MM X 20MM SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.820.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 1.5MM X 22MM SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.822.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 1.5MM X 9MM CRUCIFORM HEAD SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "400.809.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 10MM LEN 3.5MM DIA 6MM HEAD HEXAGONAL SOCKET 2.5 MM SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "404.81", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 16MM LEN 3.5 DIA 6MM HEAD HEXAGONAL SOCKET 2.5 MM SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "404.816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.0 X 8 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74402008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.0MM X 10MM VLP TITANIUM T6 SELF-TAPPING 74402010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74402010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.0MM X 12MM VLP TITANIUM T6 SELF-TAPPING 74402012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74402012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4 X 20MM SELF TAPPING FULLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402420N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4 X 24 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "358-2424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 217.0, "discounted_cash": 75.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4MM X 12MM T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4MM X 14MM T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 52.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4MM X 16MM T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.766", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 52.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4MM X 18MM T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 52.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4MM X 22MM T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 52.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4MM X 24MM T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.774", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 52.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4MM X 26MM T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 52.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7 X 12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "358-2712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7 X 14MM SELF TAPPING FULLY THREADED NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402714N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 95.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7 X 30MM SELF TAPPING FULLY THREADED T8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402730N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 58.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7 X 40MM SELF TAPPING FULLY THREADED NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402740N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7 X 46MM SELF TAPPING FULLY THREADED NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402746N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 77.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7 X 48MM SELF TAPPING FULLY THREADED NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402748N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 10MM CRUCIFORM RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.81", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 12MM T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 102.0, "discounted_cash": 35.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 14MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 14MM T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 16MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 16MM T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.876", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 102.0, "discounted_cash": 35.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 18MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 18MM T8 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.878", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 32.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 20MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.82", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 22MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 24MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 28MM NONLOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7240-2728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 58.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 28MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7240-2730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 30MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.83", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 32MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 34MM SPEHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 36MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 38MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 40MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.84", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 45MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7240-2750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 50MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.85", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 55MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM X 8MM SPHERICAL HEAD SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202.808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 284.0, "discounted_cash": 99.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM/ T8 / L 14MM 541714", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "541714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 63.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.7MM/T8/L24MM 541724", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "541724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 81.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 20MM LEN 3.5 DIA 6MM HEAD HEXAGONAL SOCKET 2.5 MM SLF TAP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "404.82", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2MM X 12MM T6 STARDRV SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.362.97", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2MM X 14MM T6 STARDRV SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.364.97", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2MM X 16MM T6 STARDRV SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.366.97", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2MM X 18MM T6 STARDRV RECESS SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.368.97", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 3.5 X 46MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 3.5MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73824010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 3.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73824012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 3.5MM X 20MM SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.82", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.94, "discounted_cash": 19.23, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 3.5MM X 50MM SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.85", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 3.5MM X 54MM SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 3.5MM X 55MM SM HEXAGONAL SOCKET SLF TAP ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 3.5MM X 60MM SM HEXAGONAL SOCKET SLF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "204.86", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 4.5 X 40 661740", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 4.5MM X 14MM 72504514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72504514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 4.5MM X 16MM 72504516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72504516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 4.5MM X 18MM 72504518", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72504518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 77.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 4.5MM X 26MM SLF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73826026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX 4.5MM X 28MM SLF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73826028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX HEXAGONAL 14 X 4.5MM SELF TAPPING FULL THREAD LG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "214-814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX PERI LOC VLP 3.5MM X 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF-TAPPING 2.0MM X 18MM T6 EVOS STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 142.8, "discounted_cash": 49.98, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF-TAPPING 3.5MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-1314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF-TAPPING 3.5MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-1316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTEX TI 3.5MM X 14MM 661414", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.0 X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MCCS2.0-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.0 X 14MM MCCS2.0-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MCCS2.0-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.0 X 16MM MCCS2.0-16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MCCS2.0-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.3 X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TRX2.3-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.3MM X 12MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-T2312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.5 X 18MMMM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.7 X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 57.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.7 X 16MM LOCKING ORIF CLAV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LCBS2.7-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.7 X 45MM SELF-TAP SMALL HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4827-045-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.8 X 14MM APTUS HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5800.14/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 63.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.8 X 16MM APTUS HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5800.16/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 63.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.8 X 18MM APTUS HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5800.18/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.8 X 20MM GOLD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5800.20/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.8 X 22MM GOLD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5800.22/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.8 X 24MM APTUS HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5800.24/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 2.8 X 26MM GOLD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5800.26/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.0 X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.3 X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "13314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.5 MM 18 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS18000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 42.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.5 X 12MM 307-35-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-35-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 183.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.5 X 14 MM A-5901.14/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5901.14/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.5 X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "567416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.5 X 18MM COLINK AFX LOW-PRO P72 ST027", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P73 ST018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.5 X 22MM LO PRO TM SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5535-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.26, "discounted_cash": 43.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.5MM X 14MM LP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "131218014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 32.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.5MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73824016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.5MM X 20MMINTERFRAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4F01-4020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 441.0, "discounted_cash": 154.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 3.5MM X 80MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 4.5MM X 16MM SELF-TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7382-6016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 4.5MM X 18MM SELF-TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7382-6018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 4.5MM X 20MM SELF-TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7382-6020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 4.5MM X 34MM FEM HUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "340634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL 70/25MM D 3.0-2.5MM M315", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "M315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL APTUS 2.8 X 12MM TITANIUM HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.12/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL APTUS 2.8 X 16MM TITANIUM HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL APTUS 2.8 X 18MM TITANIUM HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL APTUS 2.8 X 20MM TITANIUM HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.20/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL APTUS 2.8 X 22MM TITANIUM HEXADRIVE 7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.22/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL DARCO SHORT 3.5MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCN352832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 579.0, "discounted_cash": 202.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL FULL 3.5X18MM 58913518", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58913518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL FULL 3.5X30MM 58913530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58913530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL FULL 3.5X38MM 58913538", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58913538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL FULL 4.0X44MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58924044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.0, "discounted_cash": 76.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL FULL 4.0X54MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58924054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.0, "discounted_cash": 76.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LAG 3.2 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LAG3.2-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOCKING 2.3 X 18MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-T2318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.76, "discounted_cash": 76.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOCKING 3.5MM X 10MM COLS-35100-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COLS-35100-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOCKING 3.5MM X 11MM COLS-35110-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COLS-35110-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOCKING 3.5MM X 12MM COLS-35120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COLS-35120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOCKING 3.5MM X 13MM COLS-35130-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COLS-35130-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOCKING 3.5MM X 14MM COLS-35140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COLS-35140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOCKING 3.5MM X 15MM COLS-35150-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COLS-35150-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOCKING 3.5MM X 16MM COLS-35160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COLS-35160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOCKING 3.5MM X 8MM COLS-35080-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COLS-35080-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOW PRO NON LOCK 2.7MMM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOW PRO NON LOCK 2.7MMM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL NON-LOCKING 3.5MM X 11MM PANL-35110-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35110-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL NON-LOCKING 3.5MM X 13MM PANL-35130-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35130-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL NON-LOCKING 3.5MM X 15MM PANL-35150-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35150-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL SELF TAPPING 3.5 X 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CORTICAL SELF TAPPING 3.5 X 75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COUNTERSINK 2.0 X 2.5MM LAG P06 S0691", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P06 S0691", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COUNTERSINK 2.2CCS AO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-3937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 825.83, "discounted_cash": 289.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COUNTERSINK 2MM TO 2.4MM CANNULATED", "code_information": [{"code": "316-0101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COUNTERSINK 3.5MM FPS CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS328017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 644.0, "discounted_cash": 225.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COUNTERSINK 6.5/7.5MM SCREWS 98230532", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "98230532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COUNTERSINK FOR 3.0MM COLAG CANNULATED LAG P06 N0501", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P06 N0501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2050.0, "discounted_cash": 717.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COUNTERSINK LAG 3.0/4.0 P06 S0711", "code_information": [{"code": "P06 S0711", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.51, "discounted_cash": 262.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW COUNTERSINK W/DENTAL SHAFT 1.7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "60-80417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 154.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CROSS 3.5 X 30MM LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5820X3530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CROSS CHECK 3.0 X 12MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CCP-L3012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 542.0, "discounted_cash": 189.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CROSS CHECK 3.0 X 14MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CCP-L3014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 542.0, "discounted_cash": 189.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CROSS CHECK 3.0 X 40MM NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CCP-N3040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 505.0, "discounted_cash": 176.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CROSS CHECK 3.5 X 22MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CCP-L3522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 542.0, "discounted_cash": 189.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CROSSLOCK DVR MD 2.7 X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CROSSLOCK DVR MD 2.7 X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CROSSLOCK DVR MD 2.7 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CROSSLOCK DVR MD 2.7MM X 14MM 131227314", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "131227314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 313.0, "discounted_cash": 109.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CRUCIFORM 2.3 X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-T2310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 529.0, "discounted_cash": 185.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CRUCIFORM NON-TOGGLING 2.3 X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-N2318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CXT 2.4 MM X 14MM 74402414", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74402414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW D:2.4MM X L:16.0MM VARIABLE ANGLE LOCKING FHF 116", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF 116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW D:2.4MM X L:20.0MM VARIABLE ANGLE LOCKING FHF 120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF 120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DART FIRE EDGE COMP D0325028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0325028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DART-FIRE EDGE COMP D0325030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0325030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DARTFIRE 2.5MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DIN25014S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DISTAL TROCHLEA COMPRESSION 3.5MMX40MM TI DTCS-35040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DTCS-35040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 509.0, "discounted_cash": 178.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DISTRACTION 12MM 7670212", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7670212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 157.5, "discounted_cash": 55.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DOUBLE LEAD LOCKING 3.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DOUBLE LEAD LOCKING 3.5MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-3516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DOUBLE LEAD LOCKING 3.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-3520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DOUBLE LEAD NON LOCKING 3.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DOUBLE LEAD NON LOCKING 3.5MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 271.0, "discounted_cash": 94.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DOUBLE LEAD NON LOCKING 3.5MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-3516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DOUBLE LEAD NON LOCKING 3.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-3520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DOUBLE LEAD NON LOCKING 3.5MM X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-3524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DOUBLE LEAD NON LOCKING 4.0MM X 55MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-4055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DRIVER 2.5MM CANNULATED T8 AO QC OS900054-NS", "code_information": [{"code": "OS900054-NS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1613.0, "discounted_cash": 564.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DRIVER 2.7MM T8", "code_information": [{"code": "320-2408", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DRIVER ATTACTMENT HX-10SHORT TAPER R3CON P99-191-TR10", "code_information": [{"code": "P99-191-TR10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 747.0, "discounted_cash": 261.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DRIVER BIT 4.0MM GRIDLOCK ANKLE", "code_information": [{"code": "320-40-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 956.0, "discounted_cash": 334.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DRIVER BIT GRIDLOCK ANKLE", "code_information": [{"code": "320-35-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 956.0, "discounted_cash": 334.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DRIVER BIT SHORT 4.0 310-31-003", "code_information": [{"code": "310-31-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 232.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DRIVER KIT PINIT BONE FUSION", "code_information": [{"code": "9A09-4000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 887.0, "discounted_cash": 310.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DRIVER LAG DRIVER T8 CANNULATED P06 S0411", "code_information": [{"code": "P06 S0411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 599.87, "discounted_cash": 209.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DRIVER LAG T15 P06 S0421 P06 S0421", "code_information": [{"code": "P06 S0421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 599.87, "discounted_cash": 209.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DRIVER T15 CANNULATED QUICK RELEASE", "code_information": [{"code": "320-2615", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1320.0, "discounted_cash": 462.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DRIVER T7 LAG CANNULATED STERILE P06 S0671", "code_information": [{"code": "P06 S0671", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EMPOWR ACETABULAR BONE 6.5 X 15MM SIZE 15MM 940-00-015", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "940-00-015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ES2 6.5X40MM S 482802640", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482802640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ES2 6.5X50MM L 482804650", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482804650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ES2 6.5X50MM S 482802650", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482802650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ES2 7.5X40MM S 482802740", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482802740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2163.0, "discounted_cash": 757.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ES2 7.5X45MM L 482804745", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482804745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ES2 7.5X45MM S 482802745", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482802745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2163.0, "discounted_cash": 757.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ES2 7.5X50MM L 482804750", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482804750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVEREST 4.5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2911-04540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVEREST 6.5 X 45 E5111-06545", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E5111-06545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1750.0, "discounted_cash": 612.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.4MM X 10MM CTX T7 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402410N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.4MM X 16MM CTS T7 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402416N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 152.4, "discounted_cash": 53.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.4MM X 17MM CTX T7 S-T 72402417", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.7 X 26MM CORTEX T8 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402726N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 159.6, "discounted_cash": 55.86, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.7MM X 10MM CORTEX T8 SELF-TAPPING 72402710", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.7MM X 17MM CORTEX T8 SELF-TAPPING 72402717", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.7MM X 26MM CORTEX T8 SELF-TAPPING 72402726", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 146.0, "discounted_cash": 51.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.7MM X 34MM LCK T8 S-T 72412734", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 286.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.7MM X 46MM LOCKING T8 SELF-TAPPING 72412746", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 286.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.7MM X 50MM LOCKING T8 SELF-TAPPING 72412750", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.7MM X 60MM CTX T8 S-T 72402760", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.7MM X 6MM LOCKING T8 SELF-TAPPING 72412706", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 704.0, "discounted_cash": 246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 2.7MM X 9MM LOCKING T8 SELF-TAPPING 72412709", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 170.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 14MM LCK S-T 72413514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 968.0, "discounted_cash": 338.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 22MM CTX SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 22MM LCK SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 968.0, "discounted_cash": 338.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 24MM CTS SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 26MM CTS SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 28MM CTS SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 28MM LCK SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 632.0, "discounted_cash": 221.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 30MM CTS SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 30MM LCK SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 32MM LCK SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 968.0, "discounted_cash": 338.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 34MM LOCK 72413534", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 580.8, "discounted_cash": 203.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 36MM LCK SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 38MM LCK SCR S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 632.0, "discounted_cash": 221.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 40MM CTX 72403540", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 42MM LOCKING SELF -TAPPING 72413542", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 44MM LCK 72413544", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413544", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 159.8, "discounted_cash": 55.93, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MM X 70MM LCK 72413570", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 3.5MMX 13MM LCK S-T 72413513", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.0MM X 12MM OSTEOPENIA T8 FULLY THREADED 72424012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 393.0, "discounted_cash": 137.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.0MM X 14MM OSTEOPENIA T8 FULLY THREADED 72424014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.0MM X 16MM OSTEOPENIA T8 FULLY THREADED 72424016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.5MM X 32MM CORTEX SELF-TAPPING 72504532", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72504532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 53.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.7MM X 16MM OST F-T 72424716", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 502.0, "discounted_cash": 175.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.7MM X 24MM OST F-T 72424724", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.7MM X 32MM OST PT 72434732", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.7MM X 36MM OST F-T 72424736", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.7MM X 40MM OST 72424740", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 95.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.7MM X 46MM PARTIALLY THREADED 72434746", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.7MM X 50MM OST PT 72434750", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS 4.7MM X 70MM 72424770", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 170.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS LOCKING 3.5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 632.0, "discounted_cash": 221.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS LOCKING 3.5MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS PARTIALLY THREADED 4.7MM X 44M 72434744", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EVOS PL-D FIBULA A/G PL 7H R 80MM 72434734", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EXCELLA 6.5MM X 35MM MIS POLYAXIAL PEDICLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EM6535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EXCELLA PEDICLE 6.5MM X 40MM MIS POLYAXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EM6540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EXCELLA PEDICLE 6.5MM X 45MM MIS POLYAXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EM6545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EXCELLA PEDICLE 6.5MM X 50MM EM6550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EM6550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EXTEMFIX CANN LONG THREAD 7.3MM X 110MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-7111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1215.0, "discounted_cash": 425.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EXTEMFIX CANN SHORT THREAD 7.3MM X 80MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "319-7080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1215.0, "discounted_cash": 425.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EXTRACTOR MICRO MINI CFT AR-8737-59", "code_information": [{"code": "AR-8737-59", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1483.73, "discounted_cash": 519.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW F-T EVOS 4.7MM X 18MM OST 72424718", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72424718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FACET SMALL WASHER 4.5MM X 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IM0061-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2570.0, "discounted_cash": 899.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FACET SMALL WASHER 4.5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IM0061-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3943.0, "discounted_cash": 1380.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FASTPITCH 2.7MM HIGH PITCH LOCKING SD21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SD21", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 985.0, "discounted_cash": 344.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FASTPITCH 2.7MM HIGH PITCH LOCKING SD22", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SD22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 985.0, "discounted_cash": 344.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FASTPITCH LAPIPLASTY 3.0MM HEADLESS COMPR SD30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SD30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1126.0, "discounted_cash": 394.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FASTTHREAD 9 X 20CM AR-4020C-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4020C-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FEMUR 000-0190", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-0190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIX 4.0MM X 14MM CBAA40014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CBAA40014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIX 4.0MM X 16MM CBAA40016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CBAA40016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 87.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIXATION 4.5MM X 45MM JONES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5601-4545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3128.0, "discounted_cash": 1094.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIXATION 48MM HEX HEADED TIVANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5983-40-48", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 51.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIXATION SYSTEM HOUSING STANDARD INERTIA CONNEXX 20-HS-01", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-HS-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIXED LOCKING 3.5 HEX 4.75MMX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIXED LOCKING 3.5 HEX 4.75MMX20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIXED LOCKING 3.5 HEX 4.75MMX25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIXED LOCKING 4.75MM X 15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIXED SCREW SELF-STARTING SIZE \u00c3\u02dc4.0X14 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8801-14014DA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIXOS 7.0 X 65MM HEADLESS COMPRESSION SHORT THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1564.0, "discounted_cash": 547.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FIXOS COMPRESSION 7.0 X 80MM SELF TAP SELF DRILL HEADLESS SHORT THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1207.0, "discounted_cash": 422.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FREE FIX COMPRESSION 3.5MM X 14MM FFC-35140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-35140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 112.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FREE FIX COMPRESSION 3.5MM X 16MM FFC-35160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-35160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 112.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FREEFIX COMPRESSION 3.5 X 26 MM TI FFC-35260-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-35260-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 112.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FREEFIX COMPRESSION 3.5MM X 30MM FFC-35300-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-35300-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 136.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FREEFIX COMPRESSION 4.5MM X 16MM FFC-45160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-45160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 326.0, "discounted_cash": 114.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FREEFIX COMPRESSION 4.5MM X 18MM TI FFC-45180-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-45180-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FREEFIX COMPRESSION 4.5MM X14MM TI FFC-45140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-45140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FREEFIX COMPRESSION 4.5MM x 20MM TI FFC-45200-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-45200-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 326.0, "discounted_cash": 114.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FREEFIX COMPRESSION 4.5MMX24MM FFC-45220-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-45220-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 326.0, "discounted_cash": 114.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FREEFIX COMPRESSION 4.5MMX24MM FFC-45240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFC-45240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 326.0, "discounted_cash": 114.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FREEFIX LOCKING 4.5MM X 24MM TI FFL-45240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFL-45240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 134.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FRS 3.0 X 18MM CANNULATED SELF TAPPING HEADLESS DUAL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P3018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FRS 3.0 X 32MM CANNULATED SELF TAPPING HEADLESS DUAL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P1032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GIBRALT 3.5 X 14MM POLYAXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-000-20-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GLENOID HEAD W/RETAINING RSP 32MM/NEUTRAL 508-32-101", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "508-32-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1391.0, "discounted_cash": 486.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GOLD 1.5MM SCREW 08MM LENGHTA-5200.08/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5200.08/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GOLD 1.5MM SCREW 09MM LENGHTA-5200.09/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5200.09/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GOLD 2.0 X 24MM CORTEX HD6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5400.24/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GOLD 2.0 X 30MM CORTEX HD6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5400.30/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GORILLA 3.5 X 12 R3CON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GORILLA 3.5MM X 18MM R3CON NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GRIDLOCK 4.0 X 24MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "301-40-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GRIDLOCK LOCKING 2.4MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-24-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GRIDLOCK NON LOCKING 2.4MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "301-24-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW GRIDLOCK NON LOCKING 2.4MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "301-24-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HAMMERLOCK 2 ANGLED PROX 12MM 0DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HL2S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2390.0, "discounted_cash": 836.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HCS 2.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11008420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 989.0, "discounted_cash": 346.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HD 4.0MM X 32MM FX-HD-4032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX-HD-4032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1026.0, "discounted_cash": 359.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.0MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.0MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.0MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.0MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.0MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.0MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 333.0, "discounted_cash": 116.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.0MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 333.0, "discounted_cash": 116.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.0MM X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 333.0, "discounted_cash": 116.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.3MM X 18MM CANNULATED HL2318", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HL2318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1143.0, "discounted_cash": 400.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.3MM X 20MM CANNULATED HL2320", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HL2320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1143.0, "discounted_cash": 400.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 12MM MINI MONSTER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-125-012F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 14MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N25014S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 16MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N25016S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 18MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N25018S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 22MM", "code_information": [{"code": "MSD02522", "type": "CDM"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 24MM", "code_information": [{"code": "MSD02524", "type": "CDM"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 30MM", "code_information": [{"code": "MSD02530", "type": "CDM"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 32MM", "code_information": [{"code": "MSD02532", "type": "CDM"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 34MM", "code_information": [{"code": "MSD02534", "type": "CDM"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 2.5MM X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD02536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 121.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 20 X 2.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IC2520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 3.0 X 14MM CANN STAR DRIVE T10 CH30214T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CH30214T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 3.0 X 16MM CANN STAR DRIVE T10 CH30216T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CH30216T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 3.0MM X 34MM DLN300345", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DLN300345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 3.0MM X 35MM DLN300365", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DLN300365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 3.5MM X 30MM DART-FIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D1N35030S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 4.0MM X 34MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD04034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 4.0MM X 42MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD04042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 385.0, "discounted_cash": 134.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 4.0MM X 42MM DN140042S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DN140042S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 123.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 4.0MM X 46MM DN140046S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DN140046S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 123.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 4.0MM X 48MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD04048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 4.0MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD04050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 4.5MM X 38MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD04538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 4.5X40MM 200-45-140", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-45-140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1092.0, "discounted_cash": 382.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 5.5 X 56CM SHORT THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-155-056S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 317.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 5.5 X 60 SHORT THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-155-060S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 317.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED 7.5 MM X 90 X 16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SCN759062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1261.0, "discounted_cash": 441.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED CANN 3.5MM X 20MM", "code_information": [{"code": "MSD03520", "type": "CDM"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED CANN 3.5MM X 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSD03532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 372.0, "discounted_cash": 130.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED MINI CANN 4.0 X 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IC-4028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 204.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED MINI CANN 4.0 X 34MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IC-4034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 204.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADED SHORT THREAD 4.0MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-140-020S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLES COMPRESSION 3.5MM X 35MMEXTENDED TI HCS-35035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-35035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1590.0, "discounted_cash": 556.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5 X 16MM COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 10MM", "code_information": [{"code": "MSL02510", "type": "CDM"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 22MM BROWN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N25022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 28MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH2528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 30MM INSTATEK CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH2530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 34MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 2.5MM X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL02536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 3.0 X 14 CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71103314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1028.0, "discounted_cash": 359.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 3.0MM X 14MM 110018450", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 3.0MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL03016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 3.0MM X 16MM 110018451", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 3.0MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL03018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 3.0MM X 18MM 110018452", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018452", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 3.0MM X 20MM IH3020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH3020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 941.0, "discounted_cash": 329.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 4.0 X 38MM COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 722.0, "discounted_cash": 252.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 4.0MM X 46MM IH4046", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH4046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 4.5MM X 38MM CANNULATED 202-45-038", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202-45-038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 4.5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSL04540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 650.0, "discounted_cash": 227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 5.5 X 50MM SHORT THREAD CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207-55-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 5.5 X 55MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "207-55-055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS CANN 3.0X16MM P20-530-016S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-530-016S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPLRESSION 7.4MM X 50MM F1-1974-050S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "F1-1974-050S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3562.0, "discounted_cash": 1246.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 2.5 X 14MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 2.5MM X 10MM TI HCS-25010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-25010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 573.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 2.5MM X 14MM TI HCS-25014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-25014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1240.0, "discounted_cash": 434.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 2.5MM X 16MM TI HCS-25016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-25016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 573.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 2.5MM X 18MM TI HCS-25018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-25018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 573.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 2.5MM X 20MM TI HCS-25020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-25020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1240.0, "discounted_cash": 434.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 2.5MM X 22MM TI HCS-25022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-25022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 992.0, "discounted_cash": 347.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 2.5MM X 24MM TI HCS-25024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-25024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 573.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 2.5MM X 28MM TI HCS-25028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-25028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 573.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 2.5MM X 30MM TI HCS-25030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-25030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 573.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 3.0 X 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH3028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 3.5MM X 18MM TI HCS-35018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-35018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1280.0, "discounted_cash": 448.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 3.5MM X 20MM TI HCS-35020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-35020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 573.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 3.5MM X 22MM TI HCS-35022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-35022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1280.0, "discounted_cash": 448.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 3.5MM X 24MM TI HCS-35024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-35024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1024.0, "discounted_cash": 358.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 3.5MM X 26MM TI HCS-35026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-35026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1280.0, "discounted_cash": 448.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 3.5MM X 28MM TI HCS-35028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-35028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1024.0, "discounted_cash": 358.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 3.5MM X 30MM TI HCS-35030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCS-35030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1280.0, "discounted_cash": 448.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 4.0 X 42MM OSSIOFIBER OF1024042S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1024042S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2430.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 5 X 38MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 756.0, "discounted_cash": 264.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 5.0MM X 44MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 756.0, "discounted_cash": 264.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 5.0MM X 46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1134.0, "discounted_cash": 396.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 5.0MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 756.0, "discounted_cash": 264.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 5.0MM X 65MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 982.0, "discounted_cash": 343.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 658048", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 722.0, "discounted_cash": 252.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION 7.4MM X 42MM F1-1974-042S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "F1-1974-042S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3562.0, "discounted_cash": 1246.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS COMPRESSION SCREW 5.0MM X 70MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 982.0, "discounted_cash": 343.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS DART-FIRE 2.5 X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N25024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS DART-FIRE 3.0MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N30020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 159.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS DART-FIRE 3.0MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D2N30040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS FIXOS COMP 7.0MM X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1564.0, "discounted_cash": 547.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS FIXOS COMP 7.0MM X 70MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1220.0, "discounted_cash": 427.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS FIXOS COMP 7.0MM X 75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "658375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1207.0, "discounted_cash": 422.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEADLESS LENGTH 36 X 2.5MM IH2536", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH2536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEMI 22X19 TI GREEN CANNULATED 4 CHI-4T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CHI-4T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8046.0, "discounted_cash": 2816.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEX 3.5MM X 36 MM CORTICAL SELF TAP SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4835-036-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEX CORTICAL 3.2MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HEX3.2-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEX LOW PROFILE 6.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7030-6520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEX LOW PROFILE 6.5MM X 50MM 7030-6550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7030-6550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEXALOBE CORTICAL NON-LOCKING 3.5 X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.26, "discounted_cash": 43.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEXALOBE MULTI 2.3MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3004-23010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 449.0, "discounted_cash": 157.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEXALOBE MULTI 2.3MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3004-23012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 449.0, "discounted_cash": 157.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEXALOBE MULTI 2.3MM X 13MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3004-23013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.76, "discounted_cash": 66.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEXALOBE MULTI 2.3MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3004-23014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.76, "discounted_cash": 66.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW HEXALOBE NON LOCKING 3.0MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW IBS 2.0-C COMPRESSION DIAM 2.0 LG13MM T7 S20 ST013", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S20 ST013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 650.0, "discounted_cash": 227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW IBS 2.0C COMPRESSION S20 ST014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S20 ST014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW IMF 2.0MM X 8MM SLF-DRILLING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201.928E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 226.0, "discounted_cash": 79.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INFINITY MULTI AXIAL 3.5 X 12MM 3603512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3603512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INFINITY MULTI AXIAL 3.5 X 16MM 3603516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3603516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INFINITY MULTI AXIAL 4..0 X 18MM 3604018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3604018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1400.0, "discounted_cash": 490.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INFINITY MULTI AXIAL 4.0 X 16MM 3604016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3604016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1400.0, "discounted_cash": 490.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INFINITY MULTI AXIAL 4.0 X 20MM 3604020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3604020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1400.0, "discounted_cash": 490.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INFINITY MULTI AXIAL 4.0 X 24MM 3604024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3604024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1400.0, "discounted_cash": 490.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INFIX LOCKING SCREW VARIAX2 T10 FULL THREAD 3.5MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INFRAME IMPLANT 2.0MM X 32MM 22031-20 EXINF922032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EXINF922032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3968.0, "discounted_cash": 1388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INION FREEDOM 2.0 X 20MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OSA-2020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INSTRUMENTS OSSIO\u00c2\u00ae COMPRESSION FOR 3.5 MM SCREWS. PACKAGE CONTAINS 1 THN00132", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "THN00132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1150.0, "discounted_cash": 402.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INTERFACE MILAGRO 11MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INTERFERANCE TITAN TENODESIS 4.5MM X 15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TS-4515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 742.0, "discounted_cash": 259.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INTERFERENCE 10 X 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231827", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INTERFERENCE 7.0MM X 25MM 110004605", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110004605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 574.0, "discounted_cash": 200.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INVICTUS 6.5X 35MM 15025-065-035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15025-065-035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW INVICTUS 6.5X40MM 15025-065-040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15025-065-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW JONES FMS 5.5MM 45MM JHEX5545", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JHEX5545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3131.0, "discounted_cash": 1095.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW JONES FMS 5TH MET 5.5MM 55MM JHEX5555", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JHEX5555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3131.0, "discounted_cash": 1095.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW JONES FRACTURE \u00c3\u02dc4.5X45.0 MM P60 ST445", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P60 ST445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1694.0, "discounted_cash": 592.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW KREULOCK COMPRESSION 2.7MM X 10MM AR-8827CL-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827CL-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.56, "discounted_cash": 223.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW KREULOCK COMPRESSION 2.7MM X 16MM AR-8827CL-16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827CL-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.56, "discounted_cash": 223.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW KREULOCK COMPRESSION 2.7MM X 18MM AR-8827CL-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827CL-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.56, "discounted_cash": 223.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW KREULOCK COMPRESSION 2.7MM X 20MM AR-8827CL-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827CL-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.56, "discounted_cash": 223.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW L 2.4 X 10 SB-LK-2410", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB-LK-2410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 2.4 X 22MM CANN TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 2.5 X 14MM S25-14T-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25-14T-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 2.5 X 14MM SS S25-14S-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25-14S-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 752.0, "discounted_cash": 263.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 2.5MM X 16MM S25-16S-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25-16S-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 730.0, "discounted_cash": 255.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 2.5MM X 18MM S25-18S-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25-18S-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.0, "discounted_cash": 223.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 2.5X06MM S25-06S-09", "code_information": [{"code": "S25-06S-09", "type": "CDM"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 173.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 3 X 12MM CANNULATED TIGER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-30-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 3.0 X06MM S30-06S-11", "code_information": [{"code": "S30-06S-11", "type": "CDM"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 184.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 3.0MM X 28MM TI D.BLUE S30-28T-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S30-28T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 3.5MM X 12MM TI D BLUE S35-12T-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S35-12T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 3.5MM X 16MM TI D.BLUE S35-16T-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S35-16T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 3.5MM X 30MM TID BLUE S35-30T-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S35-30T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 4.0MM X 2.6MM TI D BLUE S40-26T-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S40-26T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 236.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 4.0MM X 28MM TI D.BLUE S40-28T-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S40-28T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 262.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 4.0MM X 30MM TID BLUE S40-30T-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S40-30T-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 236.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 4.0X26MM S40-26S-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S40-26S-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 840.84, "discounted_cash": 294.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 4.0X34MM S40-34S-11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S40-34S-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 840.84, "discounted_cash": 294.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG 4.1MM X 28MM T10 ANCHORAGE CP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 569.0, "discounted_cash": 199.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG CP 4.1MM X 32MM T10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 569.0, "discounted_cash": 199.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG CP 4.1MM X 34MM T10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 473.0, "discounted_cash": 165.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG CROSSCHECK 3.5MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CCP-X3526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 542.0, "discounted_cash": 189.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAG DRILL 1320-0191", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1320-0191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4060.0, "discounted_cash": 1421.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAPIPLASTY 4.0 HEADLESS SK26", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK26", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 985.0, "discounted_cash": 344.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LAPIPLASTY. 2.0 MM SNAP- OFF SK21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK21", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 985.0, "discounted_cash": 344.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LARGE 4.0MMX32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "102-40032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1978.0, "discounted_cash": 692.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LCK 2.4MM X 15MM 74412415", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74412415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 692.0, "discounted_cash": 242.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LCK 2.4MM X 20MM 74412420", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74412420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 692.0, "discounted_cash": 242.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LCK2.4MM X 22MM 74412422", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74412422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 692.0, "discounted_cash": 242.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LEOS 3.5 22MM LOCKING 7621-3522", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7621-3522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 273.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LO PRO BLUNT 4X40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5051-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LO-PRO 4MM X 28MM CANN BLUNT TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5051-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LO-PRO 4MM X 36MM CANN BLUNT TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5051-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LO-PRO TI 3.5 MM X 26 MM AR-8935-26", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935-26", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 169.0, "discounted_cash": 59.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LO-PRO TI M.5MM X 38MM AR-8935-38", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935-38", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOACKING 3.0 X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "371014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCK 10-2003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Oct-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 880.0, "discounted_cash": 308.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.8MM X 16MM BLUE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.16/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.8MM X 18MM BLUE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.18/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 1.7MM X 10MM 662510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 112.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 1.7MM X 6MM 662506", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.0 20MM T6 657620", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 158.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.0 X 14MM MCLS2.0-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MCLS2.0-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.0 X 16MM MCLS2.0-16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MCLS2.0-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.0MM X 10.0MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF 010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 466.0, "discounted_cash": 163.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.0MM X 10MM VLP TITANIUM T6 SELF-TAPPING 74412010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74412010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.0MM X 12MM VLP TITANIUM T6 SELF-TAPPING 74412012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74412012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.0MM X 8.0MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF 008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 466.0, "discounted_cash": 163.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.2 X 14MM 308-22-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-22-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.2 X 16MM 308-22-016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-22-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.2 X18MM 308-22-018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-22-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.2X20MM 308-22-020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-22-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.4MM X 10.0MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF 110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 466.0, "discounted_cash": 163.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.4MM X 12.0MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF 112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 698.0, "discounted_cash": 244.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.4MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-24-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.4MM X 14.0MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF 114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 698.0, "discounted_cash": 244.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.4MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-24-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.4MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-24-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.4MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "302-24-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.4MM X 22.0MM VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF 122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.5MM X 22MM A-5750.22/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.22/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.5MM X 24MM A-5750.24/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.24/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 162.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7 X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-2710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 742.0, "discounted_cash": 259.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7 X 14 308-27-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-27-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7 X 16 308-27-016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-27-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7 X 16 MF-LK-2716", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-LK-2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 649.0, "discounted_cash": 227.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7 X 16MM (OSTEOMED)", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 640.0, "discounted_cash": 224.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7 X 20 MF-LK-2720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-LK-2720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7 X 20MM (OSTEOMED)", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-2720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-2722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 640.0, "discounted_cash": 224.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7 X 44MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7 X 46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.78MM T8 L10MM 541410", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "541410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM / T8 / L12 MM 541412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "541412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM / T8 / L14 MM 541414", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "541414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM / T8 /L16 MM 541416", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "541416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM X 10MM 00-4828-010-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4828-010-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM X 12.0MM LOW PROFILE VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FLP 212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM X 12MM - OS422512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS422512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 595.0, "discounted_cash": 208.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM X 12MM 00-4828-012-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4828-012-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM X 14.0MM LOW PROFILE VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FLP 214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM X 14MM 00-4828-014-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-4828-014-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 61.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM X 16.0MM LOW PROFILE VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FLP 216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM X 48MM EVOS 72412748", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72412748", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 490.8, "discounted_cash": 171.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.7MM X 65MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 20.MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.10/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 20MM 71354503", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71354503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 439.0, "discounted_cash": 153.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 20MM DWD020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWD020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.0 X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "371016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.0 X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "371018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.0MM X 12MM V30ST312", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V30ST312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 130.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.0MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V30 ST314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 130.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.0MM X 18MM V30 ST318", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V30 ST318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 650.0, "discounted_cash": 227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.0MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V30 ST320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 650.0, "discounted_cash": 227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.0X10MM 305-35-010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-35-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.2X12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LCBS3.2-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 10MM 308-35-010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-35-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 12MM 58803512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58803512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 12MM MF-LK-3512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-LK-3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 14MM 58803514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58803514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 160.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 14MM COLINK PLATING SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V35ST314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 650.0, "discounted_cash": 227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 14MM MF-LK-3514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-LK-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 16MM 58803516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58803516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 472.0, "discounted_cash": 165.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 16MM COLINK PLATING SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V35ST316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 650.0, "discounted_cash": 227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 18MM 58803518", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58803518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 472.0, "discounted_cash": 165.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 18MM COLINK PLATING SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V35ST318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1339.0, "discounted_cash": 468.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 18MM MPSL3518", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSL3518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSL3520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 20MM 308-35-020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-35-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 20MM 58803520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58803520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 472.0, "discounted_cash": 165.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 22MM 58803522", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58803522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 160.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 22MM COLINK PLATING SYSTEM V35 ST322", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V35 ST322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 650.0, "discounted_cash": 227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 24MM 308-35-024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-35-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 24MM 58803524", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58803524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 284.0, "discounted_cash": 99.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 26MM - MPSL3526", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSL3526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 26MM 58803526", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58803526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 160.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 28MM 308-35-028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-35-028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5 X 30MM 58803530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58803530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5MM / T15 / L14 MM 541514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "541514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 226.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5MM X 16MM MULTIDIRECT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8163-35-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 110.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-3518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5MM X 20MM MOTOBAND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15LK-3520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5MM X 20MM MULTIDIRECT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8163-35-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 110.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5MM X 22MM MULTIDIRECT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8163-35-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 110.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5MM X 30MM MPSL3530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSL3530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5MM X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 200.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5X18MM 305-35-018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "305-35-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.5X60MM 72413560", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 583.8, "discounted_cash": 204.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 4MM 4.0/L28 661028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 4MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-4012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 5 X 52.5MM 2360-5060S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2360-5060S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 5.0 X 45MM 2360-5045S 2360-5045S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2360-5045S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 5.0MM X 75MM FULLY THREADED 1896-5075S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1896-5075S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 441.0, "discounted_cash": 154.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING 5X40MM 2360-5040S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2360-5040S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING CORT 2.7 X 16MM ORTHOLOC 3DSI 40232716", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40232716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 472.0, "discounted_cash": 165.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING CORT 2.7 X 22MM ORTHOLOC 3DSI 40232722", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40232722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 472.0, "discounted_cash": 165.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING CORT 2.7 X 50MM 40232750", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40232750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING CORT 3.5 X 28MM ORTHOLOC 3DSI 40233528", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40233528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING CORT 3.5 X 30MM ORTHOLOC 3DSI 40233530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40233530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING CROSSCHECK 3.5MM X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CCP-L3524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 542.0, "discounted_cash": 189.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING DOUBLE LEAD EXTREMILOCK 3.5 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-3522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING DOUBLE LEAD EXTREMILOCK 3.5 X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-3524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING FIXED 4.75MM X 35MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING FULLY THREADED 5 X 47.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1896-5047S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 606.0, "discounted_cash": 212.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING HEXALOBE 2.7 X 10MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING HEXALOBE 2.7 X 14MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING HEXALOBE 2.7 X 16 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING HEXALOBE 3.5 X 40MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING HEXALOBE 3.5MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.26, "discounted_cash": 43.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING LG HD 2.7X12MM 58802712", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58802712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 160.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING LG HD 2.7X14MM 58802714", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58802714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 472.0, "discounted_cash": 165.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING LG HD 2.7X16MM 58802716", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58802716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 160.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING LG HD 2.7X18MM 58802718", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58802718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 160.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING LG HD 2.7X20MM 58802720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58802720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 472.0, "discounted_cash": 165.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING LG HD 2.7X22MM 58802722", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58802722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 160.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING LG HD 2.7X24MM 58802724", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58802724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 472.0, "discounted_cash": 165.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING LG HD 2.7X26MM 58802726", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58802726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 160.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING LOW PROFILE VA 2.4 X 10MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724V-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING LOW PROFILE VA 2.4 X 12MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724V-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING LOW PROFILE VA 2.4 X 14MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724V-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING SCREW BONE VARIAX2 T10 FULL THREAD 3.5MM X 46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING SELF TAPPING 3.5 X 70MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 367.0, "discounted_cash": 128.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING SELF TAPPING 3.5 X 75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 367.0, "discounted_cash": 128.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING SELF TAPPING 4.0 X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING SELF TAPPING 4.0 X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING SELF TAPPING 4.0 X 38MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING SELF TAPPING 4.0 X 46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING SELF TAPPING 4.0 X 48MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "661048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING SELF-TAP T8 STARDRIVE 2.7MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.211.025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 121.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING SELF-TAPPING 2.7MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING SELF-TAPPING 2.7MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING STERILE 5 X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1896-5040S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 158.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING T25 SELF TAPPING PERI-LOC 4.5 X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73827020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING T6 2.0MM L15MM 657615", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 158.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING T6 2.3XL10 663810", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING T6 2.3XL12 663812", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING T6 2.3XL13MM 663713", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 113.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING T6 2.3XL14 663714", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 113.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING T6 2.3XL9 663709", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 113.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING T8 3.5X14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLL3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 205.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING THREADED ANGLED 2.7MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "338-2712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 742.0, "discounted_cash": 259.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING TS 1.7MM / L7MM 662507", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING \u00c3\u02dc3.0X26.0 MM P67 ST326", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1190.0, "discounted_cash": 416.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING \u00c3\u02dc3.5X14MM P73 ST114", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P73 ST114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKING, 2.7MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27614E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOCKINGCAP TROCHLEAR COMPRESSION TCS-LC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TCS-LC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LONG 7.0MM X 110MM LARGE TIGER CANNULATED 206-70-110", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206-70-110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LONG 7.0MM X 115MM LARGE TIGER CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206-70-115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LONG 7.0MM X 120MM LARGE TIGER CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206-70-120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LONG 7.0MM X 60MM 206-70-060", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206-70-060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1270.0, "discounted_cash": 444.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LONG THREAD 7.0MM X 75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "206-70-075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1625.0, "discounted_cash": 568.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PRO CANNULA 4MM X 44MM BLUNT TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5051-44", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE 2.4X18MM CORTEX AR-8724-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE 2.4X20MM CORTEX AR-8724-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE 3.5MM X 16MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8935-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE 3.5X22MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE 3.5X35MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8835-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE CORTEX LOCKING 2.4MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724V-26", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE TM SS 2.7MM X 18MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE VA LOCKING 2.4MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724V-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE VA LOCKING 2.4MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724V-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE VA LOCKING 2.4MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724V-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE VA LOCKING 3.0 X 16.0MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8933V-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE VA LOCKING 3.0 X 18.0MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8933V-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE VA LOCKING 3.0 X 20.0MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8933V-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW PROFILE VA LOCKING 3.0MM X 14.0MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8933V-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 136.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW-PRO CORT 3.5 X 10MM 58813510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW-PRO CORT 3.5 X 14MM 58813514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW-PRO CORT 3.5 X 16MM 58813516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW-PRO CORT 3.5 X 18MM 58813518", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW-PRO CORT 3.5 X 20MM 58813520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW-PRO CORT 3.5 X 22MM 58813522", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW-PRO CORT 3.5 X 26MM 58813526", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW-PRO CORT 3.5 X 28MM 58813528", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW-PRO CORT 3.5 X 32MM 58813532", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW-PRO CORT 3.5 X 34MM 58813534", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LOW-PRO CORT 3.5 X 60MM 58813560", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58813560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LP 2.4 X 22 MM CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LP 3.0X10MM CORTICAL MTP TI AR-9933-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9933-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW LP CORTICAL NON-LOCKING 2.7 X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 97.56, "discounted_cash": 34.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MATRIX 2.0 X 12MM MANDIBLE LOCKING SLF-TPNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.503.612.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MATRIX MANDABLE 2.0MM X 14MM LOCKING SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.503.614.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MATRIXMANDIBLE 2.0 x 6MM FINE PITCH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.503.556.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MATRIXWAVE 1.85 X 6MM MMF SELF-DRILL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4.503.824.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MAX VPC 2.5 X 26MM VAR PITCH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "233225026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 762.2, "discounted_cash": 266.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MAX VPC 2.5MM X 24MM 233225024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "233225024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 432.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MDS DIR 2.7MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "131227318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 313.0, "discounted_cash": 109.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MEDIUM XMCP 5.0MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "120-22530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3801.0, "discounted_cash": 1330.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW METAPHYSEAL 2.7 X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.118.518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MI LATERAL SCREWS SELF STARTING 5.0X28 MM 4501-15028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4501-15028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MI LATERAL SCREWS SELF STARTING 5.0X40 MM 4501-15040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4501-15040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MI LATERAL SCREWS SELF STARTING 5.0X44 MM 4501-15044", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4501-15044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MI LATERAL SCREWS SELF STARTING 5.0X48 MM 4501-15048", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4501-15048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MI LATERAL SCREWS SELF STARTING 5.5X28 MM 4501-15528", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4501-15528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MIB 2.4MM SCREW CALIBRATED PILOT DRILL BIT", "code_information": [{"code": "317-24-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MILAGRO ADV. INTERFERENCE 10MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 972.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MILAGRO ADVANCE 9MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "231822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1022.0, "discounted_cash": 357.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MIN 2.5 X 38MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IH2538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 261.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI ACUTRAK 2 16MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-M16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1889.0, "discounted_cash": 661.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI ACUTRAK 2 22MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-M22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1889.0, "discounted_cash": 661.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI ACUTRAK 2 30MM CRUCIFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AT2-M30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1765.0, "discounted_cash": 617.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI COMP FT 3.5MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8730-30H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI HEADLESS 4MM X 38MM 2600-04-4338", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2600-04-4338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI MONSTER 2.0 X 14MM HEADED SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-120-014S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI MONSTER 2.0 X 16MM HEADED SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-120-016S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI MONSTER 2.0 X 17MM HEADED SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-120-017S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI MONSTER 2.0 X 18MM HEADED SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-120-018S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI MONSTER 2.0 X 20MM CANNULATED SHORT THREAD HEADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-120-020S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI MONSTER 2.0 X 24MM CANNULATED SHORT THREAD HEADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-120-024S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI MONSTER 2.0MM COUNTERSINK NHPL PERI OP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-910-2000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI MONSTER 4.0 X 40MM SHORT THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-140-040S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 692.0, "discounted_cash": 242.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI MONSTER COUNTERSINK 2.5MM HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-915-2500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI MONSTER HEADLESS SHORT THREAD 2.0MM X 38MM P20-520-038S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-520-038S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 855.0, "discounted_cash": 299.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI MONSTER HEADLESS SHORT THREAD 3.0MM X 24MM P20-530-024S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-530-024S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI-MONSTER 3.5 X 36MM CANN SHORT THREAD HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-535-036S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 855.0, "discounted_cash": 299.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI-MONSTER 4.0 X 34MM SHORT THREAD HEADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-140-034S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MINI-MOSTER SHORT 2.0X40MM P20-520-040S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-520-040S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 855.0, "discounted_cash": 299.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MIS 3.9MM BC ACHILLES SPDBRG W/ KL DX CC AR-9928BCK-MIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9928BCK-MIS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6922.5, "discounted_cash": 2422.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MIS 5.5 X 40MM EXTENDED TAB CANNULATED 108-ET-5540C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "108-ET-5540C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MIS 6.5 X 40MM 108-ET-6540C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "108-ET-6540C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MIS 6.5 X 45MM 108-ET-6545C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "108-ET-6545C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MIS BEVELED 3.0 X 36MM SF3036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SF3036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 504.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MIS POLY 7.5MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EM7550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MIS POLYAXIAL 6.5 X 35MM 108-ET-6535C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "108-ET-6535C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MODULAR CENTRAL 6.5 X 30MM 508-65-030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "508-65-030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2928.0, "discounted_cash": 1024.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSER MINI HEADED 4.0MM X 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-140-0325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSER MINI HEADED 4.0MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-140-038S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 529.0, "discounted_cash": 185.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSTER 3.0 X 36MM MINI CANNULATED S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-530-036S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSTER 4.0 X 32MM HEADLESS SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-140-032S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 595.0, "discounted_cash": 208.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSTER 4.5 X 32MM CANULATED SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-545-032S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1014.0, "discounted_cash": 354.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSTER 4.5 X 40MM HEADLESS SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-545-040S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1014.0, "discounted_cash": 354.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSTER 4.5 X 55MM LONG THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-145-055L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 727.0, "discounted_cash": 254.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSTER 5.5 X 32MM SHORT THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-155-032S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1219.0, "discounted_cash": 426.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSTER 7.0 X 70MM CANNULATED SHORT THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-170-070S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1483.0, "discounted_cash": 519.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSTER BITE 2.0 X 10MM SHORT THREAD P24-020-010S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P24-020-010S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 801.0, "discounted_cash": 280.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSTER BITE 2.0 X 12MM SHORT THREAD P24-020-012S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P24-020-012S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 801.0, "discounted_cash": 280.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSTER BITE BREAK OFF 3/4 2.0X10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P24-020-010L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 801.0, "discounted_cash": 280.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONSTER BITE BREAK OFF 3/4 2.0X12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P24-020-012L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 801.0, "discounted_cash": 280.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MONTEREY AL STAND-ALONE ANTERIOR LUMBAR 5.0 MMX17.5 MM 480115017", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "480115017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MOTOBAND 3.0MM X 10MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1500-3010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MOTOBAND 3.0MM X 14MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1500-3014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MOTOBAND CP POLYAXAIL SCREW 3.5MM X 12MM STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15PL-3512`", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MOTOBAND CP POLYAXIAL 3.5MM X 22MM 15LP-3522", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15LP-3522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MOTOBAND NON-LOCKING 3.0MM X 18MM 15NL-3018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15NL-3018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 135.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MOTOBAND POLYAXIAL 3.5MM X 22MM 15PL-3522", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15PL-3522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MOTOBAND POLYAXIAL LOCKING 3.0MM X 16MM 15PL-3016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15PL-3016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MOTOBAND POLYAXIAL LOCKING 3.0MMX 20MM 15PL-3020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15PL-3020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MOTOBAND POLYAXIAL LOCKING 3.0MMX14MM 15PL-3014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15PL-3014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI AXIAL 3.5 X 14MM 3603514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3603514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1400.0, "discounted_cash": 490.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 2.7MM X 55MM TI MTNL-27500-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-27500-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 381.0, "discounted_cash": 133.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.0MM X 10MM TI MTNL-30100-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-30100-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.0MM X 12MM TI MTNL-30120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-30120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.0MM X 14MM TI MTNL-30140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-30140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.0MM X 16MM TI MTNL-30160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-30160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.0MM X 8MM TI MTNL-30080-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-30080-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.5MM X 12MM TI MTNL-35120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-35120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.5MM X 14MM TI MTNL-35140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-35140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.5MM X 16MM TI MTNL-35160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-35160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.5MM X 18MM TI MTNL-35180-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-35180-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.5MM X 26MM TI MTNL-35260-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-35260-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.5MM X 40MM TI MTNL-35400-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-35400-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD COMPRESSION 3.5MM X 45MM TI MTNL-35450-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTNL-35450-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 2.7MM X 30MM TI MTLS-27300-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-27300-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 410.0, "discounted_cash": 143.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 2.7MM X 38MM TI MTLS-27380-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-27380-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 410.0, "discounted_cash": 143.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.0MM X 10MM TI MTLS-30100-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-30100-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.0MM X 12MM TI MTLS-30120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-30120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.0MM X 8MM TI MTLS-30080-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-30080-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 10MM TI MTLS-35100-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35100-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 12MM TI MTLS-35120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 14MM TI MTLS-35140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 16MM TI MTLS-35160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 18MM TI MTLS-35180-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35180-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 20MM TI MTLS-35200-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35200-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 22MM TI MTLS-35220-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35220-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 26MM TI MTLS-35260-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35260-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 28MM TI MTLS-35280-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35280-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 30MM TI MTLS-35300-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35300-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 38MM TI MTLS-35380-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35380-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386.0, "discounted_cash": 135.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW MULTI-THREAD LOCKING 3.5MM X 45MM TI MTLS-35450-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MTLS-35450-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NAIL HINDFOOT CROSSING 5.0MM X 28MM P32-450-028F", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P32-450-028F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 736.0, "discounted_cash": 257.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NEXIS 2.3 X 16MM NAILING COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HS010016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1329.0, "discounted_cash": 465.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NEXIS 2MM X 14MM SNAP OFF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC040014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1197.0, "discounted_cash": 418.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NEXIS 2MM X 15MM SNAP-OFF SC040015", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC040015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1197.0, "discounted_cash": 418.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NEXIS 2MM X 16MM SNAP-OFF SC040016", "code_information": [{"code": "SC040016", "type": "CDM"}], "standard_charges": [{"gross_charge": 1197.0, "discounted_cash": 418.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NEXIS PECA IMPLANT 04 LENGTH 44MM PS050044 PS050044", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PS050044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3483.0, "discounted_cash": 1219.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NEXIS SNAP-OFF 13MM SC040013", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC040013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1197.0, "discounted_cash": 418.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NL 2.4MM X 10MM SB-NL-2410", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB-NL-2410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON LOCKING 2.4MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MXM-011-24-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 104.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON LOCKING 2.7 X 10MM FULL THREAD T8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-2710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON LOCKING 2.7MMX16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 297.0, "discounted_cash": 103.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON LOCKING 2.7MMX20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-2720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 297.0, "discounted_cash": 103.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON LOCKING 3.0MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "301-30-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON LOCKING 3.5 X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-3526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON LOCKING 3.5MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-3530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON LOCKING 3.5MM X 32MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337.3532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON TOGGLING CORTICAL 2.3MM X 28MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-N2328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 398.0, "discounted_cash": 139.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON- LOCKING 3.5 X 22MM 308-35-022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-35-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 191.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCK 3.5 X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PM-MFT-011-35-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 2.0MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.18/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 63.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 2.0MM X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.24/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 2.0MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.26/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 111.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 2.4MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 83.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 2.4X16MM SB-NL-2416", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SB-NL-2416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 2.5MM X 34MM HD7 A-5700.34/1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5700.34/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 80.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 2.7 X 12 307-27-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-27-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 2.7 X 16 MF-NL-2716", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MF-NL-2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 649.0, "discounted_cash": 227.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 3.0MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V30ST218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 3.5 X 12MM MPSN3512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSN3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 3.5 X 14MM MPSN3514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSN3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 3.5 X 20MM MPSN3520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSN3520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 3.5 X 22MM 307-35-022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-35-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 162.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 3.5 X 30MM MPSN3530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSN3530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING 3.5MM X 54MM MPSN3554", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSN3554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING CORTICAL 3.5MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING CORTICAL 3.5MM X 60MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-35060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 184.0, "discounted_cash": 64.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING HEXALOBE 2.7MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-0347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.26, "discounted_cash": 43.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING LG HD 2.7X14MM 58812714", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58812714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING LG HD 2.7X16MM 58812716", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58812716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING LG HD 2.7X18MM 58812718", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58812718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING LG HD 2.7X20MM 58812720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58812720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING LG HD 2.7X22MM 58812722", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58812722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING LG HD 2.7X28MM 58812728", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58812728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.0, "discounted_cash": 76.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING MINI 2.4MM X 10MM MFSN2410", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSN2410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING MINI 2.4MM X 8MM MFSN2408", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSN2408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING MINI 2.7MM X 10MM MFSN2710", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSN2710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING STANDARD 2.7MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "337-2712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 2.0MM X 10.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 2.0MM X 14.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 2.0MM X 16.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 2.7MM X 12.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 51.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 2.7MM X 16.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 3.5MM X 10.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 205.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 3.5MM X 12.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 3.5MM X 14.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 3.5MM X 16.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 3.5MM X 18.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 4.0MM X 12.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NON-LOCKING VARIABLE ANGLE 4.0MM X 16.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS-416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW NONLOCKING 3.0MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "V30ST222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OASYS POLY NON BIASED DIA 4.0 X 10 48558410", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48558410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1545.0, "discounted_cash": 540.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSSIO FIBER COMPRESSION 4.0 X 32MM OF1024032S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1024032S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2430.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA 4.0 X 40MM SELF TAPPING PART THREAD NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72434040N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA 5.0MM X 32MM P-L VLP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA FULL THREAD 5.0MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71822010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA FULL THREAD 5.0MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-2012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA FULL THREAD 5.0MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-2016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA FULL THREAD 5.0MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7182-1130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA FULL THREAD 5.0MM X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA FULLY THREADED EVOS 4.7MM X 30MM STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7242-4730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 101.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA PARTIAL THREADED 4.0MM X 30MM T8 EVOS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7243-4030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 182.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA PARTIALLY THREADED 5.0 X 60MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 184.0, "discounted_cash": 64.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA PARTIALLY THREADED 5.0 X 70MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIA PARTIALLY THREADED 5.0 X 75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 74.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIC FT 5.0 X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71822016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIC FT 5.0 X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71822026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW OSTEOPENIC FT 5.0 X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71822050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW P-L VLP 5.0MM X 26MM OSTEOPENIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW P-L VLP 5.0MM X 48MM OSTEOPENIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71821148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PALISADE CANNULATED POLY AXIAL 65X40MM BREAK-OFF EXT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "670-6540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PALISADE CANNULATED POLY AXIAL 65X45MM BREAK-OFF EXT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "670-6545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PALISADE CANNULATED POLY AXIAL 65X50MM BREAK-OFF EXT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "670-6550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PALISADE CANNULATED POLY AXIAL 75X45MM BREAK-OFF EXT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "670-7545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEDICLE 6.5 X 40MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "55565-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5335.0, "discounted_cash": 1867.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEDICLE 6.5MM X 35MM POLYAXIAL EXCELLA III D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E3S6535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEDICLE 6.5MM X 40MM POLYAXIAL EXCELLA III D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E3S6540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEDICLE 6.5MM X 45MM POLYAXIAL EXCELLA III D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E3S6545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEDICLE 6.5MM X 50MM POLYAXIAL EXCELLA III D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "E3S6550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEDICLE PEDICLE 5.5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX.PS.5540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEDICLE PEDICLE 5.5MM X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX.PS.5545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG 2.2MM X 15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-27-015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG 2.3MM X 12MM LOCKING CORTICAL CO-S2312", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-S2312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG 2.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SP12000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG 2.5MM X 12MM FULLY THREADED LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG 2.5MM X 16MM FULLY THREADED LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG 2.5MM X 22MM FULLY THREADED LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG 2MM X 18MM SMOOTH LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P18000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG A.L.P.S. 2.5 X 24MM COBALT CHROME MULTIDIRECTIONAL LOCKING THREADED SQUARE DRIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-11-124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG PROXIMAL 4.5 X 30MM LOCKING GREEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PT4.5L30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG PROXIMAL 4.5 X 30MM NONLOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LT4.5L30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG PROXIMAL 4.5 X 32MM NONLOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LT4.5L32", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 198.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG PROXIMAL 4.5 X 40 MM LOCKING GREEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PT4.5L40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG PROXIMAL 4.5 X 42MM LOCKING GREEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PT4.5L42", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG PROXIMAL 4.5MM X 28MM PT4.5L28", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PT4.5L28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 974.0, "discounted_cash": 340.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG PROXIMAL 4.5MM X 38MM PT4.5L38", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PT4.5L38", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 974.0, "discounted_cash": 340.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG PROXIMAL 4.5MM X 48MM PT4.5L48", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PT4.5L48", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 974.0, "discounted_cash": 340.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG PROXIMAL 4.5MM X 50MM PT4.5L50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PT4.5L50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 974.0, "discounted_cash": 340.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG PROXIMAL 4.5MM X 52MM PT4.5L52", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PT4.5L52", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 974.0, "discounted_cash": 340.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEG PROXIMAL 4.5X 46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PT4.5L46", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PELVIC SPS MATTA 4.5 X 52MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "340652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERFORM REVEPERIPHERAL 42MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERI 3.5MM X 26MM 2.7MM HEAD SELF-TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2348-026-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERI LOCK T20 S-T 3.5 X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERI-LOC 4.5MM X 20MM T25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71820008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5397.0, "discounted_cash": 1888.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERI-LOC 4.5MM X 22MM T25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73827022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERI-LOC 4.5MM X 50MM T25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73827050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERI-LOC 6.5MM X 65MM CANC T25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73828165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 58.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERI-LOCK T20 3.5MMX18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 200.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERIARTICULAR 3.5 X 14MM SELF TAPPING 2.7MM HEAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2348-014-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERIARTICULAR 3.5 X 16MM SELF TAPPING 2.7MM HEAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2348-016-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERIARTICULAR 3.5 X 18MM SELF TAPPING 2.7MM HEAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2348-018-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERIARTICULAR 3.5 X 24MM SELF TAPPING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2348-024-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERIARTICULAR LOCKING 3.5MM X 16MM 2.7MM HEAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-2359-016-38", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 57.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PERIPHERAL LOCKING 4.5MM X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9145-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PHOENIX 5 X 32MM CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-405032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 487.0, "discounted_cash": 170.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PINNACLE CANCELLOUS BONE 1217-40-500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1217-40-500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE 3.5 X 16MM NON-LOCKING R3CON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE 3.5 X 20MM NON-LOCKING R3CON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE 3.5 X 30MM R3CON NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE 3.5MM X 22MM NON-LOCKING P50-453-3522", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE 3.5MM X 26MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-053-3526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE 3.5MM X 26MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-153-3526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 205.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE 4.2MM X 5000MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-153-4250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 205.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE 4.2MM X 55MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-153-4255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 205.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE HEAD LOCKING 2.5MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PRTST2518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE HEAD LOCKING 2.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PRTST2520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE HEAD LOCKING 2.5MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PRTST2522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PLATE LOCKING 3.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-053-3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAX LOCKING MINI 2.4MM X 14MM MFSL2414", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFSL2414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL 3.5 X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-000-20-3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL 3.5 X 18MM OSA-3518", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OSA-3518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2730.0, "discounted_cash": 955.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL 4.0MM X 16MM OSA-4016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OSA-4016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2730.0, "discounted_cash": 955.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL 4.0MM X 26MM OSA-4026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OSA-4026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL 4.5 X 26MM OSA-3512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OSA-3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4326.0, "discounted_cash": 1514.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL 4.5MM X 24MM OSA-4524", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OSA-4524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2730.0, "discounted_cash": 955.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL 6.5X50 10-6550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Oct-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL 6.5X55 10-6555", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Oct-55", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL LOCKING 2.5MM X 20MM CANNULATED COCR PALS-25200-CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PALS-25200-CC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL LOCKING 2.5MM X 22MM CANNULATED COCR PALS-25220-CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PALS-25220-CC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL LOCKING 2.5MM X 24MM CANNULATED COCR PALS-25240-CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PALS-25240-CC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 140.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL LOCKING 3.5 X 14MM MPSL3514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSL3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL LOCKING 3.5 X 16MM MPSN3516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSN3516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL LOCKING 3.5MM X 16MM MPSL3516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSL3516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL NON LOCKING 3.5MM X 10MM TI PANL-35100-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35100-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL NON LOCKING 3.5MM X 12MM TI PANL-35120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL NON LOCKING 3.5MM X 14MM TI PANL-35140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL NON LOCKING 3.5MM X 16MM TI PANL-35160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL NON LOCKING 3.5MM X 18MM TI PANL-35180-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35180-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL NON LOCKING 3.5MM X 20MM TI PANL-35200-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35200-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 313.0, "discounted_cash": 109.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL NON LOCKING 3.5MM X 22MM TI PANL-35220-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35220-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL NON LOCKING 3.5MM X 24MM TI PANL-35240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 114.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL NON LOCKING 3.5MM X 26MM TI PANL-35260-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35260-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 114.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL NON LOCKING 3.5MM X 28MM TI PANL-35280-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35280-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 114.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL NON LOCKING 3.5MM X 36MM TI PANL-35360-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-35360-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 114.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL REDUCTION 6.5X45 12-6545", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Dec-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2895.0, "discounted_cash": 1013.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL REDUCTION 6.5X50 12-6550", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Dec-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2575.0, "discounted_cash": 901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL REDUCTION 6.5X55 12-6555", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Dec-55", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2575.0, "discounted_cash": 901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POLYAXIAL SCREW SIZE ?3.5X14 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7601-03514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1391.0, "discounted_cash": 486.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW POST CERVICAL 3.5X14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OSA-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2730.0, "discounted_cash": 955.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PROSTEP MICA 3 X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S03036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PROSTEP MICA 4 X 52MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "57S04052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1274.0, "discounted_cash": 445.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PT 5.0 X 46MM CANNULATED 110007652", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 136.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PT 5.0MM X 46MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 136.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW QFX TI CANN ST THD CANC 4.0 X 32 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740-32PTS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 170.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW R3CON 2.7 X 28MM LOCKING SMALL JOINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-2728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.0, "discounted_cash": 223.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW R3CON 3.5 X 14MM NON LOCKING PLATE SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW R3CON 3.5 X 22MM NON LOCKING SMALL JOINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.0, "discounted_cash": 223.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW R3CON 3.5 X 24MM PLATE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 680.0, "discounted_cash": 238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW R3CON 3.5 X 26MM NON LOCKING SMALL JOINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.0, "discounted_cash": 223.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW R3CON 3.5 X 28 GORILLA LOCKG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 680.0, "discounted_cash": 238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW R3CON 3.5 X 28MM NON LOCKING SMALL JOINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW R3CON 4.2 X 10MM PLATE NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-4216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 152.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW R3CON 4.2 X 16MM PLATE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-4216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 183.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW R3CON 4.2 X 18MM PLATE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-4218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW R3CON NON-LOCKING PLATE 3.5X10MM P50-453-3510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-453-3510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RAPID COMPRESSION IMPLANTS SK62", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK62", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6974.0, "discounted_cash": 2440.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON 2.7 X 12MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-2712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 543.0, "discounted_cash": 190.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON 2.7 X 14MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-2714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 543.0, "discounted_cash": 190.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON 2.7 X 16MM LOCKING GORILLA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-2716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON 3.5 X 14MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON 3.5 X 18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.0, "discounted_cash": 223.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON 3.5 X 34MM LOCKING P50-353-3534", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P50-353-3534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 680.0, "discounted_cash": 238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON LOCKING 3.5 X 12MM TLR35-12", "code_information": [{"code": "TLR35-12", "type": "CDM"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON LOCKING 3.5 X 14MM TLR35-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR35-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON LOCKING 3.5X16MM TLR35-16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TLR35-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON NON-LOCKING 3.5X10MM TNR35-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR35-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 790.0, "discounted_cash": 276.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON NON-LOCKING 3.5X20MM TNR35-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR35-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW RECON NON-LOCKING 3.5X24MM TNR35-24", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TNR35-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 790.0, "discounted_cash": 276.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW REDUCTION 6.5MM X 45MM POLYAXIAL PEDICLE EXCELLA III D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RE36545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW REVCON 3.0 X 22MM RSN3022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RSN3022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2200.0, "discounted_cash": 770.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW REVCON \u00c3\u02dc3.0X28MM RSN3028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RSN3028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2200.0, "discounted_cash": 770.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW REVERSED CENTRAL 5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW REVERSED CENTRAL PERFORM DWJ130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW REVERSED PERIPHERAL 5.0MM X 46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW S-T PERI LOCK T20 3.5 X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "73825026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 200.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SA CERVICAL TI 3.5X14MM 52N-35-14-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52N-35-14-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SA CERVICAL TL 3.5 X 12MM 52N-35-12-SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "52N-35-12-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SCREWS POLYAXIAL 4.5X25 MM 2911-04525", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2911-04525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SCREWS POLYAXIAL 4.5X30 MM 2911-04530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2911-04530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF DRILLING 2.0MM X 4MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48570204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF DRILLING 2.0MM X 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48570206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF DRILLING VARIABLE 4.0X14MM 31-4014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "31-4014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF DRILLNG SCREW 4.0 X 18MM 8801-04018DA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8801-04018DA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF STARTING 04.0X14MM VARIABLE 8801-04014DA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8801-04014DA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF STARTING 04.5 X 16MM FIXED 8801-14516DA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8801-14516DA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF TAP TI CIRT 4.0 X 34MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71754034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 185.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF TAPPING 04.0 X 14MM FIXED 8801-14014CA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8801-14014CA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF TAPPING CORTEX EVOS 3.5MM X 42MM STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 159.8, "discounted_cash": 55.93, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF TAPPING VARIABLE 4.0X12MM 33-4012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "33-4012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1092.0, "discounted_cash": 382.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF TAPPING VARIABLE 4.0X14MM 33-4014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "33-4014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1092.0, "discounted_cash": 382.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF-DRILLING 3.5MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48335310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 91.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF-DRILLING 3.5MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48335312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 93.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF-DRILLING 4.0MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48335412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF-STARTING SIZE 4.5X14 MM FIXED 8801-14514DA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8801-14514DA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF-STARTING VARIABLE SCREW SIZE \u00c3\u02dc4.0X12 MM OZARK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8801-04012DA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF-STARTING VARIABLE SCREW SIZE \u00c3\u02dc4.0X16 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8801-04016DA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF-TAPPING EVOS 3.5MM X 32MM CORTEX 72403532", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.2, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF-TAPPING EVOS 3.5MM X 36MM CORTEX 72403536", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72403536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 111.86, "discounted_cash": 39.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF-TAPPING EVOS 3.5MM X 46MM LOCKING 72413546", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 677.6, "discounted_cash": 237.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SELF-TAPPING EVOS 3.5MM X 55MM LOCKING 72413555", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72413555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 632.0, "discounted_cash": 221.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SET (STERILE PACKED WITH SCREW)", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "670-0007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SET 108-SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "108-SS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SET 108.SS 108.SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "108.SS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SET 44-2001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44-2001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SET DISP INSTR KODIAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SET FOR HH CONNECTOR POLYAXIAL OSA-2801", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OSA-2801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 288.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SET HH CONNECTOR OS-1030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS-1030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SET HH CONNECTOR OS-2801", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS-2801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SET SCREW 10-2003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-2003.", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SET SCREW YUKON OCT SPINAL SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7601-10001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SET T27 5560010000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5560010000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SHAFT CORTICAL 4.5MM X 24MM VT4.5L24", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "VT4.5L24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 974.0, "discounted_cash": 340.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SHORT THREAD 7.0 X 65MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSS-010-70-65S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 883.0, "discounted_cash": 309.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SHORT THREAD 7.0MM X 36MM HEADLESS CANNULATED P20-570-036S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-570-036S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 194.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SHOULDER COMPREHENSIVE REVERS 6.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "115394", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SHOULDER COMPREHENSIVE REVERS 6.5MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "115395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SIZE 3.5 X 10MM POLYAXIAL 7601-03510", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7601-03510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SIZE 3.5X12 MM POLYAXIAL 7601-03512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7601-03512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SLEEVE DRILL LOCKING 3.5 MM LOCKING SCREW NONSTERILE 323.053", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "323.053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SMALL XMCP 4.0MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "102-40026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1978.0, "discounted_cash": 692.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SMOOTH 2.7MM X 14MM LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "131227114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 72.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SNAP OFF 10MM PINIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9A2A-B010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 220.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SNAP OFF 14MM PINIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9A2A-B014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 220.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SNAP OFF 2.0MMX11MM TI MAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1427-2011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 917.0, "discounted_cash": 320.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SNAP OFF 2.0MMX12MM TI MAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1427-2012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SNAP OFF 2.0MMX13MM TI MAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1427-2013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 917.0, "discounted_cash": 320.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SNAP OFF WEIL 2.0MM X 11MM WST2.0L11-ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WST2.0L11-ST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1339.0, "discounted_cash": 468.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SNAP OFF WEIL 2.0MM X 12MM WST2.0L12-ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WST2.0L12-ST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1339.0, "discounted_cash": 468.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SNAP-OFF 2.2MM X 13MM S22 ST013", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S22 ST013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SNAP-OFF 2.2MM X 14MM IBS S22 ST014B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S22 ST014B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1094.0, "discounted_cash": 382.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SNAP-OFF 2.2MMX12MM LG S22 ST012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S22 ST012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 218.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SNAP-OFF 2.7MM X 14MM S27 ST014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S27 ST014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 245.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SOLAFIX 2.2 X 14MM TWIST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S22ST014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SOLAFIX 2.5 X 18MM IBS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25ST018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SOLAFIX 2.5 X 20MM IBS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S25ST020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1123.0, "discounted_cash": 393.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SOLID 2.0MM X 17MM REUNITE FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "948496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 459.0, "discounted_cash": 160.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SOLID 4.0 X 36 LAG 113-40036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "113-40036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1978.0, "discounted_cash": 692.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SPEED RELEASE GUIDED RELEASE INSTRUMENT SD28", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SD28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SPEEDMTP LAPIPLASTY 3.5MM HEADLESS COMPR SK60", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK60", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1182.0, "discounted_cash": 413.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SPINE 6.5 X 45MM ES2 CANNULATED BLADE LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482804645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SPINE 6.5 X 45MM ES2 SYSTEM CANNULATED BLADE SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482802645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "discounted_cash": 595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SS 2.7 X 12MM KREULOCK COMPRESSION AR-8827CL-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8827CL-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ST 4.0MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48814012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ST 4.0MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48814014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ST 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8801-04514DA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW STAND-ALONE CERVICAL TI INTERBODY 3-TITANIUM 12X17X5 MM 3608-205123W", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3608-205123W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW STAND-ALONE CERVICAL TI INTERBODY 3-TITANIUM 12X17X7 MM 3608-207123W", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3608-207123W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4300.0, "discounted_cash": 1505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW STARDRIVE CORTEX 3.5MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.206.216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW STD 3.5X26MM 304-35-026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "304-35-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW STDRD 2.2X14MM 307-22-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "307-22-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SYSTEM HEAD ASSEMBLY MIS 120 5.5MM 0601-120M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "601-120M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SYSTEM INSTRUMENT KIT 3.0MM STERILE RIK30-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RIK30-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2478.0, "discounted_cash": 867.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SYSTEM SET IMS PEDICLE 0601-09M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "601-09M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 2.7MM X 12MM BONE FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 2.7MM X 14MM BONE FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 2.7MM X 16MM BONE FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 2.7MM X 18MM BONE FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 2.7MM X 20MM FULL THREAD NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 2.7MM X 22MM BONE FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 2.7MM X 24MM BONE FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 2.7MM X 28MM BONE FULL THREAD 657128", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5 X 38MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5 X 42MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 407.0, "discounted_cash": 142.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 10MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 12MM BONE FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 14MM BONE FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 14MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 16MM BONE FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 18MM BONE FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 20MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 24MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 26MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 470.0, "discounted_cash": 164.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 28MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 470.0, "discounted_cash": 164.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 30MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 470.0, "discounted_cash": 164.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 30MM LOCKING FULLY THREAD 657339", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657339", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 32MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 34MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 470.0, "discounted_cash": 164.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 36MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 470.0, "discounted_cash": 164.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 44MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 60MM BONE FULL THREAD NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 3.5MM X 60MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T10 4.2MM X 38MM CP LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "626838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 569.0, "discounted_cash": 199.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T15 LP CORT 3.5MMX12MM 110017710", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110017710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T15 LP CORT 3.5MMX12MM 110017712", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110017712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T4-S-T VLP TI 1.5 MM X 10 MM CTX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74401510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 114.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T5 1.7MM / L5MM LOCKING 662505", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T5 1.7MM L11MM BONE 662611", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T5 1.7MM L11MM LOCKING 662511", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 112.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T5 1.7MM L6MM BONE 662606", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662606", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T5 1.7MM L8MM BONE 662608", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "662608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.0, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T6 2.3MM X L13MM 663813", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T6 2.3MM/ L12MM LOCKING 663712", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 113.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T6 SELF-TAPPING 2.0MM X 6MM VLP TITANIUM 74402006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74402006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T6 SELF-TAPPING 2.0MM X 6MM VLP TITANIUM 74412006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74412006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T6 SELF-TAPPING 2.0MM X 7MM VLP TITANIUM 74402007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74402007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T7 S-T VLP TI 2.4MM X 15MM CTX 74402415", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74402415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 116.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW T8 CTX 2.7MM X 44MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72402744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 77.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TEMPORARY CERVICAL PLATE 30-1008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-1008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 144.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TEMPUS VAR 4.0 X 14MM SELF DRILLING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-18-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TI 2.0 X 15MM VAL AR-18720V-15", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-18720V-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TI 2.0 X 8MM VAL AR-18720V-08", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-18720V-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TI 3.0X12 VAL KREULOCK AR-8933VCL-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8933VCL-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.56, "discounted_cash": 223.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TI 3.0X16 VAL KREULOCK AR-8933VCL-16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8933VCL-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.56, "discounted_cash": 223.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TI CANNULATED 4.0 X 42MM 604642", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "604642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TI GOLD 09MM IMPLANT TOV TALUS TOV2-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TOV2-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6112.29, "discounted_cash": 2139.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TI LOW PROFILE 4.5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9045-40PT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1775.0, "discounted_cash": 621.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 2.0MM X 24MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-20-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 2.0MM X 26MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-20-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 2.4 X 30MM CANN LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0 X 34MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 10MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 12MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 24MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 28MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 36MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 38MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 42MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 129.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 44MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 52MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER 4.0MM X 56MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER BONE 2.4MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER BONE 2.4MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER BONE 2.4MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-24-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER CANNULATED 4.0MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER CANNULATED 4.0MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "200-40-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 172.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIGER HEADLESS COUNTERSINK 2.0MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202-20-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIMAX 4.0 X 40MM PARTIAL THREAD SM BONE CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110007555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 403.0, "discounted_cash": 141.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TIRGEN LOW PRO 5.0MM X 90MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71645090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 828.0, "discounted_cash": 289.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TRELLOSS-C 43.5X16MM 109N3516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "109N3516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TRIGEN 4.5 X 4MM LOW PROFILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71645440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 878.0, "discounted_cash": 307.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TRIGEN LOW PROFILE 5.0MM X 55MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71645055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 977.2, "discounted_cash": 342.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TRIGER 2.4MM X 16MM HEADLESS CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202-24-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TRIGER 2.4MM X 18MM HEADLESS CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202-24-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TRIGER 2.4MM X 20MM HEADLESS CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "202-24-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TWIST 2.2 X 10MM SOLAFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S22-ST010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TWIST 2.2 X 11MM SOLAFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "S22-ST011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1494.0, "discounted_cash": 522.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TWIST OFF 2.7 X 13MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1277.0, "discounted_cash": 446.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TWIST-OFF 2.0 X 14MM NS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018487", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TWISTOFF 2.0MM X 11MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110018484", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 207.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW TX-6 DRIVER ATTACHMENT CANNULATED", "code_information": [{"code": "P99-190-TX06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1150.0, "discounted_cash": 402.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ULTOS 2.7MM X 14MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS422514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 595.0, "discounted_cash": 208.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ULTOS 2.7MM X 18MM NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS422618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ULTOS 2.7MM X 20MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS422520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 595.0, "discounted_cash": 208.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ULTOS 2.7MM X 22MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OS422522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 595.0, "discounted_cash": 208.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW UNICORTICAL 2.8MM X 10.0MM UCNL-28100-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "UCNL-28100-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW UNICORTICAL 2.8MM X 12.0MM UCNL-28120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "UCNL-28120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW UNICORTICAL 2.8MM X 14.0MM UCNL-28140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "UCNL-28140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW UNICORTICAL 2.8MM X 8.0MM UCNL-28080-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "UCNL-28080-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW UNITE 3.5 X 12MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSL3512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 670.0, "discounted_cash": 234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW UNITE 3.5MM X 22MM NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MPSN3522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAL DISTAL RADIUS LOCKING 2.4MM X 16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8724V-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAL \u00c3\u02dc3.5X60MM P73 ST0222", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P73 ST0222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VALOR 5.0MM X 25MM LEN 4151150025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4151150025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 570.0, "discounted_cash": 199.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VALOR 5.0MM X 30MM LEN 4151150030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4151150030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 570.0, "discounted_cash": 199.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VALOR 5.0MM X 35MM LEN 4151150035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4151150035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 570.0, "discounted_cash": 199.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VALOR 5.0MM X 40MM LEN 4151150040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4151150040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 570.0, "discounted_cash": 199.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VALOR 5.0MM X 70MM LEN 4151150070", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4151150070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 570.0, "discounted_cash": 199.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VALOR 5.0MM X 75MM LEN 4151150075", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4151150075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 570.0, "discounted_cash": 199.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANG 2.7X24MM ACUMED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30-2324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.0, "discounted_cash": 223.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL 2.4 X 16MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "359-2416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL 2.4 X 18MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "359-2418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL 2.4 X 20MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "359-2420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL 2.7 X 12MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "359-2712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL LOCKING 2.7MM X 12.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FRP-212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 141.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL LOCKING 2.7MM X 14.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FRP-214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 141.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL LOCKING 3.0MM X 12.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FLP-312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 358.0, "discounted_cash": 125.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL LOCKING 3.0MM X 14.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FLP-314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 71.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL LOCKING 3.0MM X 16.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FLP-316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL LOCKING 3.0MM X 18.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FLP 318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL LOCKING 3.5MM X 10.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FRP-310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL LOCKING 3.5MM X 12.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FRP 312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL LOCKING 3.5MM X 14.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FRP-314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR ANGL LOCKING 3.5MM X 16.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FRP-316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VAR SD 4.0MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-16-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE 2.4MM X 20.0MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS 120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE 3.5MM X 14.0MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS 314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE 3.5MM X 32.0MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS 332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE 3.5MM X 38.0MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS 338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE 4.0 X 16 MM APV4016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "APV4016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE 4.0MM X 14MM 10-018-014 10-018-014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-018-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE 4.0MM X 50.0MM NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FBS 450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE ANGLE 6.0MM DIA X 40MM RA1106045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "RA1106045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE ANGLE LOCKING 2.0MM X 10.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE ANGLE LOCKING 2.0MM X 12.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE ANGLE LOCKING 2.0MM X 14.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE ANGLE LOCKING 2.0MM X 16.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE ANGLE LOCKING 2.4MM X 16.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FHF-116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SEL-TAPPING SIZE 4.0X16MM 8801-04016CA", "code_information": [{"code": "8801-04016CA", "type": "CDM"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF-DRILLING 4.0MM X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "31-6-4012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF-DRILLING 4.0MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "31-6-4014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIAX 2.3MM NLCK 24MM 53-23024E 53-23042E", "code_information": [{"code": "53-23042E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 77.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIAX 2.7 X 18MM LOCKING FT T7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "53-27618E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.0, "discounted_cash": 132.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIAX 2.7 X 18MM T10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "614718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIAX 2.7 X 50MM LOCKING FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIAX 2.7 X 8MM POLYAXIAL NONLOCKING SELF TAPPING T7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-27008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIAX 3.5MM X 30MM NON-LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIAX 3.5MM X 38MM FULL THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIAX 3.5MM X 65MM FULL THREAD NON LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 86.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARIBLE 16 236-1-14016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "236-1-14016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 70.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VENTED 10 X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4020C-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VENTED 7X20MM BC IF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4020C-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 212.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VLP TI 2.0 MM X 18 MM LCK T6 S-T 74412018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74412018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 205.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW WASHER FOR 6.0MM JFX 663201", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "663201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 37.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW XIA 3 7.5 X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482317545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW XIA 3 7.5MM X 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482317550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1391.0, "discounted_cash": 486.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW XIA 3 TI PA DIA 7.0 X 40 MM 482317040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482317040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1632.0, "discounted_cash": 571.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW XIA 3 TI PA DIA 7.0 X 50 MM 482317050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482317050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1632.0, "discounted_cash": 571.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW XIA 3 TI PA DIA 7.5 X 55 MM 482317555", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482317555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1632.0, "discounted_cash": 571.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW \u00c3\u02dc3.0X28.0 MM P67 ST328", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 724.0, "discounted_cash": 253.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW \u00c3\u02dc4.0X40.0 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P67 ST440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 894.0, "discounted_cash": 312.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW \u00c3\u02dc5 X 25 MM IDENTITI ALIF SA LATERAL 132-20-50-250", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "132-20-50-250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER 3.0MM ANC312", "code_information": [{"code": "ANC312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER A.L.P.S. 2.2MM RATCHET SQUARE HEAD", "code_information": [{"code": "8163-01-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 397.0, "discounted_cash": 138.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER ASNIS 2 X 2MM MICRO CANNULATED AO COUPLING STERILE", "code_information": [{"code": "45-20001S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 642.0, "discounted_cash": 224.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER BIODRIVE 3MM CANNULATED", "code_information": [{"code": "TV300B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 745.0, "discounted_cash": 260.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER BIT AO FITTING T15", "code_information": [{"code": "705015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 854.0, "discounted_cash": 298.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER BLADE 2.5/2.8MM SELF HOLDING HD7 MEDARTIS", "code_information": [{"code": "A-2013/1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER BLADE T10 AO SELF RETAINING", "code_information": [{"code": "703880", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 939.0, "discounted_cash": 328.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER BONE 5MM ASNIS III AO FITTING CANN HEX", "code_information": [{"code": "702622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1032.0, "discounted_cash": 361.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER BONE A.L.P.S. 1.3MM SQUARE SS", "code_information": [{"code": "2312-18-012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER CANNULATED ASNIS III 6.5/8.0 702629", "code_information": [{"code": "702629", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.0, "discounted_cash": 362.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER CANNULATED T20 AO FITTING", "code_information": [{"code": "705211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 908.0, "discounted_cash": 317.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER HEX 1.5MM MICRO 2.3MM BIODRIVE CANNULATED", "code_information": [{"code": "TV230B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 745.0, "discounted_cash": 260.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER HEXAGONAL 2.5MM CANNULATED", "code_information": [{"code": "702482", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1244.0, "discounted_cash": 435.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER SNAP OFF", "code_information": [{"code": "1456-0026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 109.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER SNAP OFF WMT", "code_information": [{"code": "45112000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1061.0, "discounted_cash": 371.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER T15 3.5 QUICK RELEASE", "code_information": [{"code": "320-2415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1320.0, "discounted_cash": 462.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWINTERFERENCE 10MM X 28MM ROUND DELTA TAPERED KNEE BIOCOMPOSITE POLY L D LAC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5028C-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWINTERFERENCE 11MM X 28MM ROUND DELTA TAPERED KNEE BIOCOMPOSITE POLY L D LAC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5028C-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 169.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWINTERFERENCE 8MM X 28MM ROUND DELTA TAPERED KNEE BIOCOMPOSITE POLY L D LACT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5028C-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWINTERFERENCE 9MM X 26MM ROUND DELTA TAPERED KNEE BIOCOMPOSITE POLY L D LACT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-5028C-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 692.0, "discounted_cash": 242.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWINTERFRAG 3.5 MM X 24 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4F01-4024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 448.0, "discounted_cash": 156.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWS LOCKING BLUE 2.5 X 08MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5750.08/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRN HCV INFEC NOT RECD", "code_information": [{"code": "G9386", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCRN MAM PERF RSLTS DOC", "code_information": [{"code": "G9899", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCRN MAM PERF RSLTS DOC", "code_information": [{"code": "M1302", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCRN MAM PERF RSLTS NOT DOC", "code_information": [{"code": "G9900", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCRN MAM PERF RSLTS NOT DOC", "code_information": [{"code": "M1285", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCRN ND POS ND PROV OF REC", "code_information": [{"code": "G9919", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCRNING PERF AND NEGATIVE", "code_information": [{"code": "G9920", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCROTAL EXPLORATION 55110", "code_information": [{"code": "55110", "type": "CPT"}, {"code": "1482075", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCROTOPLASTY-COMPLICATED 55180", "code_information": [{"code": "55180", "type": "CPT"}, {"code": "1482076", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCROTOPLASTY-SIMPLE 55175", "code_information": [{"code": "55175", "type": "CPT"}, {"code": "1482077", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9357.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCRW 3.5 X 12MM LOCKING 308-35-012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "308-35-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW FT AB-10-AISP FOR 4.5MM P-LCK/CRK AR-1922PBS", "code_information": [{"code": "AR-1922PBS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCS BATTERY REPLACEMENT KIT", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "9771IR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34050.0, "discounted_cash": 11917.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SEAL PORT LESS THAN 6FR BIOPSY ADJ", "code_information": [{"code": "ABP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALANT 5ML SPINE REPLACE FOR 20-4004 DURASEAL", "code_information": [{"code": "20-6520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1314.0, "discounted_cash": 459.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALANT DURASEAL 3ML SPINE SYSTEM EXACT", "code_information": [{"code": "206320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1635.0, "discounted_cash": 572.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALANT DURASEAL 5ML 206520", "code_information": [{"code": "206520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1478.25, "discounted_cash": 517.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALANT DURASEAL 5ML SPINE SYSTEM EXACT", "code_information": [{"code": "206520 (d)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2528.86, "discounted_cash": 885.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALANT FIBRIN 10 ML PRE FILLED SYRNG FROZEN W/ SYRNG PLUNGER 2 PULL STRP CONNEC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "1501263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 846.0, "discounted_cash": 296.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALANT SKIN INTEGUSEAL 20 X 10IN IS200 MICROBIAL", "code_information": [{"code": "33737", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALER 5MM ENSEAL G2 ART CURV 45CM NSLG2C45A", "code_information": [{"code": "NSLG2C45A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1139.0, "discounted_cash": 398.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALER BIPOLAR 6.0 AQUAMATYS", "code_information": [{"code": "23-112-23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 779.0, "discounted_cash": 272.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALER BP AQUAMANTYS 2.3 23-113-1", "code_information": [{"code": "23-113-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALER BP AQUAMANTYS 6.0 23-112-1", "code_information": [{"code": "23-112-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 956.0, "discounted_cash": 334.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALER BP AQUAMANTYS W LIGHT MALLEABLE 23-301-1", "code_information": [{"code": "23-301-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.0, "discounted_cash": 412.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALER LAP 5MM X 37CM DOLPHIN TIP LIGASURE", "code_information": [{"code": "LS1500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1105.0, "discounted_cash": 386.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALER LAP 5MM X 44CM PISTOL GRIP MONOPOLAR LIGASURE ADVANCE DISP", "code_information": [{"code": "LF5544", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1233.0, "discounted_cash": 431.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALER TIP BLNT LAPARASCPIC 5MMX37CM RPR LF1837", "code_information": [{"code": "LF1837", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1122.0, "discounted_cash": 392.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALER TISSUE 35CM CURVED ENSEAL G2", "code_information": [{"code": "NSLG2C35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1153.0, "discounted_cash": 403.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SEC ART THROMBECTOMY ADD-ON", "code_information": [{"code": "37186", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY CLOSURE OF WOUND OR DEHISCENCE-EXTENSIVE OR COMPLICATED 13160", "code_information": [{"code": "13160", "type": "CPT"}, {"code": "1482078", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY RECONSTRUCTION INFRAPATELLAR TENDON INC. GRAFT 27381", "code_information": [{"code": "27381", "type": "CPT"}, {"code": "1482079", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY RECONSTRUCTION QUADRICEPS OR HAMSTRING INC. GRAFT 27386", "code_information": [{"code": "27386", "type": "CPT"}, {"code": "1482080", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY REPAIR DURA FOR CEREBROSPINAL LEAK BY VASCULAR FLAP OR MYOCUTANEOUS FLAP 61619", "code_information": [{"code": "61619", "type": "CPT"}, {"code": "1482081", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY REPAIR FLEXOR TENDON W/ FREE GRAFT/ EACH 26352", "code_information": [{"code": "26352", "type": "CPT"}, {"code": "1482082", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY REPAIR FLEXOR TENDON ZONE 2-W/ FREE GRAFT/ EACH 26358", "code_information": [{"code": "26358", "type": "CPT"}, {"code": "1482084", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY REPAIR FLEXOR TENDON-ZONE 2-W/O FREE GRAFT/ EACH 26357", "code_information": [{"code": "26357", "type": "CPT"}, {"code": "1482083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY REPAIR PROFUNDUS TENDON W/ FREE GRAFT/ EACH 26372", "code_information": [{"code": "26372", "type": "CPT"}, {"code": "1482086", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY REPAIR PROFUNDUS TENDON W/O FREE GRAFT/ EACH 26373", "code_information": [{"code": "26373", "type": "CPT"}, {"code": "1482087", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY REPAIR TENDON/MUSCLE -FLEXOR-FOREARM/WRIST EACH 25263", "code_information": [{"code": "25263", "type": "CPT"}, {"code": "1482089", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY REPAIR TENDON/MUSCLE-EXTENSOR-FOREARM/WRIST EACH 25272", "code_information": [{"code": "25272", "type": "CPT"}, {"code": "1482088", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY REPAIR TENDON/MUSCLE-FLEXOR-FOREARM/WRIST-EACH-W/ FREE GRAFT 25265", "code_information": [{"code": "25265", "type": "CPT"}, {"code": "1482090", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECONDARY REVISION ORBITOCRANIOFACIAL RECONSTRUCTION 21275", "code_information": [{"code": "21275", "type": "CPT"}, {"code": "1482091", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SECURE GARD FLUID RESISTANT SURGICAL TIE", "code_information": [{"code": "AT744335", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SEDATIVE HYPNOTICS", "code_information": [{"code": "80368", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEEKER BALLOON 6 X 7MM NUVENT EM MAXILLARY", "code_information": [{"code": "1830607MAX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1250.0, "discounted_cash": 437.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SEEKER BALLOON EM SPHN 5X17MM 1830517SPH", "code_information": [{"code": "1830517SPH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 987.0, "discounted_cash": 345.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SEGMENTECTOMY", "code_information": [{"code": "32484", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEIZURES WITH MCC", "code_information": [{"code": "100", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11414.14, "maximum": 19595.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11414.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16324.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17957.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19595.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEIZURES WITHOUT MCC", "code_information": [{"code": "101", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5404.14, "maximum": 9277.56, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5404.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7729.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8501.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9277.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SELECT PICTURE AUDIOMETRY", "code_information": [{"code": "92583", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SELF CARE MNGMENT TRAINING", "code_information": [{"code": "97535", "type": "CPT"}], "standard_charges": [{"minimum": 154.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 154.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 242.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 242.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 242.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SELF SEAL CAP UROLOGY UNIVERSAL ONE SIZE FITS ALL", "code_information": [{"code": "27550ZAG/10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.72, "discounted_cash": 16.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SELF-MEAS BP 2 READG BID 30D", "code_information": [{"code": "99474", "type": "CPT"}], "standard_charges": [{"minimum": 39.73, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SELF-MEAS BP PT EDUCAJ/TRAIN", "code_information": [{"code": "99473", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SELF-MGMT EDUC & TRAIN 1 PT", "code_information": [{"code": "98960", "type": "CPT"}], "standard_charges": [{"minimum": 122.38, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 122.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 192.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 192.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 192.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SELF-MGMT EDUC/TRAIN 2-4 PT", "code_information": [{"code": "98961", "type": "CPT"}], "standard_charges": [{"minimum": 60.37, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 60.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 94.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SELF-MGMT EDUC/TRAIN 5-8 PT", "code_information": [{"code": "98962", "type": "CPT"}], "standard_charges": [{"minimum": 44.5, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMEN ANAL SPERM DETECTION", "code_information": [{"code": "89321", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMEN ANAL STRICT CRITERIA", "code_information": [{"code": "89322", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 62.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 62.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMEN ANAL VOL/COUNT/MOT", "code_information": [{"code": "89320", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS", "code_information": [{"code": "G0027", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 26.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS W/COUNT", "code_information": [{"code": "89310", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS W/HUHNER", "code_information": [{"code": "89300", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMI PRECISION ABUTMENT", "code_information": [{"code": "D6191", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMI PRECISION ATTACHMENT", "code_information": [{"code": "D6192", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEN LYM P NODE BIOP NOT PERF", "code_information": [{"code": "G8880", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENSOR 02 TEMP", "code_information": [{"code": "6050-0004-110-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 294.0, "discounted_cash": 102.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR ADHSV OXISENSOR II OXY-TIP PEDI", "code_information": [{"code": "TS-AF-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR ADHSV RESPIRATORY MONITORING OXISENSOR PEDI DISP", "code_information": [{"code": "D20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR FOREHEAD ADHESIVE MAXFAST", "code_information": [{"code": "MAXFAST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR INFANT OXIMAX MAXI", "code_information": [{"code": "MAXI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR LNCS PEDIATRIC MAXP", "code_information": [{"code": "MAXP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.87, "discounted_cash": 8.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR NEONATAL/ADLT OXIMAX MAXN", "code_information": [{"code": "MAXN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR OXMTR FINGER TARGET SPO2 CLIP DURASENSOR FOR USE W/ N65 OXIMETER MPB40 OX", "code_information": [{"code": "DS-100A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR PEDIATRIC LNCS DISP 1860", "code_information": [{"code": "1860", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.18, "discounted_cash": 1.11, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR SPO2 ADLT", "code_information": [{"code": "MAXA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.87, "discounted_cash": 8.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSORCAINE-MPF/BUPIVACAINE 0.75% PF INJ SOL 10 ML", "code_information": [{"code": "MED0617", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSORIMOTOR EXAMINATION", "code_information": [{"code": "92060", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENSORINEURAL ACUITY TEST", "code_information": [{"code": "92575", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENSORY INTEGRATION", "code_information": [{"code": "97533", "type": "CPT"}], "standard_charges": [{"minimum": 192.32, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 192.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 302.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 302.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 302.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENT DRESSING 4 CM X 4 CM SINUS NASAL OTOLOGICAL PACKING MEROGEL", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "1517002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SENT LYMPH NODE BIOPSY", "code_information": [{"code": "G8878", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENT URETERAL 7FR X 22CM TO 30CM CONTOUR VL", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061801570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SENZA 2 TEMPLATE", "code_information": [{"code": "ACCK7200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SEPARATE EYELID ADHESIONS", "code_information": [{"code": "68340", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPT9 GEN PRMTR MTHYLTN ALYS", "code_information": [{"code": "81327", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 276.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 276.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH CC", "code_information": [{"code": "549", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7603.14, "maximum": 13052.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7603.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10874.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11961.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13052.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [{"code": "548", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12475.02, "maximum": 21416.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12475.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17841.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19626.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21416.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITHOUT CC/MCC", "code_information": [{"code": "550", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5346.35, "maximum": 9178.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5346.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7646.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8411.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9178.35, "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": 39168.44, "maximum": 67242.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39168.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56019.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 61621.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67242.48, "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": 11388.59, "maximum": 19551.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11388.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16288.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17916.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19551.38, "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": 6242.98, "maximum": 10717.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6242.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8928.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9821.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10717.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTOPLASTY OR SUBMUCOUS RESECTION W/ OR W/O CARTILAGE SCORING-CONTOURING-OR GRAFT 30520", "code_information": [{"code": "30520", "type": "CPT"}, {"code": "1482038", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY OLECRANON PROCESS 24138", "code_information": [{"code": "24138", "type": "CPT"}, {"code": "1482092", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY RADIAL H/N", "code_information": [{"code": "24136", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY SHFT/DSTL HUM", "code_information": [{"code": "24134", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERIAL SALIVARY IMAGING", "code_information": [{"code": "78231", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 371.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 584.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 584.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 584.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 200.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 214.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERIAL TONOMETRY", "code_information": [{"code": "92100", "type": "CPT"}], "standard_charges": [{"minimum": 152.59, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 152.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 239.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 239.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 239.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEROSAFUSE IMPLANTABLE FASTNER KIT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "R2275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11590.0, "discounted_cash": 4056.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SERPINA1 GENE", "code_information": [{"code": "81332", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 67.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 175.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 175.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 175.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 62.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 62.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERUM IMMUNOELECTROPHORESIS", "code_information": [{"code": "86320", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 119.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 119.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 119.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 43.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 43.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERV FEE BIO AVS CERV 4 DEG WITH PLUG 10MM 77102104", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "77102104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1600.0, "discounted_cash": 560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SERV FEE BIO CHIPS CANC 15CC - 1-4 MM 7770215", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "7770215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.8, "discounted_cash": 187.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SERV FEE BIO CHIPS CORT-CANC 30CC - 1-4 MM 7770530", "code_information": [{"code": "7770530", "type": "CDM"}], "standard_charges": [{"gross_charge": 842.6, "discounted_cash": 294.91, "setting": "both", "billing_class": "facility"}]}, {"description": "SESAMOIDECTOMY-FIRST TOE 28315", "code_information": [{"code": "28315", "type": "CPT"}, {"code": "1482093", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET 5 G I2B RAPID C10 SB005", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "C10 SB005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2530.0, "discounted_cash": 885.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SET 8/10 DILATOR/SHEATH M0062601200", "code_information": [{"code": "M0062601200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.0, "discounted_cash": 60.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SET 810 COOK", "code_information": [{"code": "G15079", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 259.67, "discounted_cash": 90.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ADMIN 110IN DEHP 3 LUER LOCK PORTS DRIP CHMBR WITHOUT FILTER CONTINU FLO LF", "code_information": [{"code": "2C8537", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ADMIN 3 ML 72IN ANES MALE LUER LOCK ADAPTER UNIVSL WITHOUT FILTER AND PORTS", "code_information": [{"code": "2C9218", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 13.45, "discounted_cash": 4.71, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ADMIN 60DR ML 42433E", "code_information": [{"code": "42433E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ANCHOR CLIK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SC-4316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 721.0, "discounted_cash": 252.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ANCHOR LEAD CLICK X SPINE STIM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "SC-4318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BASIN MAJOR DOUBLE BASIN SET UP TRAY I W/ GOWNS LF STRL", "code_information": [{"code": "DYNJS0100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.65, "discounted_cash": 35.93, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BASIN SINGLE DOUBLE WRAP 13752-630", "code_information": [{"code": "13752-630", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLADE HOOK TRIANGLE STRL DISP", "code_information": [{"code": "3056", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 617.0, "discounted_cash": 215.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLD COLLECTIN SFTY-LOK 23GX0.75 367283", "code_information": [{"code": "367283", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOCK SZ F7 T7 CUTTING PATIENT MATCHED RIGHT VISIONAIRE LEGION", "code_information": [{"code": "V0100023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2707.0, "discounted_cash": 947.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOOD 10 DROP PER ML Y TYPE", "code_information": [{"code": "2C8750", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOOD 180 MICRON FILTER 1 SS 10015414", "code_information": [{"code": "10015414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOOD COLL 21G X .75 VACUTAINER 367344", "code_information": [{"code": "367344", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.86, "discounted_cash": 2.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOOD COLLECT 23G X .75 INFUSIN 367297", "code_information": [{"code": "367297", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOOD PUMP 1 PORT 33ML 121IN ALARIS", "code_information": [{"code": "2477-0007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.89, "discounted_cash": 11.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BSKT 11FR TO 13FR 36 CM URETHRAL ACCESS DUAL TAPERED TIP HYDROPHILIC COATING", "code_information": [{"code": "M0063902010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 790.0, "discounted_cash": 276.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CATH 0.8 ML 6.5IN EXT NON DEHP STANDARD BORE V LINK LUER ACTIVATED DEV W/ VI", "code_information": [{"code": "6N8378", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CATH 11FR 10FR 34 CM 9.7 CM .038IN FOIL PACKED TRCR SILICONE FOLEY CATH STYL", "code_information": [{"code": "G50615", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.0, "discounted_cash": 78.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CHOLANGIOGRAPHY PERCUT LAPARASCOPIC", "code_information": [{"code": "SC-01701", "type": "CDM"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CHOLANGIOGRAPHY PERCUT LAPARASCOPIC W/ ONE CURVED GUIDE CATH 10 FRENCH X 8 7", "code_information": [{"code": "CS-01701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CLEARLINK EXT 2/4-WAY STOPCOCK 2C8607", "code_information": [{"code": "2C8607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CLLCTN 12IN TUBING 21GA X .75IN BLOOD LUER ADAPTER WINGED VACUTAINER STRL", "code_information": [{"code": "367281", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CLLCTN LIGHT BLUE BLOOD VACUTAINER LUER ADAPTER SAFETY NDL 23GA X 3/4IN 12IN", "code_information": [{"code": "367342", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.86, "discounted_cash": 2.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET DILATOR 8FR TO 20FR 37CM URETHRAL S CURVE W/ SIDEPORT", "code_information": [{"code": "G32789", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 740.0, "discounted_cash": 259.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET DILATOR 8FR TO 24FR 37 CM URETHRAL S CURVE W/ SIDEPORTS", "code_information": [{"code": "73701-CD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 598.0, "discounted_cash": 209.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SET DILATOR FOR INTECH DISP", "code_information": [{"code": "LB-140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4737.0, "discounted_cash": 1657.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SET DISPOSABLE KNEE OUTSIDEIN FOR MENISCAL REPAIR SYS MENISCUS MENDER II", "code_information": [{"code": "7209485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SET DRILL GRIDLOCK 2.4MM", "code_information": [{"code": "310-30-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 232.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EPIDUAL ADMINISTRATION W/YELLOW STRIPE 30893", "code_information": [{"code": "30893", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXT 3.6 ML PRIMING VOLUME 33IN TUBE STANDARD BORE DEHP MALE AND FEMALE LUER", "code_information": [{"code": "MX451-FL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXT 6IN 0.1 ML VOLUME SM BORE FEMALE AND MALE LUER SLIP CONNECTOR DIST T POR", "code_information": [{"code": "471960", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.22, "discounted_cash": 1.83, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXT 8.5 STANDARDBORE W MAX+ CLR MP5301-C", "code_information": [{"code": "MP5301-C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.09, "discounted_cash": 3.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXT MAXPLUS PRESSURE RATED SLIDE CLAMP MP5314-C", "code_information": [{"code": "S1015", "type": "HCPCS"}, {"code": "MP5314-C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.61, "discounted_cash": 3.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXT MICROBR CATH BNDED NEDL FREE IV 7N8390", "code_information": [{"code": "7N8390", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXT TBNG DOUBLE NELSON W/ DUAL 1-WAY FLOW LUER LOCK FEMALE PROXIMAL CONNECTI", "code_information": [{"code": "1911-600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.35, "discounted_cash": 18.32, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION .3 ML 7IN SM BORE LUER LOCK", "code_information": [{"code": "MX448-L", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 3.18, "discounted_cash": 1.11, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION 95IN YELLOW STRIPED PRIMARY MICROBORE ATTACHED PAV GEMSTAR", "code_information": [{"code": "1375128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION 96IN 4.6ML TUBING PRIMARY MICROBORE ATTACHED PAV GEMSTAR", "code_information": [{"code": "1375828", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION IV CATH W/ MALE LUER LOCK ADAPTER", "code_information": [{"code": "2N1194", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION W MLL 34 MX451FL", "code_information": [{"code": "MX451FL", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION W/2 NEEDLELESS Y SITE 4-WAY STOPCOCK MX4439", "code_information": [{"code": "MX4439", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.51, "discounted_cash": 6.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION YELLOW STRIPED TUBING MALE TO MALE LUER", "code_information": [{"code": "21-7105-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.99, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SET GUIDE DRILL STRL CASE", "code_information": [{"code": "213207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INSTRUMENTS RTS LESSER MTP", "code_information": [{"code": "M04S0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INTRODUCER KYPHO EXPRESS BONE DRILL", "code_information": [{"code": "T34F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 589.0, "discounted_cash": 206.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IRR 81IN TRANSURETHRAL RESECTION BLADDER Y TYPE W/ DRIP CHMBR REGULATING CLA", "code_information": [{"code": "2C4041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.74, "discounted_cash": 15.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IRR 99IN ARTHROSCOPIC FOUR LEAD FOR USE W/ ARTHROMATIC PLASTIC CONTAINERS ST", "code_information": [{"code": "2C4031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IRRIGATION 4 LEAD 85IN TUBING W/ 130ML CHMBR AND LG BORE", "code_information": [{"code": "2C4013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IRRIGATION CYSTO BLADDER 81 2C4040", "code_information": [{"code": "2C4040", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 31.95, "discounted_cash": 11.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IV EXTENSION PCA WITH PLUNGER 2.6ML 90IN ALARIS", "code_information": [{"code": "10800175", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.33, "discounted_cash": 13.07, "setting": "both", "billing_class": "facility"}]}, {"description": "SET LAP-CHOLEANGIOGRAPHIC CS-01700", "code_information": [{"code": "CS-01700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 308.79, "discounted_cash": 108.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SET MODULE 2.4MM HND TI IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "145.205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21158.0, "discounted_cash": 7405.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SET MODULE 2MM HND TI IMP", "code_information": [{"code": "145.204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12567.0, "discounted_cash": 4398.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NDL 25GA 8IN SHRT BEVEL SPINAL", "code_information": [{"code": "183A65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NERVE BLOCK 18GA X 1 1/2ININSULATED TUOHY NDL CONTINUOUS NON STIMULATING CAT", "code_information": [{"code": "331695", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NERVE BLOCK 18GA X 3.5ININSULATED TUOHY NDL CONTINUOUS NON STIMULATING CATH", "code_information": [{"code": "331693", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NERVE BLOCK 18GA X 4IN ONE SIDEPORT VALVE ASSEMBLY W/ EXTENSION TUBING ONE 2", "code_information": [{"code": "336193", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NOVY CORNUAL CANNULATION", "code_information": [{"code": "G17478", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 394.0, "discounted_cash": 137.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SET OATS 10MM X 11.0MM OSETOCHONDRAL AUTO GRAFT TRANSFER SYS STRL DISP", "code_information": [{"code": "AR-1981-10S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1173.0, "discounted_cash": 410.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PIN UNIVERSAL II ECLIPSE", "code_information": [{"code": "AR-9207S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 266.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PIN UNIVERSAL REVERSE", "code_information": [{"code": "AR-9507S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1201.0, "discounted_cash": 420.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PROCEDURE HTA GENESYS PROCERVA", "code_information": [{"code": "M006580210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2989.0, "discounted_cash": 1046.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PROCEDURE W/ CASSETTE DRAIN BAG AND PROCEDURE SHEATH GENESYS HTA PROCERVA", "code_information": [{"code": "M006580211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3224.0, "discounted_cash": 1128.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PUMP ADMINISTRATION 115IN INJECTION/PORTX3 20GTT VENTED/NON VENTED GEMINI", "code_information": [{"code": "2426-0500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77280", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 219.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1067.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1678.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1678.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1678.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 555.48, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 590.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77285", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 565.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1789.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2812.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2812.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2812.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 935.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 993.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77290", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 565.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1905.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2995.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2995.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2995.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 863.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 917.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW 3.0MM X 2.0MM STSC-30020-CS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "STSC-30020-CS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW 3600215 M6 SETSCREW 3600215", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3600215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW EVEREST THORACOLUMNOSACRAL SPINE FXTN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2901-10001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW INERTIA CONNEXX 20-LC-01", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "20-LC-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW PLATE LATERAL 63-01-01", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "63-01-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW WITH PEDICLE SCREW THRESHOLD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "530-0007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW YOKE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-000-24-0275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCROTAL PUMP ZERO DEGREE ANGLE CYLINDER 20 CM", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "ES2920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20099.0, "discounted_cash": 7034.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SEAL HYSTEROSCOPE AND OUTFLOW CHANNEL SNGL USE MYOSURE", "code_information": [{"code": "40-902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SHOULDER ARTHROSCOPIC", "code_information": [{"code": "100-AS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 696.0, "discounted_cash": 243.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SHTH 13/15FR 36 CN URETERAL ACCESS DUAL TAPERED TIP HYDROPHILIC COATING NAVI", "code_information": [{"code": "M0062502080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 353.0, "discounted_cash": 123.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SLEEVE 2.0MM VITALLIUM BEADED CABLE DALL- MILES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6704-0-520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 757.0, "discounted_cash": 264.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SOLN 10 DROP PER ML 103IN Y BLODD TYPE W/ STANDARD BLOOD FILTER 170 TO 260 M", "code_information": [{"code": "2C8720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SOLN 104IN 60 DROP PER ML W/ 150ML CLEARLINK BURETTE AND 2 CLEARLINK LUER AC", "code_information": [{"code": "2C8864", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SOLUTION CONTINU-FLO 3 2C8546", "code_information": [{"code": "2C8546", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SET STENT 22FR RESONANCE", "code_information": [{"code": "C2625", "type": "HCPCS"}, {"code": "RMS-060022-R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1960.0, "discounted_cash": 686.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET STENT 26FR RESONANCE", "code_information": [{"code": "RMS-060026-R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2451.0, "discounted_cash": 857.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SET STENT 6FR 22 CM BLACK DOUBLE PIGTAIL FILIFORM SILICONE", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "G15144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SET STENT 6FR 24 CM BLACK DOUBLE PIGTAIL FILIFORM SILICONE", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "G15145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 341.94, "discounted_cash": 119.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SET STENT 6FR 26 CM BLACK DOUBLE PIGTAIL FILIFORM SILICONE", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "G15146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 233.0, "discounted_cash": 81.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SET STENT 6FR X 28 CM URETHRAL ACCESS SHEATH PATIENT CARE NAVIGATOR", "code_information": [{"code": "M0062502060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 353.0, "discounted_cash": 123.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SUTURE ANCHOR JUGGERKNOTLESS LOW PROFILE 2.1MM", "code_information": [{"code": "110003172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 771.0, "discounted_cash": 269.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TAILORS BUNION BROACH 977TBRST", "code_information": [{"code": "977TBRST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 629.46, "discounted_cash": 220.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TAPS UNIV DRIVER RATCHET HANDEL MILAGRO", "code_information": [{"code": "100-MAL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TBNG 8FT PT W/ A BACKFLOW RESTRICTOR AND TOUCH PROOF REDEUCE STRL", "code_information": [{"code": "AR-6421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.53, "discounted_cash": 32.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TBNG IRR LAP W/ SMOKEVAC TRUMPET VALVE AND COJOINED SUCTION IRRIGATION TUBIN", "code_information": [{"code": "5552001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TRANSDUCER THUNDERBEAT SHORT 20CM", "code_information": [{"code": "TB-0920-OE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1297.0, "discounted_cash": 453.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBE 10K ARTHROSCOPE INFLOW 10K100", "code_information": [{"code": "10K100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 42.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBE SZ 4 CFFD MALLINCKRODT SHILEY TRACHEOSTOMY LF STRL DISP", "code_information": [{"code": "4DCT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 33.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBING 16IN PUMP ARTHROSCOPY STRL", "code_information": [{"code": "AR-6410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBING FLUID CONTROL AQUILEX HYSTEROSCOPY OUTFLOW", "code_information": [{"code": "AQL-111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBING FLUID CONTROL AQUILEX LATEX FREE STERILE DISPOSABLE HYSTEROSCOPY", "code_information": [{"code": "AQL-110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 414.0, "discounted_cash": 144.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBING GRAVITY CHECK VALVE 2 NEEDLE-FREE VENTED/NONVENTED 10016073", "code_information": [{"code": "10016073", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.61, "discounted_cash": 1.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBING HYSTEROSCOPIC FLUID MANAGEMENT", "code_information": [{"code": "7209823", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.0, "discounted_cash": 108.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBINGINFLOW TUBE FOR DYONICS 25 FLUID MANAGEMENT SYS DYONICS 25", "code_information": [{"code": "7211004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SET UP PORT XRAY EQUIPMENT", "code_information": [{"code": "Q0092", "type": "HCPCS"}], "standard_charges": [{"minimum": 107.11, "maximum": 168.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 107.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 168.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 168.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 168.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET WARMING FLUID AND BLOOD STANDARD FLOW RANGER DISP", "code_information": [{"code": "24200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.89, "discounted_cash": 17.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SET, I. V. ADMIN, 109 INCH,3 NDL-FREE, Y-SITES", "code_information": [{"code": "DYNDTN1545", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SET-UP CARDIOVERT-DEFIBRILL", "code_information": [{"code": "93745", "type": "CPT"}], "standard_charges": [{"minimum": 1194.71, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1194.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1877.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1877.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1877.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SETINSTR FOR SM JOINT W/ 2.4 MM STEP DRILL AND DRILL GUIDE SUTTAK DISP", "code_information": [{"code": "AR-8934DSC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 422.81, "discounted_cash": 147.98, "setting": "both", "billing_class": "facility"}]}, {"description": "SETINSTR OSTEOCHONDRAL FLAP REPAIR MULTI SHOT STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4095S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1234.46, "discounted_cash": 432.06, "setting": "both", "billing_class": "facility"}]}, {"description": "SETINTUBATION .4MM PROBE DIA .64MM TUBING LACRIMAL RTU WITHOUT SUT CRAWFORD STRL", "code_information": [{"code": "28-0185", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SETINTUBATION CANALICULUS FIBER OPTIC W/ LIGHT PIPE STRL", "code_information": [{"code": "1887570", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 791.0, "discounted_cash": 276.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SEVER CRANIAL NERVE", "code_information": [{"code": "64771", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE; INCISIONAL TECHNIQUE 65865", "code_information": [{"code": "65865", "type": "CPT"}, {"code": "27443546", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1068.18, "maximum": 8450.0, "gross_charge": 2207.0, "discounted_cash": 772.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1068.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEVERING ADHESIONS OF ANTERIOR SYNECHIAE OF EYE-EXCEPT GONIOSYNECHIAE 65870", "code_information": [{"code": "65870", "type": "CPT"}, {"code": "1482094", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEVERING ADHESIONS OF POSTERIOR SYNECHIAE OF EYE 65875", "code_information": [{"code": "65875", "type": "CPT"}, {"code": "1482095", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88130", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88140", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION F TO M", "code_information": [{"code": "55980", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION M TO F", "code_information": [{"code": "55970", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SF3B1 GENE COMMON VARIANTS", "code_information": [{"code": "81347", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1936.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SFTY CNCRNS SCRN BUT NO RECS", "code_information": [{"code": "G9926", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SFTY CNCRNS SCRN ND MIT RECS", "code_information": [{"code": "G9922", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SGMDSC W/BAND LIGATION", "code_information": [{"code": "45350", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAFT CORTICAL 4.5 X 30MM SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CT4.5L30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 649.0, "discounted_cash": 227.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT DRVR 2.0MM 2.5MM CANNULATED SERIES CANNINTERNAL FXTN SYS TI6 TIINSTR", "code_information": [{"code": "FS3010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 822.0, "discounted_cash": 287.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT DRVR 3.0MM 4.0MM TC SERIES CANNINTERNAL FXTN SYS TI6INSTR", "code_information": [{"code": "FS3020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 822.0, "discounted_cash": 287.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 2.5MM 100MM SM HEXAGONAL", "code_information": [{"code": "314.03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 232.39, "discounted_cash": 81.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER CANNULATED STARDRIVE 3.0MM HCS T8", "code_information": [{"code": "3.226.004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1287.0, "discounted_cash": 450.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER LG HEXAGONAL", "code_information": [{"code": "314.15", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 217.0, "discounted_cash": 75.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER T8 SLF HOLDING STARDRVINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.832.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCRWDRVR 105MM SLF RETAINING SLF HOLDING QUICK COUPLING FOR VAR ANGLE LOCK", "code_information": [{"code": "314.467", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 681.0, "discounted_cash": 238.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SHANNON RECTA TM12013", "code_information": [{"code": "TM12013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 788.17, "discounted_cash": 275.86, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVE EPIDERMAL/DERMAL LESION SINGLE FACE/EAR/NOSE/LIP 0.5CM OR LESS 11310", "code_information": [{"code": "11310", "type": "CPT"}, {"code": "1703014", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1089.0, "discounted_cash": 381.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 527.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11301", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11306", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11311", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11302", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11312", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11313", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVING OF EPIDERMAL OR DERMAL LESION; SINGLE; SCALP/NECK/HANDS/FEET/GENITALS 1.1 TO 1.0 CM 11307", "code_information": [{"code": "11307", "type": "CPT"}, {"code": "44670108", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVING OF EPIDERMAL/ DERMAL LESION-SCALP-NECK-HANDS-FEET-GENITALIA 0.5CM OR LESS 11305", "code_information": [{"code": "11305", "type": "CPT"}, {"code": "1482096", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVING OF EPIDERMAL/ DERMAL LESION-TRUNK-ARMS-LEGS 0.5CM OR LESS 11300", "code_information": [{"code": "11300", "type": "CPT"}, {"code": "1482097", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVING OF EPIDERMAL/DERMAL LESION-SCALP-NECK-HANDS-FEET-GENITALIA OVER 2.0 CM 11308", "code_information": [{"code": "11308", "type": "CPT"}, {"code": "1582399", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVING OF EPIDERMAL/DERMAL LESION-TRUNK-ARMS-LEGS OVER 2.0 CM 11303", "code_information": [{"code": "11303", "type": "CPT"}, {"code": "1582398", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHEAR ENDO 5MM", "code_information": [{"code": "176643", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 640.0, "discounted_cash": 224.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS ELECTROSURGICAL 5MM X 14CM CVD PISTAL HANDLE HND CONTROL REPROCESS HARMON", "code_information": [{"code": "ACE14SR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 523.0, "discounted_cash": 183.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS ELECTROSURGICAL 9CM CURVED REPROCESS HARMONIC FOCUS", "code_information": [{"code": "FCS9R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 213.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS ENDO 45CM MONO", "code_information": [{"code": "174601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 183.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC 9 CM CURVED TIP COMPATIBLE W/ ETHICON ENDO SURGERY GENERATOR FOC", "code_information": [{"code": "FCS9", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1083.0, "discounted_cash": 379.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC 9CM ADAPTIVE TISSUE TECH BLUE", "code_information": [{"code": "HAR9FM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 250.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC ACE PLUS 7 W ADV HARH36", "code_information": [{"code": "HARH36", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1450.0, "discounted_cash": 507.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC ACE+7 45CM X 5MM HARH45", "code_information": [{"code": "HARH45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1514.0, "discounted_cash": 529.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC FOCUS ATT 9CM CURVED HAR9F", "code_information": [{"code": "HAR9F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 967.0, "discounted_cash": 338.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC LAP 5MM X 23MM HAR23", "code_information": [{"code": "HAR23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1172.0, "discounted_cash": 410.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC LAP 5MM X 36MM HAR36", "code_information": [{"code": "HAR36", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1322.0, "discounted_cash": 462.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS MINI ENDOSCOPIC 5MM 174301", "code_information": [{"code": "174301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.6, "discounted_cash": 47.46, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH 22CM BIG CRV", "code_information": [{"code": "MN13650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.0, "discounted_cash": 387.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACC UROPASS 10/12FR X 46CM", "code_information": [{"code": "61046BX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 311.76, "discounted_cash": 109.12, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACCEESS 27 CM 11-13FR NAVIGATOR URETERAK HDRPH", "code_information": [{"code": "M0062502000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 353.0, "discounted_cash": 123.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACCESS 1-13FR NAVIGATOR HDRPH DL TAPER TIP", "code_information": [{"code": "M0062502020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 353.0, "discounted_cash": 123.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACCESS 11-13FR X 28 CM URETERAL ACCESS RENAL NAVIGATOR STRL DISP", "code_information": [{"code": "M0062502040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 353.0, "discounted_cash": 123.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACCESS 14FR X 28 CM URETERAL FLEXOR", "code_information": [{"code": "FUS-140028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 177.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACCESS 14FR X 35CM URETHRAL FLEXOR", "code_information": [{"code": "FUS-140035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 177.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACCESS 14FR X 45 CM URETERAL FLEXOR", "code_information": [{"code": "FUS-140045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 177.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACCESS 46 CM 13 TO 15FR URETERAL NAVIGATOR TAPER TIP", "code_information": [{"code": "M0062502100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACCESS UROPASS 11/13FR X 46CM", "code_information": [{"code": "61146BX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH CLEANING 4MM LENS 30 DEGREE ENDOSRUB 2 STORZ XOMEN SHARPSITE AC", "code_information": [{"code": "1912010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 65.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ENDO-SCRUB OLYMPUS 0D 4MM 1912033", "code_information": [{"code": "1912033", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 201.0, "discounted_cash": 70.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH TIBL 30MM X 10.7MM LG FLEXI BIOCRYL TRICALCIUM PHOSPHATE POLY L LACTIDE A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "254628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 470.0, "discounted_cash": 164.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH TIBL 30MM X 8.9MM SM FLEXI BIOCRYL TRICALCIUM PHOSPHATE OR POLY L LACTIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "254629", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 799.0, "discounted_cash": 279.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH TIBL LG BIOABSORBABLE BIOINTRAFIX", "code_information": [{"code": "245625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 606.0, "discounted_cash": 212.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL ACCESS 10-12FR UROPASS 38CM", "code_information": [{"code": "61038BX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 311.76, "discounted_cash": 109.12, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL ACCESS 11-13 FR X 46CM XUSM0046", "code_information": [{"code": "XUSM0046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1642.5, "discounted_cash": 574.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL ACCESS 12/14 FR UROPASS 38CM", "code_information": [{"code": "61238BX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.47, "discounted_cash": 113.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL ACCESS 6-12FR UROPASS 24CM", "code_information": [{"code": "61224BX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.47, "discounted_cash": 113.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL ACCESS NAVIGATOR 11-13FR 46CM", "code_information": [{"code": "M0062502230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL ACCESS NAVIGATOR 13-15FR 36CM", "code_information": [{"code": "M0062502280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL ACESS 12-14 FR X 46CM XUSM0044", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "XUSM0044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH UROPASS ACCESS 11/13FR X 24CM", "code_information": [{"code": "61124BX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH UROPASS ACCESS 11/13FR X 38CM", "code_information": [{"code": "61138BX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH UROPASS ACCESS 13/15FR X 24CM", "code_information": [{"code": "61324BX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEET 1532510 10PK SILICONE 5X5CM .51MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1532510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEET GLIDE 5MM X 35MM 2.5MM RADIUS 6MM THICK IOL", "code_information": [{"code": "581033", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEET VERSAWRAP IS SUPPLIED STERILE NON-PYROGENIC FOR SINGLE USE IN DOUBLE PEEL POUCHES. VTP-2201", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "VTP-2201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 2100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEETING SILICONE 2IN X 2IN X 0.040IN", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1532520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL 54MM REDAPT MODULAR 71352354", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71352354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12103.0, "discounted_cash": 4236.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACET. CLUSTER 52E TRIDENT II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "702-04-52E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACET. CLUSTER 56F TRIDENT II", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "702-04-56F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACETABULAR 3 HOLE 52MM G7 OSSEO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110010244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8380.0, "discounted_cash": 2933.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACETABULAR 48MM G7 OSSEO SZ C 3 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110010242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 2100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACETABULAR 60MM G7 OSSEO SZ G 4 HOLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110010248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11186.0, "discounted_cash": 3915.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACETABULAR CLUSTER HOLE 50MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "702-04-50D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACETABULAR CLUSTER HOLE 54MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "702-04-54E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACETABULAR HIP 62MM 4H SZ H G7 OSSEOTI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110010249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8506.0, "discounted_cash": 2977.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTB 62MM HIP MOD REDAPT STRL LF 71352362", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71352362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9832.0, "discounted_cash": 3441.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 3 HOLE 48MM R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4158.0, "discounted_cash": 1455.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 3 HOLE 54MM R3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4283.0, "discounted_cash": 1499.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 46MM 3 HOLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4357.0, "discounted_cash": 1524.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 48MM MULTI HOLE R3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71338663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3968.0, "discounted_cash": 1388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 52MM MULTI HOLE HIP REPLACE SYS R3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71338665", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4230.0, "discounted_cash": 1480.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 52MM STANDARD THREE HOLE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3733.0, "discounted_cash": 1306.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 54MM MULTI HOLE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71338666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4441.0, "discounted_cash": 1554.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 56MM 3 HOLE STANDARD R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 1256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 56MM MULTIHOLE HIP REPLACE SYS R3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71338667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4067.0, "discounted_cash": 1423.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 58MM 3 HOLE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335558", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3733.0, "discounted_cash": 1306.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 58MM MULTI HOLE R3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71338668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4608.0, "discounted_cash": 1612.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 60MM 3 HOLE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3733.0, "discounted_cash": 1306.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL ACTBLR 62MM 3 HOLE R3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71335562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 1256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL CLUSTER 46MM HA COATING TRIDENT PSL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "542-11-46D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 980.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL CLUSTER 50MM X 51.8MM HYDROXYAPATITE TRIDENT PSL IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "542-11-50E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1751.0, "discounted_cash": 612.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL CLUSTERHOLE ACETABULAR 48MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "702-04-48D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL GRIPTION ACETABULAR SECTOR 48MM OD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1217-32-048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5641.0, "discounted_cash": 1974.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL HEMI 52MM W/ HOLES HIP SYS IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "430-98-052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2976.0, "discounted_cash": 1041.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SHELL OD ACETABULAR 3 HOLE HEMI 54X 54MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "H5-12354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2637.0, "discounted_cash": 922.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIELD CORNEAL BLUE CROUCH PROTECTOR", "code_information": [{"code": "E5699", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIELD CORNEAL PEDI DISP", "code_information": [{"code": "E5699P", "type": "CDM"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIELD EYE 3.23IN X 2.64IN X 1.58IN ALUMINUM W/ CLOTH", "code_information": [{"code": "NON1276CLOTH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIELD EYE CLR FACE", "code_information": [{"code": "8888501246", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIELD FINGER STANDARD SLV WOVEN POLYESTER FOR PROTECTION OF FINGER DURING KNOT", "code_information": [{"code": "AR-7199", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 179.0, "discounted_cash": 62.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIELD SPLASH 1.75IN RETRACTABLE ULTREX LF", "code_information": [{"code": "67720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIELD SPLASH FOR WOUND LF", "code_information": [{"code": "SS-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIGA-LIKE TOXIN AG IA", "code_information": [{"code": "87427", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHIGELLA ANTIBODY", "code_information": [{"code": "86771", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHIM NARROW SIGMA LTP INTRADISCAL 280-100-06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "280-100-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1754.92, "discounted_cash": 614.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE PAIR SPRING DSF-XFX-680", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DSF-XFX-680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2421.0, "discounted_cash": 847.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP XL MALE CLOSED HEAL ROCKER SOLE LOOP LOCK OPEN TOE LACE UP FOAM NYL", "code_information": [{"code": "79-90188", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOECOVER ANTI SKID", "code_information": [{"code": "2854", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS & ULNA", "code_information": [{"code": "25392", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTEN/LENGTHEN THIGHS", "code_information": [{"code": "27468", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF HAND TENDON", "code_information": [{"code": "26479", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF TENDON-EXTENSOR-HAND OR FINGER-EACH TENDON 26477", "code_information": [{"code": "26477", "type": "CPT"}, {"code": "1482098", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF THIGH BONE", "code_information": [{"code": "27465", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER JOINT SURGERY", "code_information": [{"code": "23101", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23334", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23335", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "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": 11967.69, "maximum": 20545.56, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11967.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17116.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18828.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20545.56, "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": 16689.93, "maximum": 28652.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16689.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23870.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26257.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28652.46, "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": 9456.02, "maximum": 16233.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9456.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13524.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14876.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16233.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHUTTLE SUT 45 DEGREE HOOK LFT CHIA PASSER IDEALINSTR", "code_information": [{"code": "251003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 651.0, "discounted_cash": 227.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SIALIDASE ENZYME ASSAY", "code_information": [{"code": "87905", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIALOLITHOTOMY SUBMANDIBULAR / SUBLINGUAL / PAROTID UNCOMPLICATED 42330", "code_information": [{"code": "42330", "type": "CPT"}, {"code": "4040505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIALOLITHOTOMY SUBMANDIBULAR COMPLICATED INTRAORAL 42335", "code_information": [{"code": "42335", "type": "CPT"}, {"code": "13397458", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "gross_charge": 2286.0, "discounted_cash": 800.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1106.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIG W/TNDSC BALLOON DILATION", "code_information": [{"code": "45340", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC W/COLLECTION OF SPECIMENS 45330", "code_information": [{"code": "45330", "type": "CPT"}, {"code": "1482102", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY FLEXIBLE W/DIRECTED SUBMUCOSAL INJECTION ANY SUBSTANCE 45335", "code_information": [{"code": "45335", "type": "CPT"}, {"code": "12595063", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.92, "maximum": 8450.0, "gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1794.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY FLEXIBLE W/REMOVAL TUMOR-POLYP-LESION BY HOT BIOPSY FORCEPS OR BIPOLAR 45333", "code_information": [{"code": "45333", "type": "CPT"}, {"code": "1482105", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY FLEXIBLE W/REMOVAL TUMOR-POLYP-TUMOR -LESION BY SNARE TECHNIQUE 45338", "code_information": [{"code": "45338", "type": "CPT"}, {"code": "1482106", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY FLEXIBLE; WITH CONTROL OF BLEEDING 45334", "code_information": [{"code": "45334", "type": "CPT"}, {"code": "1482101", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY FLEXIBLE; WITH REMOVAL OF FOREIGN BODY 45332", "code_information": [{"code": "45332", "type": "CPT"}, {"code": "1482107", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1794.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ BIOPSY 45331", "code_information": [{"code": "45331", "type": "CPT"}, {"code": "1482100", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1794.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ DECOMPRESSION INCL; PLACEMENT OF DECOMPRESSION TUBE 45337", "code_information": [{"code": "45337", "type": "CPT"}, {"code": "1480594", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1794.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ABLATION", "code_information": [{"code": "45346", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/PLCMT STENT", "code_information": [{"code": "45347", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/RESECTION", "code_information": [{"code": "45349", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ULTRASOUND", "code_information": [{"code": "45341", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/US GUIDE BX", "code_information": [{"code": "45342", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "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": 8324.59, "maximum": 14291.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8324.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11905.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13096.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14291.25, "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": 4919.32, "maximum": 8445.25, "estimated_discounted_cash": 23207.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4919.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7035.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7739.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8445.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "947", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7263.1, "maximum": 12468.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7263.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10387.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11426.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12468.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "948", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4787.93, "maximum": 8219.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4787.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6847.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7532.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8219.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SILICONE OIL SILIKON 8.5ML 1000", "code_information": [{"code": "C1814", "type": "HCPCS"}, {"code": "8065601187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE PIP PROXIMAL INTERPHALANGEAL IMPLANT SIZE 50 PIP-50", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PIP-50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1667.0, "discounted_cash": 583.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE STRIP 4.0MM", "code_information": [{"code": "C1814", "type": "HCPCS"}, {"code": "92-10 DUTCH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE TIRE STYLE 287", "code_information": [{"code": "C1784", "type": "HCPCS"}, {"code": "92-17", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SILVER NITRATE APPLICATORS", "code_information": [{"code": "MED0184", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SILVER SULFADIAZINE CREAM/SILVADENE", "code_information": [{"code": "MED0185", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMETHICONE 30ML DROPS MYLOCON", "code_information": [{"code": "MED0186", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [{"code": "194", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5255.1, "maximum": 9021.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5255.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7515.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8267.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9021.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [{"code": "193", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7980.9, "maximum": 13701.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7980.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11414.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12555.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13701.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC", "code_information": [{"code": "195", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4050.06, "maximum": 6952.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4050.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5792.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6371.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6952.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMPLE REPAIR OF WOUNDS-FACIAL-EARS-MUCOUS MEMBRANES 2.5CM OR LESS 12011", "code_information": [{"code": "12011", "type": "CPT"}, {"code": "1481941", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 620.0, "discounted_cash": 217.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 300.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMPLE REPAIR SUPERFICIAL WOUNDS SCALP-NECK-AXILLAE-GENITALIA-TRUNK-EXT. 12.6CM-20.0CM 12005", "code_information": [{"code": "12005", "type": "CPT"}, {"code": "1481989", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMPLE REPAIR WOUNDS SCALP-NECK-AXILLAE-GEITALIA-TRUNK-EXT. 2.5CM OR LESS 12001", "code_information": [{"code": "12001", "type": "CPT"}, {"code": "1481990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMPLE REPAIR WOUNDS SCALP-NECK-AXILLAE-GENITALIA-TRUNK-EXT. 2.6CM TO 7.5CM 12002", "code_information": [{"code": "12002", "type": "CPT"}, {"code": "1481991", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 213.92, "maximum": 8450.0, "gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 213.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINGLE ENERGY X-RAY STUDY", "code_information": [{"code": "G0130", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.12, "maximum": 165.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 105.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 165.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 165.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 165.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 65.12, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 69.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINGLE STRAND SEMITENDINOSUS SST-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SST-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2266.0, "discounted_cash": 793.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE STRAND SEMITENDINOSUS TENDON", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "SST-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1906.0, "discounted_cash": 667.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE TRANSFER TOE-HAND", "code_information": [{"code": "26553", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINGLE USE KIT COLAH P06 S0004", "code_information": [{"code": "P06 S0004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1062.55, "discounted_cash": 371.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE MONOPOLAR STIMULATING PROBE 2701-90026", "code_information": [{"code": "2701-90026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.77, "discounted_cash": 51.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SINK 4.0 CANNULATED COUNTER 211-40-002", "code_information": [{"code": "211-40-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.6, "discounted_cash": 225.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SINK COUNTER CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8241-58-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 544.0, "discounted_cash": 190.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SINSUSOTOMY FRONTAL EXTERNAL SIMPLE 31070", "code_information": [{"code": "31070", "type": "CPT"}, {"code": "42882905", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 5771.0, "discounted_cash": 2019.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2793.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITH CC/MCC", "code_information": [{"code": "135", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13038.91, "maximum": 22384.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13038.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18648.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20513.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22384.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "136", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7637.21, "maximum": 13111.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7637.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10922.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12015.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13111.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUS CAUS BAC INX", "code_information": [{"code": "G9364", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSOIDAL ROTATIONAL TEST", "code_information": [{"code": "92546", "type": "CPT"}], "standard_charges": [{"minimum": 400.52, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 400.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 629.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 629.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 629.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSOTOMY FRONTAL TRANSORBITAL UNILATERAL 31075", "code_information": [{"code": "31075", "type": "CPT"}, {"code": "41581220", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSOTOMY MAXILLARY ANTROTMY INTRANASAL 30120", "code_information": [{"code": "30120", "type": "CPT"}, {"code": "1668563", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSOTOMY MAXILLARY INTRANASAL 31020", "code_information": [{"code": "31020", "type": "CPT"}, {"code": "42873625", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1487.81, "maximum": 8450.0, "gross_charge": 3074.0, "discounted_cash": 1075.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1487.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSOTOMY MAXILLARY RADICAL W/REMOVAL OF ANTROCHOANAL POLYPS 31032", "code_information": [{"code": "31032", "type": "CPT"}, {"code": "13495689", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 9310.0, "discounted_cash": 3258.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4506.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSOTOMY MAXILLARY/ RADICAL WITHOUT REMOVAL POLYPS 31030", "code_information": [{"code": "31030", "type": "CPT"}, {"code": "3548654", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5229.0, "discounted_cash": 1830.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSOTOMY/SPHENOID WITH OR WITHOUT BIOPSY 31050", "code_information": [{"code": "31050", "type": "CPT"}, {"code": "1482114", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SITE NO LUNG OR LUNG CX", "code_information": [{"code": "G9424", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SITE NOT SMALL CELL LUNG CA", "code_information": [{"code": "G9285", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIZE 2 RTS LESSER MTP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M40SE020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4894.0, "discounted_cash": 1712.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZE 3 RTS LESSER MTP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M40SE030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4894.0, "discounted_cash": 1712.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZE MEDIUM STOCKING ANTI EMBOLISM SHORT MDS160844", "code_information": [{"code": "MDS160844", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZER HEMI GREAT TOE IMPLANT MED/LG", "code_information": [{"code": "375-0006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 845.0, "discounted_cash": 295.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZER IMPLANT RTS SIZE 1-4", "code_information": [{"code": "M03S0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZER IMPLANT SZ 20", "code_information": [{"code": "MCP-205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZER IMPLANT SZ 30", "code_information": [{"code": "MCP-305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZER STAPLE NEOSPAN DISPOSABLE", "code_information": [{"code": "T05-S0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZER TOE DISP", "code_information": [{"code": "15267025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1304.0, "discounted_cash": 456.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZING GUIDE CONTINOUS COMPRESSION IMPLANT", "code_information": [{"code": "SG-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.0, "discounted_cash": 39.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SKEL MUSC RELAXANT 3 OR MORE", "code_information": [{"code": "80370", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKELETAL MUSCLE RELAXANT 1/2", "code_information": [{"code": "80369", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKILL TRAIN AND DEV/DIEM", "code_information": [{"code": "H2038", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKILLED NURSING FACILITY SS", "code_information": [{"code": "G4033", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN AND MUSCLE REPAIR FACE", "code_information": [{"code": "15845", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN CLOSURE SURGICAL 24CM ZIP LATEX FREE ADHESIVE UP", "code_information": [{"code": "PS1240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITH CC", "code_information": [{"code": "571", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9948.14, "maximum": 17078.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9948.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14227.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15650.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17078.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITH MCC", "code_information": [{"code": "570", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17286.06, "maximum": 29675.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17286.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24722.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27195.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29675.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITHOUT CC/MCC", "code_information": [{"code": "572", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6718.07, "maximum": 11533.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6718.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9608.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10569.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11533.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN FLAP EYELIDS-NOSE-EARS-LIPS-INTRAORAL 15576", "code_information": [{"code": "15576", "type": "CPT"}, {"code": "1482115", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN FLAP FOREHEAD-CHEEKS-CHIN-MOUTH-NECK-AXILLAE-GENITALIA-HANDS-FEET 15574", "code_information": [{"code": "15574", "type": "CPT"}, {"code": "1482117", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN FLAP SCALP-ARMS-LEGS 15572", "code_information": [{"code": "15572", "type": "CPT"}, {"code": "1482116", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [{"code": "577", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15509.22, "maximum": 26625.47, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15509.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22181.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24399.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26625.47, "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": 30802.49, "maximum": 52880.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30802.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 44054.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48459.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52880.22, "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": 9703.6, "maximum": 16658.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9703.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13878.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15266.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16658.67, "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": 19748.46, "maximum": 33903.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19748.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28244.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31069.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33903.2, "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": 33694.35, "maximum": 57844.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33694.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48190.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53009.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57844.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC", "code_information": [{"code": "575", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10725.55, "maximum": 18413.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10725.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15339.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16873.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18413.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [{"code": "623", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11384.33, "maximum": 19544.07, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11384.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16282.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17910.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19544.07, "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": 21989.44, "maximum": 37750.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21989.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31449.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34594.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37750.4, "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": 6684.61, "maximum": 11475.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6684.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9560.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10516.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11475.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITH CC/MCC", "code_information": [{"code": "904", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22671.34, "maximum": 38921.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 22671.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32424.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 35667.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38921.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "905", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10036.95, "maximum": 17230.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10036.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14355.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15790.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17230.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN MARKER PRE SURG MINI", "code_information": [{"code": "933292", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SKIN PEEL THERAPY", "code_information": [{"code": "17360", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT T/A/L ADD-ON", "code_information": [{"code": "15272", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRFT T/ARM/LG CHILD", "code_information": [{"code": "15273", "type": "CPT"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TEST CANDIDA", "code_information": [{"code": "86485", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TEST UNLISTED ANTIGN EA", "code_information": [{"code": "86486", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH CC", "code_information": [{"code": "593", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6938.27, "maximum": 11911.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6938.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9923.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10915.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11911.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH MCC", "code_information": [{"code": "592", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10306.43, "maximum": 17693.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10306.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14740.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16214.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17693.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITHOUT CC/MCC", "code_information": [{"code": "594", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4963.73, "maximum": 8521.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4963.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7099.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7809.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8521.49, "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": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT T/A/L CHILD ADD", "code_information": [{"code": "15274", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61576", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLCO1B1 GENE COM VARIANTS", "code_information": [{"code": "81328", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 445.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEP APNEA ASSESS", "code_information": [{"code": "G8839", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEP REMOTE - SLEEP APNEA 2580", "code_information": [{"code": "2580", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2884.0, "discounted_cash": 1009.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEP REMOTE CONTROL MODEL", "code_information": [{"code": "2500N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2884.0, "discounted_cash": 1009.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEP STUDY ATTENDED", "code_information": [{"code": "95807", "type": "CPT"}], "standard_charges": [{"minimum": 1651.32, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1651.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2594.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2594.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2594.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEP STUDY UNATT&RESP EFFT", "code_information": [{"code": "95806", "type": "CPT"}], "standard_charges": [{"minimum": 395.75, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 395.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 621.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 621.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 621.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE COMPRESSION MED KNEE LOWER LEG SCD 9529-", "code_information": [{"code": "9529-", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE DRILL 11MM PURPLE TRUKORINSTR", "code_information": [{"code": "72200940", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 779.0, "discounted_cash": 272.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE DRILL 2.8MM", "code_information": [{"code": "323.054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 158.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE EXPANDABLE RADIALLY VERSASTEP VS101000", "code_information": [{"code": "VS101000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 308.0, "discounted_cash": 107.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE IRRIGATION FOR TPX 58TPXSLV", "code_information": [{"code": "58TPXSLV", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1268.01, "discounted_cash": 443.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE KII 5 X 75 ADVFIX", "code_information": [{"code": "CFS03", "type": "CDM"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE LABTICIAN 3.75 OVAL", "code_information": [{"code": "C1784", "type": "HCPCS"}, {"code": "3084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE LAPROSCOPIC 5MM 75MM ENDOPATH BLADELESS CB5ST", "code_information": [{"code": "CB5ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE LOBECTOMY", "code_information": [{"code": "32486", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE PNEUMONECTOMY", "code_information": [{"code": "32442", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE PROTECTION FEMALE REAMER 21MM", "code_information": [{"code": "P01-911-2102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 873.0, "discounted_cash": 305.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE RESURFACING T8 MODULAR HEAD HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74222400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5192.0, "discounted_cash": 1817.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE SCD KENDALL KNEE LENGTH LG 9789B", "code_information": [{"code": "9789B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.84, "discounted_cash": 17.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE SCD KENDALL KNEE LENGTH MED 9529B", "code_information": [{"code": "9529B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.25, "discounted_cash": 13.74, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE SILICON OVAL STYLE 72", "code_information": [{"code": "C1814", "type": "HCPCS"}, {"code": "92-30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE SILICONE OVAL 2.5MM X 1.6MM X 5MM", "code_information": [{"code": "C1814", "type": "HCPCS"}, {"code": "S3084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE SILICONE OVAL STYLE", "code_information": [{"code": "C1814", "type": "HCPCS"}, {"code": "92-36", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE STABILITY 12MM DIAMETER 2B12LT", "code_information": [{"code": "2B12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 266.24, "discounted_cash": 93.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE STABILITY TROCAR XCEL 12MMX100MM CB12LT", "code_information": [{"code": "CB12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.0, "discounted_cash": 111.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE STABILITY TROCAR XCEL 5MMX100MM 2CB5LT", "code_information": [{"code": "2CB5LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE STABILITY TROCAR XCEL 5MMX100MM CB5LT", "code_information": [{"code": "CB5LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.63, "discounted_cash": 43.27, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE STERILE", "code_information": [{"code": "599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.73, "discounted_cash": 1.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE TAPER 0MM OPTION HEAD CERAMIC TYPE 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "650-1066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 725.0, "discounted_cash": 253.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE TAPER 6 TYPE 1 FOR CERAMIC BIOLOXDELTA OPTION HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "650-1064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 680.0, "discounted_cash": 238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE TROCAR 5MM X 100MM UNIVERSAL STABILITY REPROCESS ENDOPATH XCEL", "code_information": [{"code": "CB5LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.95, "discounted_cash": 16.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE XL SCD EXPRESS KNEE LENGTH 9790", "code_information": [{"code": "9790", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVEINFUSION CO AXIAL ANT VITRECTOMY STRL", "code_information": [{"code": "8065750352", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM MED 15IN X 8IN THUMB LOOP SHOULDER PAD WEB STRP COTTON POLYESTER", "code_information": [{"code": "SDJ7984005", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM MED BLUE UNISEX HOOK AND LOOP CLOSURE COTTON POLYESTER PROCARE", "code_information": [{"code": "79-84005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING DESARA BLUE SHORT SUTURE FOR FEMALE STRESS URINARY INCONTINENCE CAL-DS01BS", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "CAL-DS01BS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1728.0, "discounted_cash": 604.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING OPERATION CORRECTION MALE URINARY INCONTINENCE 53440", "code_information": [{"code": "53440", "type": "CPT"}, {"code": "1482123", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 14796.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING OPERATION FOR STRESS INCONTINENCE 57288", "code_information": [{"code": "57288", "type": "CPT"}, {"code": "1482122", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING TRANSVAGINAL ADVANTAGE FIT MID", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "M0068502110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2398.0, "discounted_cash": 839.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SLINGSHOT 70 UP CHAMPION", "code_information": [{"code": "CAT02862", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 739.75, "discounted_cash": 258.91, "setting": "both", "billing_class": "facility"}]}, {"description": "SLIT KNIFE 2.75 ANGLED ROUND STOCK 962751 AMBLER", "code_information": [{"code": "962751 AMBLER", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SLIT KNIFE 2.75MM WIDE ANGLED", "code_information": [{"code": "962851", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54000", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE DORSAL OR LAT. EXCEPT NEWBORN 54001", "code_information": [{"code": "54001", "type": "CPT"}, {"code": "1668560", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLOTTED HEAD CRADLE FOAM POSITIONER", "code_information": [{"code": "FP-HEADSL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP STDY UNATND W/ANAL", "code_information": [{"code": "95801", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATTENDED", "code_information": [{"code": "95800", "type": "CPT"}], "standard_charges": [{"minimum": 570.57, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 570.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 896.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 896.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 896.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL 10 DEGREE HAMMERTOE IMPLANT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HT-00004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 1076.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL ANIMAL INOCULATION", "code_information": [{"code": "87003", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44363", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44364", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44365", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44366", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44369", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44373", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44376", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44378", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44382", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44384", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44381", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/BIOPSY", "code_information": [{"code": "44377", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/STENT", "code_information": [{"code": "44370", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL LAG SCREW SOLID 4.0 X 34 113-40034", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "113-40034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1978.0, "discounted_cash": 692.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL LOCKING CLIP AXTIHA 64-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "64-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL SOCKET INSERT 32MM NEUTRAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "509-02-032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1391.0, "discounted_cash": 486.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALLPOX&MONKEYPOX VAC 0.5ML", "code_information": [{"code": "90611", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMART PIN 1.1MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 242.0, "discounted_cash": 84.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SMART PIN 1.1MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 72.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SMART PROGRAMMER", "code_information": [{"code": "TH90G01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4096.0, "discounted_cash": 1433.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SMART TOE IMP ANGLED 10DEG SZ 20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ST0A-21P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2559.0, "discounted_cash": 895.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SMART TOE IMP ANGLED 10DEG SZ 22", "code_information": [{"code": "ST0A-22P", "type": "CDM"}], "standard_charges": [{"gross_charge": 5269.0, "discounted_cash": 1844.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SMARTSET HV HIGH VISCOSITY BONE CEMENT 40G 3092-040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3092-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SMEAR COMPLEX STAIN", "code_information": [{"code": "87209", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 27.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMEAR SPECIAL STAIN", "code_information": [{"code": "87207", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMEAR WET MOUNT SALINE/INK", "code_information": [{"code": "87210", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMMG CNCRNT APPL IMU SNR", "code_information": [{"code": "778T", "type": "CPT"}], "standard_charges": [{"minimum": 370.85, "maximum": 583.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 370.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 583.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 583.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 583.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMN1 GEN NOWN FAMIL SEQ VRNT", "code_information": [{"code": "81337", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 472.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMN1 GENE DOS/DELETION ALYS", "code_information": [{"code": "81329", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMN1 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81336", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 768.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 433.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMN1&SMN2 FULL GENE ANALYSIS", "code_information": [{"code": "236U", "type": "CPT"}], "standard_charges": [{"minimum": 349.35, "maximum": 867.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 867.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 867.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMOKE EVACUATION SYSTEM LAPAROSCOPIC ACTIVE AND PASSIVE SEL7010", "code_information": [{"code": "SEL7010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 43.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SMPD1 GENE COMMON VARIANTS", "code_information": [{"code": "81330", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 58.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 119.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 188.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 188.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 188.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 67.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 67.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SNARE COLD 2.4MM X230 CM 9MM SNARE EXACTO", "code_information": [{"code": "711115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SNARE ELECTROSURGICAL 20MM X 230CM SPIRAL", "code_information": [{"code": "SD-230U-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SNARE OVAL 0.4MM 25MM LOOP 2.8MM 230 CM PLIABLE STRL", "code_information": [{"code": "SD-240U-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SNARE POLYECTOMY 240 CM 2.4MM 27MM OVAL LOOP ENDO", "code_information": [{"code": "M00562672", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SNARE POLYECTOMY 240 CM 2.4MM 27MM OVAL LOOP STANDARD SHRTTHROW ENDO", "code_information": [{"code": "M00562671", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SNARES HOT LARGE BRAIDED OVAL", "code_information": [{"code": "129-0675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SNIP INCISION OF LACRIMAL PUNCTUM 68440", "code_information": [{"code": "68440", "type": "CPT"}, {"code": "16066206", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SNRPN/UBE3A GENE", "code_information": [{"code": "81331", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 63.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 204.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 204.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 204.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 73.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 73.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SO GSAP CL FR CPY NMBR&MCRST", "code_information": [{"code": "81463", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SO GSAP CLL FR DNA/DNA&RNA", "code_information": [{"code": "81462", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SO GSAP CLL FR MCRSTL INS", "code_information": [{"code": "81464", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SO GSAP DNA CPY NMBR&MCRSTL", "code_information": [{"code": "81458", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP 5-50 RNA ALYS", "code_information": [{"code": "81449", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 860.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 860.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP 5-50DNA/DNA&RNA", "code_information": [{"code": "81445", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 747.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 860.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 860.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP DNA MCRSTL INS", "code_information": [{"code": "81457", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP DNA/DNA&RNA", "code_information": [{"code": "81459", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SO/HL 51/>GSAP DNA/DNA&RNA", "code_information": [{"code": "81455", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 11707.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3649.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7444.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SO/HL 51/>GSAP RNA ALYS", "code_information": [{"code": "81456", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 11707.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7444.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4204.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM BICARB 4.2% IV SOL 5ML", "code_information": [{"code": "MED0243", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM BICARBONATE 4% 5ML VIAL", "code_information": [{"code": "MED0285", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM BICARBONATE 4.2% IV SOL 10ML IM", "code_information": [{"code": "MED0405", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9 INJECTION, USP 1000 mL", "code_information": [{"code": "798309", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% 10 ML VIAL", "code_information": [{"code": "MED0187", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% 20 ML VIAL", "code_information": [{"code": "MED0188", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% IRR SOL 3000 ML", "code_information": [{"code": "2B7127", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 39.03, "discounted_cash": 13.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% IV SOL 1000ML (MEDID)", "code_information": [{"code": "MED0415", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% IV SOL 50ML", "code_information": [{"code": "MED0417", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 14.6% PF 20ML", "code_information": [{"code": "MED0189", "type": "CDM"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 23.4% 30 ML", "code_information": [{"code": "MED0538", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM CHONDROITIN-HYALURONATE (VISCOAT) 40-30MG/ML 0.5ML INTRAOCULAR", "code_information": [{"code": "MED0059", "type": "CDM"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 41.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SOFNOLIME CO2 ABSORBER SO077", "code_information": [{"code": "SO077", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.21, "discounted_cash": 19.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SOFT TIP CANNULA MICROSURGICAL INSTRUMENT 25GA DSP 0.8MM 8065149530", "code_information": [{"code": "8065149530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SOFT TISSUE PROCEDURES WITH CC", "code_information": [{"code": "501", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10670.19, "maximum": 18318.07, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10670.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15260.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16786.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18318.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SOFT TISSUE PROCEDURES WITH MCC", "code_information": [{"code": "500", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19401.73, "maximum": 33307.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19401.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27748.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 30523.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 33307.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SOFT TISSUE PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "502", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8107.42, "maximum": 13918.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8107.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11595.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12754.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13918.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SOFT-TISSUE MESH ANCHOR TISSUETAK ABSORBABLE FIXATION SYSTEM 10 ABSORBABLE FASTENERS AR-19021TT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "AR-19021TT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1803.0, "discounted_cash": 631.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION ANTI FOG W/ FOAM PAD", "code_information": [{"code": "CF-1001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION ANTI-FOG FOAM-PAD 31142527", "code_information": [{"code": "31142527", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION ANTI-STICK FOR CAUTERY TIP EL101", "code_information": [{"code": "EL101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION APPLICATOR SURGIPHOR WOUND IRRIGATION SYSTEM 910110", "code_information": [{"code": "910110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 197.78, "discounted_cash": 69.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION BSS\u00c2\u00ae STERILE IRRIGATION 500 ML BAG - USA 0065179504", "code_information": [{"code": "65179504", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 32.56, "discounted_cash": 11.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION CONTROL CONTROL SOL HIGH LOW DUO PRO BLOOD GLUCOSE SURESTEP", "code_information": [{"code": "B5375-8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION DEVELOPER 10 GALLON TYPE S 2 2 PART RADIOGRAPHIC FILM", "code_information": [{"code": "262889-2", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION DEXTROSE 5% 1000 ML USP 2B0064X", "code_information": [{"code": "2B0064X", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION DEXTROSE 5% 500 ML USP 2B0063Q", "code_information": [{"code": "2B0063Q", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.95, "discounted_cash": 3.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION DEXTROSE 5% NACL 0.45% 1000 2B1074X", "code_information": [{"code": "2B1074X", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION GLYCINE 1.5% IRRIGATION 3000ML 2B7317", "code_information": [{"code": "2B7317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.77, "discounted_cash": 16.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION IRR 3000 ML SODIUM CHLORIDE NACL 0.9", "code_information": [{"code": "2B7477", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 43.7, "discounted_cash": 15.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION IRR 3000 ML SODIUM CHLORIDE NACL 0.9 3KB7127", "code_information": [{"code": "3KB7127", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 40.68, "discounted_cash": 14.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION IRRG H2O 1000L", "code_information": [{"code": "2F7114", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 10.98, "discounted_cash": 3.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION IRRIGATION 3000 ML FLEXIBLE SODIUM CLORIDE 0.9 PERCENT LATEX FREE", "code_information": [{"code": "797208", "type": "CDM"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION IRRIGATION BSS BAG 500ML", "code_information": [{"code": "65179540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.45, "discounted_cash": 11.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION IRRIGATION OPHTHALMOLOGY BALANCED SALT SOLUTION 500ML", "code_information": [{"code": "65-0795-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION KCL 20MEQ/L 5%DEX .45% NACL 2B1654X", "code_information": [{"code": "2B1654X", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION LACT RINGERS INJ 1000ML BAG 2B2324X", "code_information": [{"code": "2B2324X", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 10.98, "discounted_cash": 3.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION LACTATED RINGERS 3000 ML IRR ARTHROMATIC PLASTIC CONTAINER SOL STRL BG", "code_information": [{"code": "2B7487", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION NACL 0.9% 500ML VIAFLO UE1323D", "code_information": [{"code": "UE1323D", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 13.51, "discounted_cash": 4.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION NACL INJ 0.9% 1000ML BAG 2B1324X", "code_information": [{"code": "2B1324X", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 10.43, "discounted_cash": 3.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION NACL INJ 0.9% 500ML BAG 2B1323Q", "code_information": [{"code": "2B1323Q", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.24, "discounted_cash": 2.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION OPHTHALMIC .55 ML PROVISC .50 ML VISCOAT VISCOELASTIC SYRNG DUOVISC", "code_information": [{"code": "8065183150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.6, "discounted_cash": 68.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION OPHTHALMIC 0.55 ML VISCOELASTIC VL 1 PCT SODIUM HYALURONATE PROVISC", "code_information": [{"code": "8065183055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION RINGER'S LACT INJ 500ML BAG 2B2323Q", "code_information": [{"code": "2B2323Q", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.89, "discounted_cash": 3.11, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION SOD CHL 0.9% 250ML INJ BAG 2B1322Q", "code_information": [{"code": "2B1322Q", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.85, "discounted_cash": 2.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION SODIUM CHLORIDE 0.45% 1000M 2B1314X", "code_information": [{"code": "2B1314X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.01, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION SODIUM CHLORIDE 0.9% 1000ML", "code_information": [{"code": "FE1323D", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION SODIUM CHLORIDE 0.9% 5000ML 2B7479", "code_information": [{"code": "2B7479", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION SODIUM CHLORIDE 0.9% 500ML", "code_information": [{"code": "FE1323", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLUTION WTR 440 ML WITHOUT HUMIDIFIER ADAPTER FOR USE W/ MODEL 000-11 AQUAPAK H", "code_information": [{"code": "4-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SOMATOSENSORY TESTING", "code_information": [{"code": "95925", "type": "CPT"}], "standard_charges": [{"minimum": 467.24, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 467.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 734.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 734.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 734.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOMATOSENSORY TESTING", "code_information": [{"code": "95926", "type": "CPT"}], "standard_charges": [{"minimum": 449.78, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 449.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 706.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 706.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 706.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SONIC TIP", "code_information": [{"code": "1910-1011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 161.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SOTROVIMAB INFUSION", "code_information": [{"code": "M0247", "type": "HCPCS"}], "standard_charges": [{"minimum": 1984.5, "maximum": 3118.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1984.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACEMAKER STRUCTURAL BALLOON TROCAR OMST10SB", "code_information": [{"code": "OMST10SB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 226.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER 36 X 9 DWB931", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "DWB931", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2115.0, "discounted_cash": 740.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER 7 X 12 X 14 X 4 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48321074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5562.0, "discounted_cash": 1946.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER 7MM 7X11X14MM CORTICAL CERVICAL 977ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "977ST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER 8 HEIGHT 22 WIDTH 60 LENGTH 10 IDENTITI LIF 100-08226010-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-08226010-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7200.0, "discounted_cash": 2520.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER 9X14X16X4DEG AVS AS SPACER 48324094", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "48324094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER AVS 12MM X 14MM 7MM PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48324074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER AVS ARIA 10.0 X 18.0 X 45.0MM 8DEG LORDOTIC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "48751110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER CERVICAL 16MM X 14MM PEEK DA161406C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DA161406C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1770.0, "discounted_cash": 619.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER CONICAL 9.5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3-009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4522.0, "discounted_cash": 1582.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER HUMERAL FRACTURE SIZE 3/4 9MM THICKNESS PFX00012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PFX00012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER IDENTITI ALIF 6X34X24MM 15D 232-06342415-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "232-06342415-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10496.0, "discounted_cash": 3673.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER INTERVERT 10MM X 55MM X 8DEG 18MM WIDE PEEK AVS ARIA IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48751310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6798.0, "discounted_cash": 2379.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER MODULUS ALIF 6 X 34 X 24MM 15DEG 1921005P2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1921005P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16309.0, "discounted_cash": 5708.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PROLIFT EXPANDABLE SYSTEM 58-1028-1210K", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "58-1028-1210K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8600.0, "discounted_cash": 3010.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SILKTOE SIZE 50 TOTAL SILASTIC BRDNEWP5050R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BRDNEWP5050R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SILKTOE TG SIZE 30 RIGHT BRDNEWP3030R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BRDNEWP3030R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPAZIATORE SILKTOE TG 50 L BRDNEWP5050L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "BRDNEWP5050L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINE 6 X 14 X 16MM 4DEG VERTEBRAL INTERBODY FUSION PEEK AVS AS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48324064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINE 8DEG X 18 X 50 X 12MM AVS ARIA", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "48751212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER STRUT DISTRACTION BLOCK RIGID 150MM DNE-6000-150", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-6000-150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1246.0, "discounted_cash": 436.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER STRUT DISTRACTION RIGID COMP 75MM DNE-6000-750", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-6000-750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 872.0, "discounted_cash": 305.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TENDON SWANSON/HUNTER 24CM X 4MM FLEXSPAN 24270004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "24270004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2746.0, "discounted_cash": 961.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TENDON SWANSON/HUNTER 24CM X 5MM FLEXSPAN 24270005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "24270005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2746.0, "discounted_cash": 961.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TENDON SWANSON/HUNTER 24CM X 6MM FLEXSPAN 24270006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "24270006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2746.0, "discounted_cash": 961.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACERINTERVERT 10MM X 50MM X 8DEG 18MM WIDE PEEK AVS ARIA IMP", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "48751210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACERINTERVERT 12MM X 55MM X 8DEG 18MM WIDE PEEK AVS ARIA IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48751312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACERINTERVERT 12MM X 60MM X 8DEG 18MM WIDE PEEK AVS ARIA IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48751412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPATULA PLASMA 33 CM X 5MM W/ CORD FOR USE W/ PK G400 GENERATOR ONLY PKS", "code_information": [{"code": "952005PK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 947.0, "discounted_cash": 331.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEC GENE TEST HYP CARDIOMY", "code_information": [{"code": "S3866", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEC RPT NO DOC CLASS HISTO", "code_information": [{"code": "G9425", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEC SIT NOT PRIM TUMOR", "code_information": [{"code": "G8723", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEC SITE NO CUTANEOUS", "code_information": [{"code": "G9430", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEC SITE NO LUNG", "code_information": [{"code": "G9420", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEC STAINS FOR MICROORGANIS", "code_information": [{"code": "D0476", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEC STAINS NOT FOR MICROORG", "code_information": [{"code": "D0477", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99190", "type": "CPT"}], "standard_charges": [{"minimum": 1586.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1586.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2492.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2492.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2492.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99191", "type": "CPT"}], "standard_charges": [{"minimum": 1179.28, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1179.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1853.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1853.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1853.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99192", "type": "CPT"}], "standard_charges": [{"minimum": 785.11, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 785.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION DOSIMETRY", "code_information": [{"code": "77331", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 219.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 133.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 133.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 133.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 46.63, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 49.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION TREATMENT", "code_information": [{"code": "77470", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 914.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 178.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 178.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 178.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 94.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 100.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL REPORTS OR FORMS", "code_information": [{"code": "99080", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL SUPPLIES PHYS/QHP", "code_information": [{"code": "99070", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL TELETX PORT PLAN", "code_information": [{"code": "77321", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 565.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 195.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 307.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 307.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 307.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 108.51, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 115.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIALIST ST CAST PDG 4X4YD 30-321", "code_information": [{"code": "30-321", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECIALTY CARE TRANSPORT", "code_information": [{"code": "A0434", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIMEN FAT STAIN", "code_information": [{"code": "89125", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIMEN HANDLING OFFICE-LAB", "code_information": [{"code": "99000", "type": "CPT"}], "standard_charges": [{"minimum": 7.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIMEN HANDLING PT-LAB", "code_information": [{"code": "99001", "type": "CPT"}], "standard_charges": [{"minimum": 8.95, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIMEN INFECT AGNT CONCNTJ", "code_information": [{"code": "87015", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIMEN SITE NOT ESOPHAGUS", "code_information": [{"code": "G8797", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIMEN SITE NOT PROSTATE", "code_information": [{"code": "G8798", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECTROPHOTOMETRY", "code_information": [{"code": "84311", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH AUDIOM THRESH & RECOG", "code_information": [{"code": "211T", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 231.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH AUDIOMETRY COMPLETE", "code_information": [{"code": "92556", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH AUDIOMETRY THRESHOLD", "code_information": [{"code": "210T", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 231.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH EVALUATION COMPLEX", "code_information": [{"code": "70371", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 168.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH LANGUAGE PATH SS", "code_information": [{"code": "G4034", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH SOUND LANG COMPREHEN", "code_information": [{"code": "92523", "type": "CPT"}], "standard_charges": [{"minimum": 880.5, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 880.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1383.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1383.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1383.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH THRESHOLD AUDIOMETRY", "code_information": [{"code": "92555", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH/HEARING THERAPY", "code_information": [{"code": "92507", "type": "CPT"}], "standard_charges": [{"minimum": 354.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 354.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 556.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 556.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 556.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH/HEARING THERAPY", "code_information": [{"code": "92508", "type": "CPT"}], "standard_charges": [{"minimum": 106.5, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 167.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 167.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 167.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEED CINCH CURVED NEEDLE IMP 2 FWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEED FRAME VJ RING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-200-SEV", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEED RAIL FROME", "code_information": [{"code": "9000-SFR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5639.0, "discounted_cash": 1973.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEEDBRIDGE ACHILLIES SYSTEM BIO-COMP MID-SUBSTANCE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8929BC-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2177.0, "discounted_cash": 761.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEEDTRAP 30 WHITE", "code_information": [{"code": "232749", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEEDTRAP 30 WHITE/GREEN", "code_information": [{"code": "232750", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPERM ANTIBODY TEST", "code_information": [{"code": "89325", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 42.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 42.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 42.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 15.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 15.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM EVALUATION TEST", "code_information": [{"code": "89329", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 78.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 78.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 78.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM IDENTIFICATION", "code_information": [{"code": "89257", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION COMPLEX", "code_information": [{"code": "89261", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION SIMPLE", "code_information": [{"code": "89260", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM WASHING", "code_information": [{"code": "58323", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHENOID SINUS SURGERY", "code_information": [{"code": "31051", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHERE 16MM WITH ENUCLEATION IMPLANT INSERTER 6326", "code_information": [{"code": "6326", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 393.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHERE GLENOID 36MM X 29MM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWD190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9785.0, "discounted_cash": 3424.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHERE SHOULDER 29 X 36MM +2MM AEQUALIS GLENOID ECCENTRIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWD192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6751.0, "discounted_cash": 2362.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHERE WITH ENUCLEATION INSERTER SZ 18MM", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "6327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 393.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHERE WITH ENUCLEATION SST EZ 16MM 80008", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "80008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1450.0, "discounted_cash": 507.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHERES NAVIGATION 25 PACKS OF 4 8000-100-004", "code_information": [{"code": "8000-100-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 219.06, "discounted_cash": 76.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHERES STERILE 000-0112", "code_information": [{"code": "-0112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 230.0, "discounted_cash": 80.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHINCTEROPLASTY-ANAL-FOR INCONTINENCE-ADULT; MUSCLE TRANSPLANT 46760", "code_information": [{"code": "46760", "type": "CPT"}, {"code": "1482134", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHINCTEROPLASTY-ANAL-FOR INCONTINENCE/PROLAPSE-ADULT 46750", "code_information": [{"code": "46750", "type": "CPT"}, {"code": "1482132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHINCTEROTOMY ANAL-DIVISION OF SPHINCTER 46080", "code_information": [{"code": "46080", "type": "CPT"}, {"code": "1482137", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIN/BRAIN PUMP REFIL & MAIN", "code_information": [{"code": "95990", "type": "CPT"}], "standard_charges": [{"minimum": 416.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 416.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 654.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 654.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 654.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL DISORDERS AND INJURIES WITH CC/MCC", "code_information": [{"code": "52", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11274.84, "maximum": 19356.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11274.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16125.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17737.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19356.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC", "code_information": [{"code": "53", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6912.72, "maximum": 11867.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6912.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9886.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10875.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11867.43, "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": 39514.56, "maximum": 67836.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39514.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56514.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 62165.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67836.68, "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": 52313.8, "maximum": 89809.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52313.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74820.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 82302.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89809.8, "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": 30461.23, "maximum": 52294.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30461.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43566.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 47922.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52294.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [{"code": "29", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20054.43, "maximum": 34428.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20054.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28682.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31550.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34428.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITH MCC", "code_information": [{"code": "28", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35421.92, "maximum": 60810.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35421.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50660.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 55727.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60810.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "30", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14336.41, "maximum": 24612.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14336.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20504.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22554.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24612.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PUNCTURE LUMBAR DIAGNOSTIC 62270", "code_information": [{"code": "62270", "type": "CPT"}, {"code": "1482138", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 213.92, "maximum": 8450.0, "gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 213.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL PUNCTURE THERAPEUTIC FOR DRAINAGE OF CEREBROSPINAL FLUID 62272", "code_information": [{"code": "62272", "type": "CPT"}, {"code": "1482139", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63078", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE JACK EXPANSION KIT 5.0 0909-200-050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909-200-050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1287.0, "discounted_cash": 450.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINEJACK PREPARATION KIT 5.8MM 0909-100-058", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909-100-058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2574.0, "discounted_cash": 900.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIR RES DOC FEV1/FVC<70%", "code_information": [{"code": "G8924", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIRMTRY W/BRNCHDIL INF-2 YR", "code_information": [{"code": "94012", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIRO RESULTS WTH OBS DOC", "code_information": [{"code": "M1214", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIROMETER INCENTIVE 4000M 8884719010", "code_information": [{"code": "8884719010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.62, "discounted_cash": 3.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETER INCENTIVE VOLUME EXERCISE 2500ML", "code_information": [{"code": "84719025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETERINCENTIVE 2500 ML VOLDYNE BUILTIN HANDLE PARTICULATE FILTER SCREEN LF", "code_information": [{"code": "8884719025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETERINCENTIVE 5000 ML BUILTIN HANDLE PARTICULATE FILTER SCREEN W/ HANDLE L", "code_information": [{"code": "8884719009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETRY UP TO 2 YRS OLD", "code_information": [{"code": "94011", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLEEN IMAGING", "code_information": [{"code": "78185", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 691.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1086.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1086.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1086.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 330.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 352.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH CC", "code_information": [{"code": "800", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17968.57, "maximum": 30847.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17968.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25698.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28268.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 30847.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH MCC", "code_information": [{"code": "799", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31311.63, "maximum": 53754.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31311.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 44782.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 49260.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53754.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "801", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10243.77, "maximum": 17586.01, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10243.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14650.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16115.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17586.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLICE SPLEEN/KIDNEY VEINS", "code_information": [{"code": "37181", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLICING OF URETERS", "code_information": [{"code": "50770", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLINT CAST FIBERGLASS ROLL 15 MIN SET ORTHOGLASS 3IN X 15FT WHITE", "code_information": [{"code": "ZZZSCSOG3L2H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.0, "discounted_cash": 60.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT IMMOBILIZER 15FT X 2IN ORTHO RIGHT LAT FIBERGLASS ORTHO-GLASS", "code_information": [{"code": "OG-2L1", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL 2.38IN X 1.53IN MED EXTERNAL SNGL FOAM RUBBER", "code_information": [{"code": "1528121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL BIORESORABLE DRESSING AND SINUS STENT COLLAGEN AND HYALURONIC ACID", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "1520000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 217.0, "discounted_cash": 75.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL BREATH-EASY SILICONE 20-10500", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "20-10500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 38.2, "discounted_cash": 13.37, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL LG EXTERNAL SNGL XOMED", "code_information": [{"code": "15-28138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL LG THERMASPLINT EXTERNAL SINGLES", "code_information": [{"code": "15-29020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL MED THERMASPLINT EXTERNAL SINGLES", "code_information": [{"code": "1529010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.84, "discounted_cash": 17.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL NEXPAK X INTRANASAL 1.5CM X 5.1CM 9110534", "code_information": [{"code": "9110534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL OPEN LUMEN DOYLE", "code_information": [{"code": "60-203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 306.0, "discounted_cash": 107.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL SM EXTERNAL SNGL XOMED", "code_information": [{"code": "15-28111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL SM THERMASPLINT SINGLES", "code_information": [{"code": "1529000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.73, "discounted_cash": 26.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL W/AIRWAY SGYISP7930005", "code_information": [{"code": "SGYISP7930005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.35, "discounted_cash": 26.37, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASALINTERNALINTRANASAL AIRWAY SILICONE DOYLE II", "code_information": [{"code": "1524055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.1, "discounted_cash": 29.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT ONE-STEP 3 X 12 76312A", "code_information": [{"code": "76312A", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT ONE-STEP 4 X 30 76430", "code_information": [{"code": "76430", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 197.0, "discounted_cash": 68.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT ONE-STEP 4X15", "code_information": [{"code": "76415A", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT SEPTAL NASAL SILICONE DOYLE II", "code_information": [{"code": "1524050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT WRIST UNIVERSAL LFT LF", "code_information": [{"code": "BF506683", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLIT BLOOD OR PRODUCTS", "code_information": [{"code": "86985", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLIT THICKNESS AUTOGRAFT FACE-NECK-EARS-GENITALIA-HANDS-FEET-1ST 100 SQ CM 15120", "code_information": [{"code": "15120", "type": "CPT"}, {"code": "1482140", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLIT THICKNESS AUTOGRAFT TRUNK-ARMS -LEGS 1ST 100 SQ CM OR LESS/ 1% BODY AREA INF./CHILDREN 15100", "code_information": [{"code": "15100", "type": "CPT"}, {"code": "1482113", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLIT THICKNESS AUTOGRAFT TRUNK/ARM/LEG EA. ADD 100SQ CM OR 1 PERCENT INFANT/CHILD 15101", "code_information": [{"code": "15101", "type": "CPT"}, {"code": "1969180", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1762.0, "discounted_cash": 616.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 852.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPONGE ABS 8X6.25CM HMSTC AGNT GELTN SRGFM THK10MM STRL LF 1973", "code_information": [{"code": "1973", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE CANCELLOUS 1.5CM X 1.5CM 15MM MODLABLE TENSIX", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "TSS-1515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3910.0, "discounted_cash": 1368.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE CANCELLOUS 2.0 X 2.0 X 2.0CM", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "TSS-2020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE CANCELLOUS 2CM X 2CM X .5CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "TSS-20205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5131.0, "discounted_cash": 1795.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE CLEANING INSTRUMENT ENDOZYME 345SPG", "code_information": [{"code": "345SPG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE DISSECTOR CHERRY SECTO 480 81-1002", "code_information": [{"code": "81-1002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE EYE SPEAR WECK CEL", "code_information": [{"code": "8680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 12 PLY 4IN X 4IN STRL", "code_information": [{"code": "NON21424", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 2' X 2' STERILE NON21420H", "code_information": [{"code": "NON21420H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 2IN X 2IN 8 PLY STRL", "code_information": [{"code": "NON21420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 4IN X 4IN 12 PLY WOVEN COTTON LF STRL", "code_information": [{"code": "NON21426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 4IN X 4IN 16 PLY COTTON ACCUSORB STRL", "code_information": [{"code": "NON21428", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 4IN X 4IN 16 PLY X RAY DETECT LF STRL", "code_information": [{"code": "NON21430LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 4IN X 4IN 8 PLY NON STRL", "code_information": [{"code": "NON25408", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GELATIN SURGIFOAM 8CMX12.5CMX2MM 1975", "code_information": [{"code": "1975", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GLTIN SURGIFM 8CMX12.5CMX10MM 1974", "code_information": [{"code": "1974", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE K DISSECTOR CHERRY 9MM", "code_information": [{"code": "23275-440", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE LAP 18IN X 18IN LAPAROTOMY XRAY DETECT COTTON W/ LOOP LF STRL", "code_information": [{"code": "MDS251518LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE NEURO 1 2X6 10 PK 30-301", "code_information": [{"code": "30-301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE NEURO 1/2IN X 1/2IN LF STRL", "code_information": [{"code": "30-056", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE NEURO COTTON 09 NEUROSPNG09", "code_information": [{"code": "NEUROSPNG09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.94, "discounted_cash": 4.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE NEURO COTTONOID 0.5IN X 0.5IN NEUROSPNG05", "code_information": [{"code": "NEUROSPNG05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.99, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE NEURO COTTONOID 0.5IN X 1.5IN", "code_information": [{"code": "NEUROSPNG07", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE PACKING 4.5 CM NASAL W/ STRING MEROCEL", "code_information": [{"code": "470401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE PACKING 8 CM NASAL W/ STRING MEROCEL 2000", "code_information": [{"code": "470404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE PEANUT .375IN 9.5MM X RAY DETECT STRL", "code_information": [{"code": "81-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.94, "discounted_cash": 1.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE SCLERAL 2.5 X 5.0 X 80MM BUCKLE HALF OVAL STYLE 510 SILICONE", "code_information": [{"code": "92-55-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE STERILE RND CHERRY X-RAY DISSECTOR MDS71757", "code_information": [{"code": "MDS71757", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.73, "discounted_cash": 1.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE SURG 1.5IN X .5IN COTTONOID RADIOPAQUE LF STRL DISP", "code_information": [{"code": "801404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE SURG 1/2IN X 3IN WHT NEURO PATTY RAYON W/ STRING AND COUNTING CARD LF STR", "code_information": [{"code": "30-057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE TONSIL 1IN MED DOUBLE STRUNG ON COUNT CARD", "code_information": [{"code": "78914", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE TONSIL DBL STRNG XR LG 1-1/4 ST MDS78916", "code_information": [{"code": "MDS78916", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE TONSIL DBL STRNG XRAY MED 1 STRL MDS78914", "code_information": [{"code": "MDS78914", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.79, "discounted_cash": 1.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE TONSIL LG 1.25IN X RAY OPAQUE STRL", "code_information": [{"code": "78916", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE TONSIL MEDIUM DBL", "code_information": [{"code": "30-041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONTANEOUS NYSTAGMUS STUDY", "code_information": [{"code": "92531", "type": "CPT"}], "standard_charges": [{"minimum": 47.67, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPONTANEOUS NYSTAGMUS TEST", "code_information": [{"code": "92541", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "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": 5690.04, "maximum": 9768.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5690.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8137.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8951.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9768.38, "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": 4399.23, "maximum": 7552.38, "estimated_discounted_cash": 24233.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4399.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6291.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6921.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7552.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPRAY CATHETERS Spray Catheter 133-5544 220 2.2", "code_information": [{"code": "SC62241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPRAY CATHETERS Spray Catheter 133-5545 250 2.8", "code_information": [{"code": "SC62301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPRAYCLIP FOR AR-200 AR-200SP", "code_information": [{"code": "AR-200SP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 817.0, "discounted_cash": 285.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SPRCHOROIDAL SPC NJX RX AGT", "code_information": [{"code": "67516", "type": "CPT"}], "standard_charges": [{"minimum": 1423.02, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1423.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2236.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2236.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2236.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPUN MICROHEMATOCRIT", "code_information": [{"code": "85013", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPUTUM SPECIMEN COLLECTION", "code_information": [{"code": "89220", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRCH FOR CT W IN 12 MOS", "code_information": [{"code": "G9341", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES COMPLEX ADDL", "code_information": [{"code": "61799", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 45000.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES SIMPLE ADDL", "code_information": [{"code": "61797", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 45000.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION COMPLEX", "code_information": [{"code": "61798", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 45000.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS LINEAR BASED", "code_information": [{"code": "77372", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 13239.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13239.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4762.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7487.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7487.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7487.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS MULTISOURCE", "code_information": [{"code": "77371", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 33274.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13239.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4762.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7487.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7487.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7487.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 33274.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION", "code_information": [{"code": "63620", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 45000.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION ADDL", "code_information": [{"code": "63621", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 45000.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRSF2 GENE COMMON VARIANTS", "code_information": [{"code": "81348", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1936.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 252.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 252.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SSCREW MOTOBAND CP 3.0 X 18MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1500-3018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 178.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STAB PHLEB VEINS XTR 10-20", "code_information": [{"code": "37765", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAGGERED SPONDAIC WORD TEST", "code_information": [{"code": "92572", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STANDARD PERINEAL COLD PACK", "code_information": [{"code": "11500-010", "type": "CDM"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STANDARD ROUND BUR 4.0 0375-940-012", "code_information": [{"code": "375-940-012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPEDECTOMY/STAPEDOTOMY 69660", "code_information": [{"code": "69660", "type": "CPT"}, {"code": "1482141", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPEDOTOMY/STAPEDOTOMY WITH FOOTPLATE DRILL OUT 69661", "code_information": [{"code": "69661", "type": "CPT"}, {"code": "1482142", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPH A DNA AMP PROBE", "code_information": [{"code": "87640", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE 10 X 10 X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "500-10-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4738.0, "discounted_cash": 1658.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE 15 X 15 X 15MM SNIPER 500-15-101", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "500-15-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4738.0, "discounted_cash": 1658.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE 18 X 15 X 15MM SNIPER 500-18-102", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "500-18-102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4021.0, "discounted_cash": 1407.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE 20MM X 20MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "500-20-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4738.0, "discounted_cash": 1658.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE AGRAFE 8 X 8 X 8 COMPRESSIVE EXPRESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "139-08-0808-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2683.0, "discounted_cash": 939.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE ARCAD COMPRESSIVE STAPLE 20MM X 25MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS062020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5140.0, "discounted_cash": 1799.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE BONE COMPRESSION SYSTEM EASY FUSE 18MM X 20MM FFS21820", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS21820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3112.0, "discounted_cash": 1089.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE BONE FIXATION SYSTEM 14MMX14MMX14MM 3000-00-141414", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3000-00-141414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4144.8, "discounted_cash": 1450.68, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE BONE HIMAX NITINOL INTERAXIS LENGTH 18MM, LEG LENGTH 14MM, REAMER SIZE 3.2MM, LEG WIDTH 1.8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7118-1414KT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4441.0, "discounted_cash": 1554.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE BONE IMPLANTS RAPID COMPRESSION SK50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK50", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6720.0, "discounted_cash": 2352.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE COMPESSION ARCAD 10-09-09MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CS010909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4728.0, "discounted_cash": 1654.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE COMPRESSION 11 X 10MM OF2061110S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF2061110S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 1256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE COMPRESSION 12X12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "500-12-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2600.0, "discounted_cash": 910.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE COMPRESSION 20X20MM OSSIOFIBER OF1062020S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1062020S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5552.0, "discounted_cash": 1943.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE COMPRESSION NEOSPAN SUPERELASTIC 15W X 15 X 15", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T50 SN115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5140.0, "discounted_cash": 1799.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE COMPRESSION OSSIOFIBER 15X15MM OF1061515S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1061515S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 1256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE COMPRESSION W/INSTRUMENTS SIZE 15X15X15 NEOSPAN SUPER ELASTIC T50 SN215", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T50 SN215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4522.0, "discounted_cash": 1582.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE DYNAFORCE SUPERLASTIC BONE MOTOCLIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7012-1212KT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3123.0, "discounted_cash": 1093.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE EASY FUSE 25MMX20MM FFS22520", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS22520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3546.0, "discounted_cash": 1241.1, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE EASYFUSE 18X15 NITINOL 2-LEG FFS21815", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS21815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3205.0, "discounted_cash": 1121.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE FUSEFORCE 20 X 20 NITINOL HAND FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFNS2020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3700.0, "discounted_cash": 1295.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE HIMAX 18MM X 18MM X 14MM 7118-1814KT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7118-1814KT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4441.0, "discounted_cash": 1554.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE KIT 12 X 12MM MSK11212", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSK11212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3800.0, "discounted_cash": 1330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE KIT 9X9X9", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7009-0909KT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 937.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE KIT OS2-VP VARISATION INERAXIS 9MM 26D T40 SP126", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T40 SP126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2878.0, "discounted_cash": 1007.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE KIT REFLEX MAX 15 X 15MM MSK41515", "code_information": [{"code": "MSK41515", "type": "CDM"}], "standard_charges": [{"gross_charge": 5200.0, "discounted_cash": 1820.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE KIT VARISATION INTERAXIS 9MM 90D T40 SP190", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T40 SP190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1994.0, "discounted_cash": 697.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE LAPIPLASTY SPEEDPLATE 28X17X14MM ANATOMIC QUAD RAPID COMPRESSION IMPLANT SK53", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK53", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6524.0, "discounted_cash": 2283.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE MEMORY 8MM 1.5 X 1.2 WIRE 2MM REAMER EASY CLIP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EZM08-08-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2507.0, "discounted_cash": 877.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE METRIC 18 X 18 X 15 SUPER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "17301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE MTP LNITINOL 4-LEG FFS4MTPL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS4MTPL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4096.0, "discounted_cash": 1433.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE NEOSPAN 10 X 10 X 10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T50 SN010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.0, "discounted_cash": 1438.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE NEOSPAN 12 X 12 X 12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T50 SN012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2668.0, "discounted_cash": 933.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE NEOSPAN 15 X 12 X12 SUPERELASTIC COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T50SN015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4728.0, "discounted_cash": 1654.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE NEOSPAN SUPERELASTIC COMPRESSION SIZE 20X15X15 T50 SN120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T50 SN120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE NITINOL 9 X 8 X 8 SUPERELASTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK988", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3286.0, "discounted_cash": 1150.1, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE OSSIOFIBER COMPRESSION SYSTEM 20 X 20MM OF2062020S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF2062020S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7612.0, "discounted_cash": 2664.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE PILOT DRILL 8/10MM", "code_information": [{"code": "510-10-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE RELOAD 060 2.5S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GIA0625S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 714.0, "discounted_cash": 249.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE RELOAD 2.5MM RED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GIA6025L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE RELOAD 30 2.5 ENDO GIA MULTIFIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30805L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE SIZER FUSEFORCE", "code_information": [{"code": "FFHSIZER", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE SPEEDMTP LAPIPLASTY 40X13X11 RAPID COMPR STANDARD SK58", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK58", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6748.0, "discounted_cash": 2361.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE SUPER ELASTIC COMP 20 X 20 X 20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T50 SN020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4118.0, "discounted_cash": 1441.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE SYSTEM OSSIOFIBER 15X15MM OF2061515S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF2061515S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4250.0, "discounted_cash": 1487.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE SYSTEM SNIPER 10MM X 10MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "500-10-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5026.0, "discounted_cash": 1759.1, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE TENDON ARTHROSCOPY ROTATOR CUFF REPAIR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2504-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2200.0, "discounted_cash": 770.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE TOGGLELOC 2.9MM W/NDLS 110017308", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110017308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1318.0, "discounted_cash": 461.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE W/ INSTRUMENTS NEOSPAN SZ 25X22X22 T05 S0001", "code_information": [{"code": "T05 S0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 115.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER 12MM - 4.8MM ENDO UNIVERSAL 65 HERNIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "173052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 541.0, "discounted_cash": 189.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER 33MM HEMORRHOID 3.5MM STAPLE HEM3335", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HEM3335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 865.0, "discounted_cash": 302.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER 90 MM TA", "code_information": [{"code": "TL90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 94.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER CONTOUR CURVED CUTTER CS40G", "code_information": [{"code": "CS40G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 913.0, "discounted_cash": 319.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER DISPOSABLE SURGICAL SKIN STAPLER35WA", "code_information": [{"code": "STAPLER35WA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.71, "discounted_cash": 11.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ECHELN FLEX POWERED VASC. W/ ADV PLACEMENT TIP", "code_information": [{"code": "PVE35A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 861.0, "discounted_cash": 301.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ECHEON POWERED 45MM", "code_information": [{"code": "PLEE45A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 847.0, "discounted_cash": 296.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDO 25MM 28CM CURVEDINTRALUMINAL ADJ HEATED DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECS25A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDO 30MM GRN LINEAR CUTTER RELOAD TI", "code_information": [{"code": "ESXR30G", "type": "CDM"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDO 33MM HEMORRHODIAL CIRCULAR MR CONDTIONAL LINEAR CUTTER PROXIMATE PP", "code_information": [{"code": "PPH03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 277.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDO 4MM X 4.8MM LINEAR CUTTER RELOADABLE", "code_information": [{"code": "ESTX30G", "type": "CDM"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 51.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDO 60MM LNG LINEAR ARTCLTNG CTTR FLEX 60 ENDOPATH LF STRLINSTR DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "LONG60A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 795.0, "discounted_cash": 278.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDO GIA 4 XL EGIAUXL", "code_information": [{"code": "EGIAUXL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 974.0, "discounted_cash": 340.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDO LNR CTR 45MM", "code_information": [{"code": "EC45A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 713.0, "discounted_cash": 249.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDOSCPC CRVD INTRALUM DIR O ECS33A", "code_information": [{"code": "ECS33A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER GIA 60-3.8 RELOADABLE SNGLE GIA6038S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GIA6038S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER GIA 80-3.8 RELOADABLE SNGLE GIA8038S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GIA8038S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 657.0, "discounted_cash": 229.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER INTRALUM 29 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECS29A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER LOADING UNIT GIA 80MM- 3.8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GIA8038L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 446.0, "discounted_cash": 156.1, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER MULTIFIRE VERSATACK 4.8M TIT 174023", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "174023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 459.0, "discounted_cash": 160.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN 12MM MULTIFIRE REPROCESS WITHOUT STAPLES ENDO GIAINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30811R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN 2MM ENDO GIA 30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 802.0, "discounted_cash": 280.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN 35 WIDE BLUE DISP", "code_information": [{"code": "54887", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN DISPOSABLE WITH COUNTER 35 WIDE STAPLER35WPB", "code_information": [{"code": "STAPLER35WPB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.08, "discounted_cash": 18.93, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN PRECSEVISTA DISP 35WIDE 3995", "code_information": [{"code": "3995", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN WIDE 35 CAUNT ROTATING HEAD REPROCESS", "code_information": [{"code": "PRW35R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 20.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN WIDE ROYAL BLUE 35 COUNT REPROCESS", "code_information": [{"code": "54887R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.0, "discounted_cash": 59.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKININSORBSTERILEDIRONLY 2030", "code_information": [{"code": "A4649", "type": "HCPCS"}, {"code": "2030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SURG 60MM RELOADABLE PROXIMATE LINEAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TL60", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 55.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SURG 60MM UNIT LOADING RELOADABLE TITANIUM PROXIMATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TR60", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER VASCULAR 30MM RELOAD PROXIMATE TI", "code_information": [{"code": "TX30V", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 261.0, "discounted_cash": 91.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER WND 4MM STAPLES SQUEEZE HANDLE W/ TITANIUM STAPLERS MULTIFIRE VERSATACKI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "174021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 446.0, "discounted_cash": 156.1, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLERINTRALUMINAL 21MM ENDO CURVED ADJ HEIGHTINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECS21A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLERINTRALUMINAL 25MM X 16.4MM X 18 CM CURVEDINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CDH25A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLERINTRALUMINAL 29MM X 20.4MM X 18 CM CURVEDINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CDH29A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLERINTRALUMINAL 33MM CURVEDINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CDH33A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 141.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLES RELOAD TA6035L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TA6035L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 381.0, "discounted_cash": 133.35, "setting": "both", "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1106", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1111", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1116", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1121", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1126", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1135", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAT LAB", "code_information": [{"code": "S3600", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.2, "maximum": 8.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAT LAB HOME/NF", "code_information": [{"code": "S3601", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.2, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STATIN MED PRES AT DISCH", "code_information": [{"code": "G8816", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEINMANN PIN 3/32 X 9 INCH STYLE 6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1870269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM #5 NECK ANGLE HIP 35X108MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6721-0535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3811.0, "discounted_cash": 1333.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM 02 LEFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "MRH-350-02-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4285.0, "discounted_cash": 1499.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM 13MM X 135MM OFFSET 3MM SPLINED 42-5603-135-13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5603-135-13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM 13MM X 90MM AEQUALIS FLEX REVIVE PARTIALLY COATED DISTAL ARS980903", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ARS980903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7965.0, "discounted_cash": 2787.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM 7.0 MUC COUNTERSINK CANNULATED CHARLOTTE F and A SYSTEM 44180015", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44180015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 104.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM 8.0X6.0MM TI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TR-S0806-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4233.0, "discounted_cash": 1481.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM 8MM X 63MM SHORT HUMERAL 520-08-000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-08-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM 9MM X 6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ALN-RST-0906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4917.0, "discounted_cash": 1720.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM CELLS TOTAL COUNT", "code_information": [{"code": "86367", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 97.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 198.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 311.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 311.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 311.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM CEMENT 10MM X 120MM LNG STRAIGHT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM CEMENTED 12MM X 50MM TRIATHLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5560-S-112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM CEMENTED 15MM X 100MM TRIATHLON PRESS FIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5565-S-015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3933.0, "discounted_cash": 1376.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM CONICAL DISTAL 17MM X 115MM 6276-7-417", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6276-7-417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4624.76, "discounted_cash": 1618.67, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM DRIVER 2MM 2.4MM CANNULATED QUICK RELEASE", "code_information": [{"code": "316-0132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 790.0, "discounted_cash": 276.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM DRIVER 3MM 4MM CANNULATED LNG QUICK RELEASE", "code_information": [{"code": "316-0232", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 790.0, "discounted_cash": 276.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM DRIVER 3MM 4MM CANNULATED SHRT QUICK RELEASE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "316-0233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 205.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM DRIVER 6.5MMINSTR", "code_information": [{"code": "316-0022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM ELBOW LATERAL SZ 3 RADIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "310-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8648.0, "discounted_cash": 3026.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM EVOLVE 5.5MM 496S055", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "496S055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3817.0, "discounted_cash": 1335.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM EXT 12X135MM PSN REV STRAIGHT SPLINE 42-5601-135-12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5601-135-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM EXT STRAIGHT 13X135MM 42-5601-135-13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5601-135-13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM EXTENSION 11MM X 135MM 3MM OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-603-135-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM EXTENSION STRAIGHT SPLINED PLUS 135MM LENGTH 10MM DIAMETER 42-5601-135-10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5601-135-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FEMORAL 11MM X 120MM STRAIGHT PRESS FIT LEGION IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3179.0, "discounted_cash": 1112.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FEMORAL 11MM X 140MM POROUS COATED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9234.0, "discounted_cash": 3231.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FEMORAL 12MM X 150MM SYNERGY POROUS COATED TI IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9234.0, "discounted_cash": 3231.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FEMORAL 13MM X 120MM STRAIGHT PRESS FIT LEGION IMP 71424026", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3912.0, "discounted_cash": 1369.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FEMORAL 7MM PRESS FIT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "STEM-0920-025-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4625.0, "discounted_cash": 1618.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FEMORAL APEX K1 POROUS SIZE 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HC-00030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7251.0, "discounted_cash": 2537.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FEMORAL SZ 14 160MM SYNERGY POROUS COATED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8878.0, "discounted_cash": 3107.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FEMORAL SZ 17 175MM SYNERGY POROUS COATED TI IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9695.0, "discounted_cash": 3393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FEMORAL SZ 9 135MM STANDARD POROUS COATED TI IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9234.0, "discounted_cash": 3231.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FOOT HEMI 3S SM STERILE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "100-00-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FRACTURE SIZE 12 STD PFX12130", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PFX12130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15450.0, "discounted_cash": 5407.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FRACTURE STD SIZE 11 L:130MM PFX11130", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "PFX11130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18540.0, "discounted_cash": 6489.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HIP C 9 TAPER 12/14 FITMORE IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1.00551.409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12234.0, "discounted_cash": 4281.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HIP SIZE 6 PLASMA SPRAY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "101-0006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HIP SZ 5 35MM X 108MM 132 DEGREE ANGLE ACCOLADE II IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6720-0535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7714.0, "discounted_cash": 2699.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HIP TAPER 12/14 SZ10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "101-0010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2472.0, "discounted_cash": 865.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUM SHRT SM 12X48MM 533-12-048", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "533-12-048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13168.0, "discounted_cash": 4608.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 10MM MICRO COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 10MM MINI-LENGTH SHOULDER SYS COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 10MM X 108MM SMALL SHELL 533-10-108", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "533-10-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5987.0, "discounted_cash": 2095.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 11MM MICRO COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 12MM MICRO COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 12MM X 67MM SHORT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-12-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 13MM MICRO COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 14MM POROCOAT COATED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113014200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7189.0, "discounted_cash": 2516.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 14MM X 108MM P2 REVERSE POROUS COATED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "530-14-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11973.0, "discounted_cash": 4190.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 16MM MICRO COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 20MM MICRO COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 3C 135 DEGREE 74MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7503303C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9100-06S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4921.0, "discounted_cash": 1722.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 6MM MICRO COMPREHENSIVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "113606", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7828.0, "discounted_cash": 2739.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 82MM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7503305C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 8MM POROCOAT COATED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1130-08-200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7189.0, "discounted_cash": 2516.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL 8MM X 108MM SMALL SHELL 533-08-108", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "533-08-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11241.0, "discounted_cash": 3934.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL AEQUALIS ASCEND FLEX SZ 6B", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF606B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8034.0, "discounted_cash": 2811.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL ASCEND STANDARD SZ 3C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF603C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12731.0, "discounted_cash": 4455.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL CEMENTED 132.5DEG SZ6B 82MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF706B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11145.0, "discounted_cash": 3900.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL DWX2SS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX2SS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL MONOBLOCK RSP SZ10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "510-00-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL MONOBLOCK RSP SZ12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "510-00-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL PLUS LONG SIZE 2+ DWX2PL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX2PL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11124.0, "discounted_cash": 3893.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL PTC SZ6 86MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF606C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12731.0, "discounted_cash": 4455.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL REVERSE SIZE 16MM X 108MM 530-16-108", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "530-16-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11973.0, "discounted_cash": 4190.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SHOULDER ALTIVATE REVERSE PRIMARY 108 X 8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "530-08-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11973.0, "discounted_cash": 4190.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SIZE 1 STD SHORT DWX1SS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX1SS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SIZE 2 SHORT PUS DWX2PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX2PS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL STANDARD SHELL SIZE 12MM X 48MM 530-12-048", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "530-12-048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13168.0, "discounted_cash": 4608.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SZ 1 DWX1PL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX1PL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11124.0, "discounted_cash": 3893.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SZ 10 PRIMARY TURON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-01-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12051.0, "discounted_cash": 4217.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SZ 10 STANDARD GLOBAL UNITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110010100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4219.0, "discounted_cash": 1476.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SZ 10 X 108 MM REVERSE ALTIVATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "530-10-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11973.0, "discounted_cash": 4190.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SZ 10MM X 48MM SHORT 530-10-048", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "530-10-048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13168.0, "discounted_cash": 4608.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SZ 12 PRIMARY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-01-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10300.0, "discounted_cash": 3605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SZ 12 STANDARD GLOBAL UNITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1100-12-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4219.0, "discounted_cash": 1476.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SZ 6C 86MM 137.5 DEGREE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7503306C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13390.0, "discounted_cash": 4686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SZ 8 STANDARD GLOBAL UNITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110008100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4219.0, "discounted_cash": 1476.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERALSZ6 X 108MM REVERSE ALTIVATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "530-06-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11973.0, "discounted_cash": 4190.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERIS TA6V SIZE 15 CEMENTLESS TI/HA 316-0015", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "316-0015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 908.0, "discounted_cash": 317.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM INBONE TALAR 10MM LG 200347901", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "200347901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2730.0, "discounted_cash": 955.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM KNEE RHEAD PLASMA COATED SIZE 3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "310-2012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7688.0, "discounted_cash": 2690.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM LESS MET STRAIGHT PLT 6 HOLE ORTHOLOC PLATING SYSTEM 5201000306", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5201000306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1465.0, "discounted_cash": 512.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM LGN CEMENT STEM12MMX120MM STRT 71424184", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3800.0, "discounted_cash": 1330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM LGN CEMENT STEM14MMX120MM STRT 71424186", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4079.0, "discounted_cash": 1427.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM LGN CEMENT STEM16MMX160MM STRT 71424208", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2487.6, "discounted_cash": 870.66, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM ORIGIN STANDARD OFFSET SIZE 13 D111-18-1300", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "D111-18-1300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PERFORM HUMERAL SYSTEM HUMERAL DWX1PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX1PS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PERFORM SZ 4 PLUS HUMERAL DWX4PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX4PS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PLATE AKIN 3 HOLE ORTHOLOC PLATING SYSTEM 5201000504", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201000504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 274.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PLATE LESS MET T 6 HOLE ORTHOLOC PLATING SYSTEM 5201000206", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201000206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1819.0, "discounted_cash": 636.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PLATE LESS MET T 7 HOLE ORTHOLOC PLATING SYSTEM 5201000204", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201000204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1716.0, "discounted_cash": 600.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PLATE STRAIGHT TUBULAR 6 HOLE ORTHOLOC 3DI PLATING SYSTEM 58880006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58880006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1314.0, "discounted_cash": 459.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PLATE STRAIGHT TUBULAR 7 HOLE ORTHOLOC 3DI PLATING SYSTEM 58880007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58880007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 266.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM POLARCEMENTLESS LAT TI.HA 7 75100480", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "75100480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10074.0, "discounted_cash": 3525.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM POLARCEMENTLESS LAT TI.HA 8 75100481", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "75100481", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10074.0, "discounted_cash": 3525.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM POROUS 160MM COATED SYNERGY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9234.0, "discounted_cash": 3231.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PRESSFIT 10MM X 160MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71424043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2048.0, "discounted_cash": 716.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PRESSFIT STRT 14 X 160MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2954.0, "discounted_cash": 1033.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PSN REV 3MM OFFSET EXT 10X135MM 42-5603-135-10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5603-135-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PSN REV 3MM OFFSET EXT 14 X 135MM 42-5603-135-14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5603-135-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM PSN REV 6MM OFFSET EXT 11X135MM 42-5606-135-11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5606-135-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM QUICK STAPLE 9MM INTERAXIS CHARLOTTE F and A SYSTEM 42110001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "42110001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 517.0, "discounted_cash": 180.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM RADIAL 6MM X 24MM MODULAR EXLPOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-210061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM RADIAL 7MM X 26MM MODULAR HEAD FOR ELBOW SURG TECHNIQUE EXPLOR IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-210062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM RADIAL 8MM X 0MM X 30MM X 15MM ALIGN TI IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ALN-RST-0800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM RADIAL 8MM X 28MM MODULAR EXPLOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-210063", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4388.0, "discounted_cash": 1535.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM RADIAL 9 X 2 X 36MM ALIGN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ALN-RST-0902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4516.0, "discounted_cash": 1580.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM RADIAL 9MM X 0MM X 30MM X 15MM ALIGN TI IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ALN-RST-0900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4738.0, "discounted_cash": 1658.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM RADIAL 9MM X 2MM ALN-RST-09M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ALN-RST-09M2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4516.0, "discounted_cash": 1580.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM RADIAL 9MM X 30MM MODULAR EXPLOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-210064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4388.0, "discounted_cash": 1535.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM RADIAL 9MM X 4MM ALIGN ALN-RST-0904", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ALN-RST-0904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4917.0, "discounted_cash": 1720.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM RADIAL SZ7 7MMX0MM ALIGN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ALN-RST-0700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM REDAPT 190MM SIZE 21 71354471", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71354471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20910.0, "discounted_cash": 7318.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM REVERS CAP COATED SIZE 11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9501-11CPC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7313.0, "discounted_cash": 2559.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM REVERSE SIZE 6MM X 150MM HUMERAL 530-06-175", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "530-06-175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14676.0, "discounted_cash": 5136.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM REVERSED - CEMENTLESS 12 MM DIAMETER X 100 MM LENGTH CALL FOR AVAILABILITY DWE050", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5088.0, "discounted_cash": 1780.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM REVERSED - CEMENTLESS 9 MM DIAMETER X 100 MM LENGTH CALL FOR AVAILABILITY DWE045", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWE045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3706.0, "discounted_cash": 1297.1, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW 7.0 MUC 40MM X 16MM CHARLOTTE F and A SYSTEM 44174016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44174016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1139.0, "discounted_cash": 398.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW 7.0 MUC 80MM X 16MM CHARLOTTE F and A SYSTEM 44178016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44178016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2627.0, "discounted_cash": 919.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW JONES 4.5 X 60MM CHARLOTTE F and A SYSTEM 56014560", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "56014560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2592.0, "discounted_cash": 907.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW LISFRANC 3.7 X 32MM CHARLOTTE F and A SYSTEM 43503732", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "43503732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2088.0, "discounted_cash": 730.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW MUC 4.3MM X 36MM SHORT CHARLOTTE F and A SYSTEM 44110025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44110025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW MUC 4.3MM X 40MM SHORT CHARLOTTE F and A SYSTEM 44110027", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44110027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW SNAP OFF 2.0MM X 11MM CHARLOTTE F and A SYSTEM 45110001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45110001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 498.0, "discounted_cash": 174.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW SNAP OFF 2.0MM X 12MM CHARLOTTE F and A SYSTEM 45110002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45110002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 498.0, "discounted_cash": 174.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW SNAP OFF 2.0MM X 14MM CHARLOTTE F and A SYSTEM 45110003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45110003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 498.0, "discounted_cash": 174.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW SNAP OFF 2.7MM X 13MM CHARLOTTE F and A SYSTEM 45110004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45110004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 498.0, "discounted_cash": 174.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW SNAP OFF 2.7MM X 15MM CHARLOTTE F and A SYSTEM 45110005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45110005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 498.0, "discounted_cash": 174.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.0 X 10MM ORTHOLOC PLATING SYSTEM 5201020010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201020010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 161.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.0 X 12MM ORTHOLOC PLATING SYSTEM 5201020012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201020012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.0 X 14MM ORTHOLOC PLATING SYSTEM 5201020014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201020014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.0 X 16MM ORTHOLOC PLATING SYSTEM 5201020016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201020016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.0 X 18MM ORTHOLOC PLATING SYSTEM 5201020018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201020018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.0 X 20MM ORTHOLOC PLATING SYSTEM 5201020020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201020020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.0 X 8MM ORTHOLOC PLATING SYSTEM 5201020008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201020008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.4 X 14MM ORTHOLOC PLATING SYSTEM 5201024014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201024014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.4 X 16MM ORTHOLOC PLATING SYSTEM 5201024016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201024016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 581.0, "discounted_cash": 203.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.4 X 18MM ORTHOLOC PLATING SYSTEM 5201024018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201024018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 161.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.4 X 20MM ORTHOLOC PLATING SYSTEM 5201024020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201024020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.4 X 22MM ORTHOLOC PLATING SYSTEM 5201024022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201024022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.4 X 24MM ORTHOLOC PLATING SYSTEM 5201024024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201024024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 206.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI LOCK 2.4 X 30MM ORTHOLOC PLATING SYSTEM 5201024030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201024030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 161.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI NON LOCK 2.0 X 10MM ORTHOLOC PLATING SYSTEM 5201120010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201120010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 67.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI NON LOCK 2.0 X 12MM ORTHOLOC PLATING SYSTEM 5201120012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201120012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 67.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI NON LOCK 2.0 X 14MM ORTHOLOC PLATING SYSTEM 5201120014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201120014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SCREW TI NON LOCK 2.4 X 14MM ORTHOLOC PLATING SYSTEM 5201124014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5201124014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SHOULDER 12MM 135DEG GLOBAL UNITE ANATOMIC REVERSE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1100-40-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2373.0, "discounted_cash": 830.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SINGLE TROCAR WIRE 1.6X150MM CHARLOTTE F and A SYSTEM 44112008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "44112008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SIZE 0S 15.9 X 37.6MM JOINT TOE SWANSON HINGE FLEXIBLE GROMMET SM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "G426-0110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1790.0, "discounted_cash": 626.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SIZE 10MM X 65MM SHORT HUMERAL 520-10-000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "520-10-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SIZE 3 HUMERAL DWX3PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX3PS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SIZE 3 HUMERAL STD LEFT DWX3SS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWX3SS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SMS SOLID STD #5 01.36.045", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1.36.045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM STANDARD SZ 14 129MM POROCOAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1100-14-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4219.0, "discounted_cash": 1476.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM STIMULATOR BONE GROWTH PHYSIO-STIM", "code_information": [{"code": "E0749", "type": "HCPCS"}, {"code": "3202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10701.0, "discounted_cash": 3745.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM STRT 18 X 120MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3912.0, "discounted_cash": 1369.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SYNERGY CEMENTLESS POROUS-COATED 150MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7130-6112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8878.0, "discounted_cash": 3107.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SYNERGY POROUS COAT HIGH OFFSET SZ13 155MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306113", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8878.0, "discounted_cash": 3107.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SYNERGY POROUS COATED 10 DEG 140MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7130-6110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8878.0, "discounted_cash": 3107.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SZ 10 SYNERGY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9234.0, "discounted_cash": 3231.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SZ 6 35X111MM ANGLE HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6720-0635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3811.0, "discounted_cash": 1333.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SZ 7 HIP 37 X 114MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6721-0737", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7422.0, "discounted_cash": 2597.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM SZ1 CPTI RHEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "310-2010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7688.0, "discounted_cash": 2690.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TIBL 5DEG SZ 3 RIGHT POST STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5320-071-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1648.0, "discounted_cash": 576.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TIBL 5DEG SZ D RIGHT POST STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5320-067-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3308.0, "discounted_cash": 1157.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TIBL 5DEG SZ G LFT POST STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5320-079-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3308.0, "discounted_cash": 1157.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TRIATHLON 13MM X 100MM CEMENTLESS TI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5565-S-013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM ZVPLASY UNIPEDICULAR KYPHOPLASTY SY15MM BALLOON VCF-1015-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "VCF-1015-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5871.0, "discounted_cash": 2054.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STENGER TEST PURE TONE", "code_information": [{"code": "92565", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENGER TEST SPEECH", "code_information": [{"code": "92577", "type": "CPT"}], "standard_charges": [{"minimum": 2141.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT BALLOON W/INFLATION DEVICE", "code_information": [{"code": "G17080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT DRESSING NASAL SINUS XTENTUS INJ BLU WHT", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "CG1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT HYPOCURE SINUS TERSI SZ 7", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "HYP-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT KWART URETERAL 6 X 24", "code_information": [{"code": "G14886", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT KWART URETERAL 6 X 26", "code_information": [{"code": "G14887", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT MINI MONOKA DIL ADMIN SIL STRL", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "S1.1500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT PLACEMT ANTE CAROTID", "code_information": [{"code": "37218", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PLACEMT RETRO CAROTID", "code_information": [{"code": "37217", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PLMT CTR DIALYSIS SEG", "code_information": [{"code": "36908", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT RENSONANCE METALLIC URETERAL STENT 24FR 6MM", "code_information": [{"code": "C1875", "type": "HCPCS"}, {"code": "RMS-060024-R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2358.0, "discounted_cash": 825.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT SALIVARY WALVEKAR 0.6 X 74MM", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "WSS-0.6S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 131.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT SALIVARY WALVEKAR 1.0 X 74MM", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "WSS-1.0-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 131.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT SET 6FR 22CM BLACK SILICONE FILIFORM DOUBLE PIGTAIL URETERAL G46438", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "G46438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 367.4, "discounted_cash": 128.59, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT SET 6FR 24CM BLACK SILICONE FILIFORM DOUBLE PIGTAIL URETERAL G46439", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "G46439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 123.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT SET 6FR 26CM BLACK SILICONE FILIFORM DOUBLE PIGTAIL URETERAL G46440", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "G46440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 123.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT TRABECULAR LEFT MICRO BYPASS", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "GTS100L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3430.0, "discounted_cash": 1200.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT TRABECULAR MICRO-BYPASS G2W-US", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "G2W-US", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3428.0, "discounted_cash": 1199.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URET 2 PGTL CRV 2 PGTL TPR TIP INLY HDRPH LF 7FR 28CM", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 142.5, "discounted_cash": 49.88, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URET 4.7FR 24 CM DOUBLE PIGTAIL CURVED HYDROPHILIC WITHOUT GUIDEWIREINLAY", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URET 6FR 22 CM DOUBLE PIGTAIL LUBRICIOUS CATH RADIOPAQUE HYDROPHILIC WITHO", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 56.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URET 6FR 24 CM DOUBLE PIGTAIL LUBRICIOUS HYDROPHILIC WITHOUT GUIDEWIREINLA", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 56.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URET 6FR 26 CM J CURVED DOUBLE PIGTAIL HYDROPHILIC WITHOUT GUIDEWIREINLAY", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 56.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URET 6FR 28CM J CRV DBL PGTL WO GW INLY HDRPH STRL LF", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 56.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URET 7FR X 26CM UNIVERSAL FIRM UFH-726-RT1", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "UFH-726-RT1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 284.0, "discounted_cash": 99.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URET DBL PGTL WO GW INLY LUB BLU 7FR 24CM", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 189.0, "discounted_cash": 66.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 4.8FR X 22CM TO 30CM CONTOUR VL", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061801550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 FRX24CM SOF CURL TEC", "code_information": [{"code": "C1875", "type": "HCPCS"}, {"code": "SSC6024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FR 22 CM GRN STONE REMOVAL SURG WITHOUT GUIDEWIREINLAY", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "788622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 223.0, "discounted_cash": 78.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FR 24 CM GRN STONE REMOVAL SURG WITHOUT GUIDEWIREINLAY", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "788624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 223.0, "discounted_cash": 78.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FR 26 CM 150 CM .038IN OPEN TIP FLEXIBLE TIP EZ GLIDER", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "5556026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FR 26 CM GRN STONE REMOVAL SURG WITHOUT GUIDEWIREINLAY", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "788626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 223.0, "discounted_cash": 78.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FR X 22 CM DOUBLE PIGTAIL CLASSIS HYDROPHILIC COATING", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "5606022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FR X 22CM TO 30CM CONTOUR VL", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061801560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FR X 24 CM DOUBLE PIGTAIL CLASSIC HYDROPHILIC COATING", "code_information": [{"code": "C1875", "type": "HCPCS"}, {"code": "5606024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FR X 26 CM DOUBLE PIGTAIL CLASSIC HYDROPHILIC COATING", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "5606026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FR X 26 CM METALLIC RESONANCE", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "G34111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2451.0, "discounted_cash": 857.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FR X 28CM CLASSIC DOUBLE PIG TAIL HYDROPHILIC COATING", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "5606028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FR X22CM SOF CURL TEC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SSC6022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FRX26CM SOF CURL TEC", "code_information": [{"code": "C1875", "type": "HCPCS"}, {"code": "SSC6026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 6FRX28CM SOF CURL TEC", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "SSC6028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL SOF CURL", "code_information": [{"code": "5626024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 119.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL TRIA FIRM 6F X 26CM M0061902230", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061902230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 592.9, "discounted_cash": 207.52, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 4.7 FRENCH 22 CM TAPER TIP DOUBLE PIGTAIL HYDROPHILIC VINYL LF ST", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 4.7 FRENCH 26 CM PIGTAIL CURVED TAPER TIP LUBRICATED VINYL", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 4.7 FRENCH 28 CM PIGTAIL LUBRICATED CVD DOUBLE WITHOUT GUIDEWIRE", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 65.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7 FRENCH 22 CM PIGTAIL PUSHER CURVED MRKG TAPER TIP", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 189.0, "discounted_cash": 66.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7 FRENCH 26 CM PIGTAIL CURVED HYDROPHI;IC TAPER TIP VINYL LF", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "778726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 189.0, "discounted_cash": 66.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 22CM INLAY W/NITINOL GUIDEWIRE 776722", "code_information": [{"code": "776722", "type": "CDM"}], "standard_charges": [{"gross_charge": 253.5, "discounted_cash": 88.73, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 26CM INLAY W/HYDROGLIDE GUIDEWIRE 787726", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "787726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 249.2, "discounted_cash": 87.22, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT UTERINE 2.8CM X 3CM BLLN SI TO REDUCE UTERINE BLEEDING LF DISP", "code_information": [{"code": "J-BUS-253000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT UTERINE 4 CM BALLOON X 4 CM BALLOON", "code_information": [{"code": "J-BUS-404000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STEREOISOMER ANALYSIS", "code_information": [{"code": "80374", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOSCOPIC X-RAY GUIDANCE", "code_information": [{"code": "G6002", "type": "HCPCS"}], "standard_charges": [{"minimum": 132.63, "maximum": 386.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 245.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 386.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 386.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 386.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 132.63, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 141.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC COMPUTER ASSISTED NAVIGATIONAL PROCEDURE 61782", "code_information": [{"code": "61782", "type": "CPT"}, {"code": "1587116", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC COMPUTER ASSISTED NAVIGATIONAL PROCEDURE; CRANIAL/INTRADURAL 61781", "code_information": [{"code": "61781", "type": "CPT"}, {"code": "44927249", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1161.0, "discounted_cash": 406.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC COMPUTER ASSISTED PROCEDURE; SPINAL 61783", "code_information": [{"code": "61783", "type": "CPT"}, {"code": "44623922", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC RADIATION TRMT", "code_information": [{"code": "77432", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1897.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2983.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2983.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2983.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STERI STRIP 1/2 BROWN", "code_information": [{"code": "45090E4547", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STERIFUSE DBM EVOLVED 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "32605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILANT CIDEX OPA 1 GAL NON-GLUT", "code_information": [{"code": "AS 20390", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE KIT TENOTAC 2.0 SOFT TISSUE STANDARD P42-222-0075-SK", "code_information": [{"code": "P42-222-0075-SK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2099.66, "discounted_cash": 734.88, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER 2000ML FOR INJECTION 2B0306", "code_information": [{"code": "2B0306", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 54.9, "discounted_cash": 19.22, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER FOR INJECTION 100ML VIAL", "code_information": [{"code": "MED0191", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER FOR INJECTION 10ML", "code_information": [{"code": "MED0190", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER FOR INJECTION 5ML", "code_information": [{"code": "MED0192", "type": "CDM"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STERNAL DEBRIDEMENT", "code_information": [{"code": "21627", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEROTACTIC BIOPSY-ASPIRA 61751", "code_information": [{"code": "61751", "type": "CPT"}, {"code": "1482144", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEROTACTIC BIOPSY-ASPIRATION OR EXCISION-INC. BURR HOLE(S) FOR INTRACRANIAL LESION 61750", "code_information": [{"code": "61750", "type": "CPT"}, {"code": "1482143", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEROTACTIC LOCALIZATION W/INSERTION OF CATHETERS/PROBES TO PLACE RADIATION SOURCE 61770", "code_information": [{"code": "61770", "type": "CPT"}, {"code": "1482146", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 9357.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEROTACTIC RADIOSURGERY; 1 SIMPLE CRANIAL LESION 61796", "code_information": [{"code": "61796", "type": "CPT"}, {"code": "1482148", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 45000.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45000.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 33274.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STETHOSCOPE ESOPHAGEAL 18FR REG TUBE MALE LUER FITTING CONNECTION 400 SERIES TEM", "code_information": [{"code": "1011EU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STETHOSCOPE ESOPHAGEAL 18FR W/ 700 THERMISTOR TEMPERATURE SENSOR MON A THERM DIS", "code_information": [{"code": "90072", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMROUTER IMPLANTABLE KIT ST2-1000", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "ST2-1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14410.0, "discounted_cash": 5043.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULAN RAPID CURE 5CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "620-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULANTS SYNTHETIC", "code_information": [{"code": "80371", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATION OF SPINAL CORD", "code_information": [{"code": "63610", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATION PACING HEART", "code_information": [{"code": "93623", "type": "CPT"}], "standard_charges": [{"minimum": 732.68, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 732.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1151.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1151.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1151.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATOR 3 STIMULATING BALL TIP PROBE AIX1321-S", "code_information": [{"code": "AIX1321-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1554.9, "discounted_cash": 544.22, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR BONE GROWTH", "code_information": [{"code": "E0749", "type": "HCPCS"}, {"code": "3303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10290.0, "discounted_cash": 3601.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR BONE HEALING SSYSTEM OSTEOGENIC", "code_information": [{"code": "2001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR EXTERNAL TRIAL SC-5170", "code_information": [{"code": "SC-5170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR IMAGEREADY MR CONDITIONAL SPINAL CORD SC-5590", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "SC-5590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR NEURO SACRAL NERVE NON RECHARGEABLE BATTERYINTERSTIM II", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23127.0, "discounted_cash": 8094.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR NEURO TRIAL", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "SC-5132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR PC HANDSET COMMUNICATOR TH91SCSR", "code_information": [{"code": "TH91SCSR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR PHYSIOSTIM BONE GROWTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "655303-0001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5871.0, "discounted_cash": 2054.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR RECHARGABLE NEUROSTIMULATOR 977119", "code_information": [{"code": "C1826", "type": "HCPCS"}, {"code": "977119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44000.0, "discounted_cash": 15400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR TRIAL 1601", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "1601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 591.8, "discounted_cash": 207.13, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR VERIFY EXTERNAL NEUROSTIMULATOR 353101", "code_information": [{"code": "353101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.0, "discounted_cash": 387.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR WIRELESS EXTERNAL NEUROSTIMULATOR 9772501", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "9772501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE CAST 2IN X 25YD UNBLEACHED TUBULAR", "code_information": [{"code": "MDT221200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE IMPERVIOUS LG 12X48 1587", "code_information": [{"code": "1587", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.18, "discounted_cash": 6.01, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE TUBULAR 12IN X 48IN IMPERVIOUS STRL", "code_information": [{"code": "NON22535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE TUBULAR 6IN X 48IN 1 PLY STRL", "code_information": [{"code": "NON22370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE TUBULAR 6IN X 48IN BEIGE SNGL PLY COTTON LF STRL", "code_information": [{"code": "51648", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING 2XL THIGH LENGTH REGULAR SWD3184LF", "code_information": [{"code": "SWD3184LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.5, "discounted_cash": 5.78, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI AMBOLISM EXTRA XL SHRT TED HOSE COMPR T.E.D LF", "code_information": [{"code": "7470", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM EXTRA EXTRA XL REG KNEE LEN TED HOSE", "code_information": [{"code": "7472", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM KNEE LG LONG WHT", "code_information": [{"code": "MDS160668", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM KNEE MED LONG WHT", "code_information": [{"code": "MDS160648", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM LARGE LONG LARGE CALF WHITE THIGH LENGTH NYLON SPANDEX LATEX FREE", "code_information": [{"code": "MDS160868", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM LG BLUE THIGH LEN ANTI EMBOLISM TED LF", "code_information": [{"code": "3856LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM LG LNG BLUE KNEE LEN TED LF", "code_information": [{"code": "7594", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.38, "discounted_cash": 3.63, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM LG LNG BLUE THIGH LEN TED", "code_information": [{"code": "3856", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM LNG MED WHT THIGH HIGHINSPECTION TOE SPANDEX NYLON TED", "code_information": [{"code": "3549", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM LONG MEDIUM CALF WHITE THIGH LENGTH NYLON SPANDEX LATEX FREE", "code_information": [{"code": "MDS160848", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM LONG REGULAR LARGE CALF WHITE THIGH LENGTH NYLON SPANDEX LATEX FREE", "code_information": [{"code": "MDS160864", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM MED LNG KNEE LEN CIRCULATION TED HOSE T.E.D LF", "code_information": [{"code": "7480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM REG LG CALF WHT BELOW KNEE LEG LEN NYLON SPANDEX LF", "code_information": [{"code": "MDS160664", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM REG XL CALF WHT THIGH LEN NYLON SPANDEX LF", "code_information": [{"code": "MDS160884", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM SM REG YELLOW KNEE LEN OPENINSPECTION TOE NYLON SPANDEX T", "code_information": [{"code": "7071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM XL REG GRN KNEE LEN OPENINSPECTION TOE NYLON SPANDEX TED", "code_information": [{"code": "7604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM XL REG THIGH LEN TED HOSE GRADUATED COMPRESSION LF", "code_information": [{"code": "3181LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.05, "discounted_cash": 9.82, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM KNEE LENGTH SMALL LONG LF", "code_information": [{"code": "MDS160628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM KNEE LENGTH SMALL REG LF", "code_information": [{"code": "MDS160624", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM KNEE LENGTH XL REG LF", "code_information": [{"code": "MDS160684", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM KNEE LENGTH XXL LONG LF", "code_information": [{"code": "MDS160698", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM MED WHT REG THIGH LENINSPECTOIN TOE NYLON SPANDEX T.E.D.", "code_information": [{"code": "3416LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM T-L XXL REG L", "code_information": [{"code": "MDS160894", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM TED THIGH LEN 3728LF", "code_information": [{"code": "3728LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM XXXL 361", "code_information": [{"code": "361", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISMK-LXXXL REG.LF MDS160604", "code_information": [{"code": "MDS160604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTIEMBOLISM EXTRA XL LNG KNEE CAP T.E.D. LF", "code_information": [{"code": "7471LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING COMPRESSION KNEE LENTH X-LARGE REGULAR G- 7615", "code_information": [{"code": "7615", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.16, "discounted_cash": 3.56, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING LG LONG THIGH KDL3856LF", "code_information": [{"code": "KDL3856LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.32, "discounted_cash": 9.21, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING LIMB MED THIGH LEN ANTI EMBOLISM", "code_information": [{"code": "3416", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED KNEE LNGTH XXL LATEX FREE 7470LF", "code_information": [{"code": "7470LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.42, "discounted_cash": 7.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED THIGH MED-REG416LF 416LF", "code_information": [{"code": "416LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED THIGH XXL REG LATEX FREE 3184LF", "code_information": [{"code": "3184LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.99, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING XL LARGE LONG", "code_information": [{"code": "4352DS160688", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [{"code": "327", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15601.07, "maximum": 26783.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15601.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22312.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24544.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26783.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC", "code_information": [{"code": "326", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32339.05, "maximum": 55518.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32339.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46251.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50876.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 55518.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "328", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10139.75, "maximum": 17407.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10139.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14502.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15952.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17407.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STONE COLLECTION BOTTLE 8MM 140ML XUSM0031", "code_information": [{"code": "XUSM0031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.72, "discounted_cash": 49.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STOOL CULTR AEROBIC BACT EA", "code_information": [{"code": "87046", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOPCOCK LOPEZ 3-WAY HIGH FLOW", "code_information": [{"code": "4020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STOPCOCK MEDICAL 456020", "code_information": [{"code": "456020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STOPCOCK, 4-WAY, 45,PSI,HI-FLO DYNJSC401", "code_information": [{"code": "DYNJSC401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.57, "discounted_cash": 1.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STORAGE/YEAR EMBRYO(S)", "code_information": [{"code": "89342", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR OOCYTE(S)", "code_information": [{"code": "89346", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR REPROD TISSUE", "code_information": [{"code": "89344", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR SPERM/SEMEN", "code_information": [{"code": "89343", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STPLER SKIN PROXIMATE PLUS MD REG 35 PMR35", "code_information": [{"code": "PMR35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STPLR RELOAD ECHLN SS VASC ENDO 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR45W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STPLR RELOAD PRX TI THKTIS 55MM", "code_information": [{"code": "TRT55", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STPLR RELOAD REG ECHLN 6 RW 45 X 3.5MM BLUE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR45B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 83.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STPLR RELOAD REG ECHLN 6 RW 45 X 4.1MM GREEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR45G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 83.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STPLR SKIN DISP ROTATING HEAD 35 REG PRR35", "code_information": [{"code": "PRR35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STR MARKERS SPEC ANAL ADDL", "code_information": [{"code": "81266", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 381.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 777.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1222.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1222.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1222.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 438.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 438.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STR MARKERS SPECIMEN ANAL", "code_information": [{"code": "81265", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 331.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 594.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 934.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 934.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 934.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 335.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 335.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRABISMUS SURGERY 1 HORIZONTAL MUSCLE 67311", "code_information": [{"code": "67311", "type": "CPT"}, {"code": "1482152", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRABISMUS SURGERY 1 VERTICAL MUSCLE 67314", "code_information": [{"code": "67314", "type": "CPT"}, {"code": "1482149", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRABISMUS SURGERY 2 HORIZONTAL MUSCLES 67312", "code_information": [{"code": "67312", "type": "CPT"}, {"code": "1482150", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRABISMUS SURGERY 2 OR MORE VERTICAL MUSCLES 67316", "code_information": [{"code": "67316", "type": "CPT"}, {"code": "1482151", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRABISMUS SURGERY-ANY PROCEDURE-SUPERIOR OBLIQUE MUSCLE 67318", "code_information": [{"code": "67318", "type": "CPT"}, {"code": "1482153", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAIGHT STAPLE ASSEMBLY, 10MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P71-010-1010-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4522.0, "discounted_cash": 1582.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAP ABSORBABLE FIXATION DEVICE 5MM STRAP25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "STRAP25", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 941.5, "discounted_cash": 329.53, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAP ANKLE DISTRACTION ARTHROSCOPY NONINVASIVE", "code_information": [{"code": "AR-1712", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 59.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAP ANKLE DISTRACTION SMOOT STERILE 713400", "code_information": [{"code": "713400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.92, "discounted_cash": 27.97, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAP ANKLE DISTRACTION STRL DISP", "code_information": [{"code": "AR-1710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAP TOURNIQUET 1X18 LF BLUE TEXTU CH5060", "code_information": [{"code": "CH5060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAPPING OF CHEST", "code_information": [{"code": "29200", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HIP", "code_information": [{"code": "29520", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF SHOULDER", "code_information": [{"code": "29240", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF TOES", "code_information": [{"code": "29550", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPS BEACH CHAIR HEAD AND CHIP711005", "code_information": [{"code": "711005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.61, "discounted_cash": 19.11, "setting": "both", "billing_class": "facility"}]}, {"description": "STREP A AG IA", "code_information": [{"code": "87430", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A ASSAY W/OPTIC", "code_information": [{"code": "87880", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 66.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 66.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 66.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A DNA AMP PROBE", "code_information": [{"code": "87651", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A DNA DIR PROBE", "code_information": [{"code": "87650", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A DNA QUANT", "code_information": [{"code": "87652", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 64.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 60.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 60.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP B ASSAY W/OPTIC", "code_information": [{"code": "87802", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP B DNA AMP PROBE", "code_information": [{"code": "87653", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOKINASE ANTIBODY", "code_information": [{"code": "86590", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRESS TTE COMPLETE", "code_information": [{"code": "93351", "type": "CPT"}], "standard_charges": [{"minimum": 659.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 659.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1036.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1036.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1036.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRESS TTE ONLY", "code_information": [{"code": "93350", "type": "CPT"}], "standard_charges": [{"minimum": 522.89, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 522.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 821.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 821.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 821.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRIP BUCKLING 3.5MM SCLERAL STYLE 41 SILICONE", "code_information": [{"code": "C1814", "type": "HCPCS"}, {"code": "92-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP CLOSURE 1/4IN X 3IN FLEXIBLE NON STRL SUT STIP PLUS LF", "code_information": [{"code": "TP-1101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP CLOSURE SKIN BLEND TONE 1/2 X 4 B1557 B1557Z", "code_information": [{"code": "B1557Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.23, "discounted_cash": 1.48, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP CLOSURE SKIN REINFORCD 1 2X4 R1547", "code_information": [{"code": "R1547", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP CLOSURE SKIN REINFORCED 1 4X3 R1541", "code_information": [{"code": "R1541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP CLOSURE SKIN REINFORCED 1/4\"X4\" R1546", "code_information": [{"code": "R1546", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP CLOSURE SKN REINFORCED 1 2X2 R1549", "code_information": [{"code": "R1549", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.23, "discounted_cash": 1.48, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP CLOSURE SKN REINFORCED 1 8X3 R1540", "code_information": [{"code": "R1540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP DBM 50X20X5 DBMS20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DBMS20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5768.0, "discounted_cash": 2018.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP FINGER 1/2IN X 18IN", "code_information": [{"code": "ORT32100118", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP PACKING .25IN X 5YD IODOFORM WOVEN GAUZE 100PCT COTTON CURAD STRL", "code_information": [{"code": "NON256145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP PACKING 1/2IN X 5YD IODOFORM", "code_information": [{"code": "NON256125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP PKNG 1/2IN X 5YD WHT PLN DRSG 100 PCT COTTON CURITY LF STRL", "code_information": [{"code": "7632", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP SPLINT 4IN X 15IN PRECUT 1-STEP MOLDABLE 3M SCOTCHCAST LF", "code_information": [{"code": "M76415A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP SPLINT 4INX 30IN PRECUT 1-STEP MOLDABLE 3M SCOTCHCAST", "code_information": [{"code": "M76430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP SUTUR PLS 1 2X4 6 PK 50PK BX TP1103", "code_information": [{"code": "TP1103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP TEST GLUCOSE SURE STEP", "code_information": [{"code": "10-797", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STRK CR PREV POS OUTCME MVP", "code_information": [{"code": "G0054", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRYKER EGG BURR MEDIUM 4.0MM", "code_information": [{"code": "5120-015-040R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STRYKER SYS 7 SAW BLADE WIDE 200138108S", "code_information": [{"code": "200138108S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET 40MM ALPHATEC 17166-040", "code_information": [{"code": "17166-040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.25, "discounted_cash": 167.39, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET ALUMINUM COATED 6FR M0906", "code_information": [{"code": "M0906", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET ALUMINUM COATED SIZE 14FR", "code_information": [{"code": "M0914", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET BEVEL WITH SHEATH 11G 0306-150-000", "code_information": [{"code": "306-150-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET II G BEVEL", "code_information": [{"code": "306-331-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.8, "discounted_cash": 45.43, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET INTUBATING 14 FR 85865", "code_information": [{"code": "85865", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET INTUBATION 14FR LUBRICATED", "code_information": [{"code": "251014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET PVC COATING ALUMINUM 10FR", "code_information": [{"code": "M0910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET SURGICAL INSTRUMENT 10GA IVAS BEVEL STERILE LATEX FREE DISPOSABLE", "code_information": [{"code": "306-531-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLETINTUBATING 10FR", "code_information": [{"code": "85864", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLETINTUBATING 6FR", "code_information": [{"code": "85863", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLUS RHINAER CAT840", "code_information": [{"code": "CAT840", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2143.0, "discounted_cash": 750.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLUS RHINAER DISOSABLE HANDHELD DEVICE CAT1394", "code_information": [{"code": "CAT1394", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4380.0, "discounted_cash": 1533.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLUS VIVAER ARC CAT500 CAT1785", "code_information": [{"code": "CAT1785", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4380.0, "discounted_cash": 1533.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLUS VIVAER CAT723", "code_information": [{"code": "CAT723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4270.5, "discounted_cash": 1494.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBCONJUNCTIVAL INJECTION 68200", "code_information": [{"code": "68200", "type": "CPT"}, {"code": "11906509", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 203.28, "maximum": 8450.0, "gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 203.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBMUCUS RESECTION INFERIOR TURBINATE/PARTIAL OR COMPLETE 30140", "code_information": [{"code": "30140", "type": "CPT"}, {"code": "1482155", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBRTA NJX RX AGT W/VTRC", "code_information": [{"code": "810T", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBSEQUENT REPAIR OF NERVE", "code_information": [{"code": "64872", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBSTITUTE BONE 10CC HYDROSET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "397010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5705.0, "discounted_cash": 1996.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBSTITUTE BONE 15CC HYDROSET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "397015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8198.0, "discounted_cash": 2869.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBSTITUTE BONE 3CC HYDROSET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "397003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2406.0, "discounted_cash": 842.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBSTITUTE BONE 5CC HYDROSET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "397005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3895.0, "discounted_cash": 1363.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBSTITUTE GRAFT 4CC BONE EXTREMITY PRO STIM IMP", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "86SR-0404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5892.0, "discounted_cash": 2062.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/DEB", "code_information": [{"code": "29906", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FB RMVL", "code_information": [{"code": "29904", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTEMPORAL DECOMPRESSION", "code_information": [{"code": "61340", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCTION CATH 14FR CONTROL COIL", "code_information": [{"code": "T60C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION CATH 5/6FR CONTROL COIL", "code_information": [{"code": "T63C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION DISC QUICKSUITE FLOOR SUCTION BASIC", "code_information": [{"code": "DYNDQSF1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION ENDO 9FR MALLEABLE SUCTION STANDARD TIP LF", "code_information": [{"code": "9735016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 787.0, "discounted_cash": 275.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION SINGLE USE AIR/WATER BUTTON ORCA POD W/WATER JET W/CAP", "code_information": [{"code": "SUV-629-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.14, "discounted_cash": 17.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUAL", "code_information": [{"code": "84377", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUANT", "code_information": [{"code": "84379", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS SINGLE QUAL", "code_information": [{"code": "84376", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS SINGLE QUANT", "code_information": [{"code": "84378", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 17.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUICD BASED CLN EVAL", "code_information": [{"code": "M1355", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUICD BASED CLN EVAL", "code_information": [{"code": "M1361", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUICD C-SSRS ASSESSMENT", "code_information": [{"code": "M1360", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUICD C-SSRS ASSESSMENT, EQU", "code_information": [{"code": "M1352", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPERFICIAL BIOPSY SOFT TISSUE LEG OR ANKLE AREA 27613", "code_information": [{"code": "27613", "type": "CPT"}, {"code": "1482156", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPERION IDS KIT", "code_information": [{"code": "102-9800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5357.0, "discounted_cash": 1874.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPLEMENTAL ELECTRICAL TEST", "code_information": [{"code": "92547", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPPORT CARE NEUR COND MVP", "code_information": [{"code": "M0004", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPPORT FOR ORGAN DONOR", "code_information": [{"code": "1990", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPORT UPPER EXTREMINTY ARM AC200", "code_information": [{"code": "AC200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORT VAGINAL UPHOLD LITE SLIM", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "831-817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4234.0, "discounted_cash": 1481.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORT VAGINAL UPHOLD LITE W/CAPIO SLIM", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "M0068318170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORT WRIST 9IN X 3.5IN 14.5IN ARTERIAL ADLT", "code_information": [{"code": "29980", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER ATHLETIC 32IN TO 38IN MED REGULAR", "code_information": [{"code": "IMP91002", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 20.7, "discounted_cash": 7.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER ATHLETIC 39 TO 44IN LG WHT SWIMMER NYLON AND ELASTIC 3M BAUER AND BLAC", "code_information": [{"code": "206972", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER ATHLETIC ADLT MEDIUM 33-38 202549", "code_information": [{"code": "202549", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER ATHLETIC ADULT ELASTIC XL 2570-01XL", "code_information": [{"code": "2570-01XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER ATHLETIC ADULT LARGE 39- 4 202636", "code_information": [{"code": "202636", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER ATHLETIC ADULT SMALL 26-32 202460", "code_information": [{"code": "202460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER ATHLETIC MED ADJ WAISTBAND LEG STRAPS SUSPENSORY LATEX 3M", "code_information": [{"code": "201161", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER ATHLETIC REGULAR SIZE XL 44\" - 50\" 0910-04", "code_information": [{"code": "910-04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER ATHLETIC XL 44IN TO 50IN REGUALR", "code_information": [{"code": "IMP091004", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 23.72, "discounted_cash": 8.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER ATHLETIC XL ELASTIC ADLT", "code_information": [{"code": "2570-XL", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER SCROTAL XL", "code_information": [{"code": "IMO091004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPRACERVICAL ABDOMINAL HYSTERECTOMY W/ OR W/O REM'L TUBES/OVARYS 58180", "code_information": [{"code": "58180", "type": "CPT"}, {"code": "1482157", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPRAHYOID LYMPHADENECTOMY 38700", "code_information": [{"code": "38700", "type": "CPT"}, {"code": "1482158", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPRV INTERFAC TRNSPORT ADDL", "code_information": [{"code": "99486", "type": "CPT"}], "standard_charges": [{"minimum": 298.78, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 298.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 469.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 469.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 469.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPRV INTERFACILTY TRANSPORT", "code_information": [{"code": "99485", "type": "CPT"}], "standard_charges": [{"minimum": 344.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 344.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 541.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURECLIP HEMOSTAT CLIP 16 235CM", "code_information": [{"code": "128-5655", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SURECLIP HEMOSTATIC CLIP 16MM 235CM", "code_information": [{"code": "ROCC-F-26-23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 155.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SURFACTANT ADMIN THRU TUBE", "code_information": [{"code": "94610", "type": "CPT"}], "standard_charges": [{"minimum": 811.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 811.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1274.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF ANTERIOR", "code_information": [{"code": "D3501", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF MOLAR", "code_information": [{"code": "D3503", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF PREMOLAR", "code_information": [{"code": "D3502", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG PLACE CRANIOFACIAL IMPL", "code_information": [{"code": "D7993", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG PLACE ZYGOMATIC IMPL", "code_information": [{"code": "D7994", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG PROC W/SILICONE OIL", "code_information": [{"code": "G9756", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG PROC W/SILICONE OIL", "code_information": [{"code": "G9757", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES ANTERIOR", "code_information": [{"code": "D3471", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES MOLAR", "code_information": [{"code": "D3473", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES PREMOLAR", "code_information": [{"code": "D3472", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG. PREP/CREATION RECIP. SITE BY EXC./INC. 1ST 100SQ CM FACE-NECK-EARS-GENITALIA-HANDS-FEET 15004", "code_information": [{"code": "15004", "type": "CPT"}, {"code": "1482121", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGALLOY V-LOC 3-0 0.5 CIRC. 12IN NON-ABSORB TPR", "code_information": [{"code": "VLOCN0614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 32.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGERY ELECTROCORTICOGRAM", "code_information": [{"code": "95829", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 10981.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6988.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10981.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10981.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10981.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR LIVER LESION", "code_information": [{"code": "47300", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY OF GREAT VESSEL", "code_information": [{"code": "33916", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY OF PANCREATIC CYST", "code_information": [{"code": "48500", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY POSITIONING BOARD LATERAL PATIENT MODULE 181-700", "code_information": [{"code": "181-700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1345.0, "discounted_cash": 470.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27475", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27477", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27479", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27485", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY/SPEECH PROSTHESIS", "code_information": [{"code": "31611", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA WITH PLASTIC REPAIR 31825", "code_information": [{"code": "31825", "type": "CPT"}, {"code": "26440564", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1640.76, "maximum": 8450.0, "gross_charge": 3390.0, "discounted_cash": 1186.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1640.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL EXPOSURE PROSTATE", "code_information": [{"code": "55860", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 6", "code_information": [{"code": "2D73DP60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 6 1/2", "code_information": [{"code": "2D73DP65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 7 1/2", "code_information": [{"code": "2D73DP75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 8", "code_information": [{"code": "2D73DP80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 8 1/2", "code_information": [{"code": "2D73DP85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 9", "code_information": [{"code": "2D73DP90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL LUBRICANT (SURGILUBE) 5 GRAM OINTMENT", "code_information": [{"code": "MED0193", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL MASK SECURE-GARD DUCKBILL ANTI-FOG FLUID RESISTANT 160MMHG MEDITERRANEAN BLUE", "code_information": [{"code": "AT54535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL MASK, DUCKBILL, BLUE", "code_information": [{"code": "AT51334", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL MESH BIOBRACE 23 X 30MM BB23X30", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "BB23X30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1895.0, "discounted_cash": 663.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43351", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43352", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43500", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43510", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF THROAT", "code_information": [{"code": "42955", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PREP/CREATION RECIPIENT SITE BY EXCISION/INCISION 1ST 100SQ CM TRUNK-ARMS-LEGS 15002", "code_information": [{"code": "15002", "type": "CPT"}, {"code": "1482120", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PREP/CREATION RECIPIENT SITE BY EXCISION/INCISION EA ADDTL 100SQ CM TRUNK-ARMS-LEGS 15003", "code_information": [{"code": "15003", "type": "CPT"}, {"code": "14526138", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1240.0, "discounted_cash": 434.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 600.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43501", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43502", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL REVISION INTESTINE", "code_information": [{"code": "44680", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL SITE INFECTION", "code_information": [{"code": "G9312", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL SYSTEM OMNI ERGO SERIES 1-108", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "1-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3399.0, "discounted_cash": 1189.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL 4X8 PACKET", "code_information": [{"code": "MED0194", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 134.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL ABSORBABLE HEMOSTAT 2 X 4IN SNOW NONWOVEN STRL DISP", "code_information": [{"code": "2082 Surgicel", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 155.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL FIBRILLAR 1X2 PACKET", "code_information": [{"code": "MED0195", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 469.0, "discounted_cash": 164.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL SNOW\u00c2\u00ae ABS HEMOSTAT 2\" X 4\" 2082", "code_information": [{"code": "2082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICLIP PREMIUM III 9.0 133650", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "133650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 306.0, "discounted_cash": 107.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFLO", "code_information": [{"code": "MED0196", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.0, "discounted_cash": 164.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFLO 8ML HEMOSTATIC MATRIX KIT W/ THROMBIN 2994", "code_information": [{"code": "2994", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 418.64, "discounted_cash": 146.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFLO APPLICATOR MS1995", "code_information": [{"code": "MS1995", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 53.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFOAM 8X12.5CMX10MM SPONGE", "code_information": [{"code": "MED0197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIPHOR STERILE WOUND IRRIGATION 214380", "code_information": [{"code": "214380", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 71.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIWAND II 5MM CAUT SPATULA TUB GFS 178094", "code_information": [{"code": "178094", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 469.0, "discounted_cash": 164.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SURV SCORE NO IMPROV W/TX", "code_information": [{"code": "G9605", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURVEY NOT COMPLETE", "code_information": [{"code": "G0914", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPEND BOWEL W/PROSTHESIS", "code_information": [{"code": "44700", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58410", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF VAGINA", "code_information": [{"code": "57280", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE #2 FIBERLOOP W FIBERTAG ST NEEDLE", "code_information": [{"code": "AR-7264", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 18 COATED VICRYL PLS UND BR CR VCP724D", "code_information": [{"code": "VCP724D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CHROMIC GUT CT-1 812H", "code_information": [{"code": "812H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CHROMIC GUT MO-4 4924H", "code_information": [{"code": "4924H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CHROMIC GUT SH G124H", "code_information": [{"code": "G124H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CHROMIC GUT UR-5 U246H", "code_information": [{"code": "U246H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 COAT VICRYL PLS UND BR CT-2 VCP270H", "code_information": [{"code": "VCP270H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC UND BR CP-2 J870H", "code_information": [{"code": "J870H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC UND BR CT-2 J270H", "code_information": [{"code": "J270H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.63, "discounted_cash": 2.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC UND BR J260H", "code_information": [{"code": "J260H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC UND BR SH J418H", "code_information": [{"code": "J418H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.91, "discounted_cash": 5.92, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR CP-1 J467H", "code_information": [{"code": "J467H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR CT-2 J334H", "code_information": [{"code": "J334H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR CT3/F J329H", "code_information": [{"code": "J329H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR UR-4 J381H", "code_information": [{"code": "J381H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR UR-5 J376H", "code_information": [{"code": "J376H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR UR-6 J603H", "code_information": [{"code": "J603H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 MONOCRYL VIO MONO CT Y340H", "code_information": [{"code": "Y340H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 MONOCRYL VIO MONO UR Y606H", "code_information": [{"code": "Y606H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 PDS II VIO MONO CT-1 Z340H", "code_information": [{"code": "Z340H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 PDS PLUS VIO MONO CT1 PDP340H", "code_information": [{"code": "PDP340H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 PDS PLUS VIO MONO CT2 PDP334H", "code_information": [{"code": "PDP334H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27IN COATED VICRYL PLUS UND VCP267H", "code_information": [{"code": "VCP267H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27IN COATED VICRYL PLUS UND VCP534H", "code_information": [{"code": "VCP534H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 3-18 CTD VIC UND BR OS- J749T", "code_information": [{"code": "J749T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 36 CHROMIC GUT CT-1 924H", "code_information": [{"code": "924H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 36 COATD VICRYL PLS UND BR CTX VCP978H", "code_information": [{"code": "VCP978H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 36 COATED VICRYL PLS UND BR CT VCP958H", "code_information": [{"code": "VCP958H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 36 CTD VIC UND BR J946H", "code_information": [{"code": "J946H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.24, "discounted_cash": 6.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 36 MONOCRYL UND MONO CT Y946H", "code_information": [{"code": "Y946H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 36 PDS II VIO MONO CT-1 Z346H", "code_information": [{"code": "Z346H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 36 PDS PLUS VIO MONO CT1 PDP346H", "code_information": [{"code": "PDP346H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 36IN COATED VICRYL PLUS UND VCP946H", "code_information": [{"code": "VCP946H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 60 PDS II VIO MONO CTX Z990G", "code_information": [{"code": "Z990G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.2, "discounted_cash": 18.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 60 PDS II VIO MONO TP-1 Z991G", "code_information": [{"code": "Z991G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 60 PDS PLUS VIO MONO CTX PDP990G", "code_information": [{"code": "PDP990G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 618IN COATED VICRYL UND BRAID VCP112G", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "VCP112G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20.1, "discounted_cash": 7.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 8-18 CTD VIC UND BR CTB JB840", "code_information": [{"code": "JB840", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 8-18 CTD VIC UND BR CTX J724D", "code_information": [{"code": "J724D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 8-18 CTD VIC VIO BR CT- J727D", "code_information": [{"code": "J727D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 8-18 PDS II VIO MONO CT Z740D", "code_information": [{"code": "Z740D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 8-18IN COATED VICRYL PLUS UND VCP840D", "code_information": [{"code": "VCP840D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.6, "discounted_cash": 27.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 8-18IN COATED VICRYL PLUS VCP740D", "code_information": [{"code": "VCP740D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 8-18IN CTD VICRYL PLUS VIO VCP727D", "code_information": [{"code": "VCP727D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 8-27 CTD VIC UND BR CT- JJ41G", "code_information": [{"code": "JJ41G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 8-27 CTD VIC VIO BR CT- JJ31G", "code_information": [{"code": "JJ31G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 CHROMIC TIES 54 INCH REEL", "code_information": [{"code": "S114H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 TC43 1/2 CIRCLE TAPER POLYPRO", "code_information": [{"code": "M0068331241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 VLOC180 18 GS-11 VLOCL2826", "code_information": [{"code": "VLOCL2826", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 CHROMIC GUT CT-2 885H", "code_information": [{"code": "885H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 CTD VIC UND BR CP-1 J268H", "code_information": [{"code": "J268H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 CTD VIC UND BR CP-2 J871H", "code_information": [{"code": "J871H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 CTD VIC UND BR CT-1 J261H", "code_information": [{"code": "J261H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 CTD VIC UND BR OS-6 J535H", "code_information": [{"code": "J535H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 CTD VIC VIO BR CT-2 J335H", "code_information": [{"code": "J335H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 CTD VIC VIO BR CTX J365H", "code_information": [{"code": "J365H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 CTD VICRYL UND BR OS-4 J695H", "code_information": [{"code": "J695H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 PDS II VIO MONO CT Z353H", "code_information": [{"code": "Z353H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 PDS II VIO MONO OS-6 Z535H", "code_information": [{"code": "Z535H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 PDS PLUS VIO MONO CP1 PDP468H", "code_information": [{"code": "PDP468H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27 PDS PLUS VIO MONO CT1 PDP341H", "code_information": [{"code": "PDP341H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27IN COATED VICRYL VIL CT2 VCP335H", "code_information": [{"code": "VCP335H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 27IN COATED VICRYL VIL CTX VCP365H", "code_information": [{"code": "VCP365H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 3-18 CTD VIC VIO BR OS- J708T", "code_information": [{"code": "J708T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 36 CHROMIC GUT CT-1 925H", "code_information": [{"code": "925H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 36 CHROMIC GUT V-34 945H", "code_information": [{"code": "945H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 36 CTD VIC UND BR CT J959H", "code_information": [{"code": "J959H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 36 CTD VIC UND BR CT-1 J947H", "code_information": [{"code": "J947H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.95, "discounted_cash": 6.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 36 CTD VIC VIO BR CT J359H", "code_information": [{"code": "J359H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 36 CTD VIC VIO BR CT-1 J347H", "code_information": [{"code": "J347H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 36 CTD VIC VIO BR CTX J371H", "code_information": [{"code": "J371H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 36 PDS PLUS VIO MONO CT1 PDP347H", "code_information": [{"code": "PDP347H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 36 PDS PLUS VIO MONO CTX PDP371T", "code_information": [{"code": "PDP371T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 36IN COATED VICRYL UND CTX VCP977H", "code_information": [{"code": "VCP977H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 48 PDS II VIO MONO TP-1 Z880G", "code_information": [{"code": "Z880G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.67, "discounted_cash": 6.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 48 PDS II VIO MONO XLH Z881G", "code_information": [{"code": "Z881G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 48 PDS PLUS VIO MONO TP1 PDP880G", "code_information": [{"code": "PDP880G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 8-18 CHROMIC GUT CT-1 CC40G", "code_information": [{"code": "CC40G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 8-18 CTD VIC UND BR CT- J841D", "code_information": [{"code": "J841D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 8-18 CTD VIC UND BR CTB JB841", "code_information": [{"code": "JB841", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 8-18 CTD VIC VIO BR CT J753D", "code_information": [{"code": "J753D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 8-18 CTD VIC VIO BR CT- J741D", "code_information": [{"code": "J741D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 8-18 PDS II VIO MONO CT Z741D", "code_information": [{"code": "Z741D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 8-18 PDS II VIO MONO CT Z765D", "code_information": [{"code": "Z765D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 8-27 CTD VIC UND BR CT- JJ40G", "code_information": [{"code": "JJ40G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 818 CTD VIC UND BR CTX JB725", "code_information": [{"code": "JB725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 818 CTD VIC VIO BR CTX J765D", "code_information": [{"code": "J765D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 827IN COATED VICRYL UND CR CT VCPP40D", "code_information": [{"code": "VCPP40D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 757.83, "discounted_cash": 265.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 CHROMIC GUT SG15T", "code_information": [{"code": "SG15T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 PROLENE TAPER POINT CT 30IN BLUE", "code_information": [{"code": "8435H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 1 VICRYL CPX 27\" UNDYED J569H", "code_information": [{"code": "J569H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 10 0 4 VIC VIO MONO CS-B- V966G", "code_information": [{"code": "V966G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 18 PDS PLUS 3/0 CLR MONO PS-1 PDP683 G", "code_information": [{"code": "PDP683 G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 18 PDS PLUS 4/0 CLR MONO P-3 PDP494 G", "code_information": [{"code": "PDP494 G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 0 27 CHROMIC GUT CT3 FN 893H", "code_information": [{"code": "893H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 0 27 PDS II VIO MONO CP Z466H", "code_information": [{"code": "Z466H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 2-27 CTD VIC UND BR TP J849G", "code_information": [{"code": "J849G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 2.3MM SWGD 2.2 TT BLK-WHT 3911-523-731", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3911-523-731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1180.0, "discounted_cash": 413.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 2.3MM SWGD 2.2 TT BLU-BLK 3911-523-730", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3911-523-730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1180.0, "discounted_cash": 413.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 27 CTD VIC UND BR CP J195H", "code_information": [{"code": "J195H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 27 PDS II VIO MONO CCS- Z807T", "code_information": [{"code": "Z807T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 27 PDS II VIO MONO CP Z195T", "code_information": [{"code": "Z195T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 27IN COATED VICRYL UND CP VCP195H", "code_information": [{"code": "VCP195H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 36X36CM 1 2C 36MM PT QUILL PDO RX-1062Q", "code_information": [{"code": "RX-1062Q", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 4-27 CTD VIC VIO BR TP- J649G", "code_information": [{"code": "J649G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2 54 CTD VIC UND BR TP-1 J880T", "code_information": [{"code": "J880T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2-0 27IN COATED VICRYL PLUS UND VCP259H", "code_information": [{"code": "VCP259H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2-0 27IN COATED VICRYL PLUS UND VCP533H", "code_information": [{"code": "VCP533H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2-0 27IN COATED VICRYL PLUS UND VCP869H", "code_information": [{"code": "VCP869H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2-0 27IN COATED VICRYL PLUS VIO VCP317H", "code_information": [{"code": "VCP317H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2-0 36IN COATED VICRYL PLUS UND VCP945H", "code_information": [{"code": "VCP945H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2-0 8-18IN COATED VICRYL PLUS VCP726D", "code_information": [{"code": "VCP726D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2-0 8-18IN COATED VICRYL PLUS VCP739D", "code_information": [{"code": "VCP739D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2-0 8-18IN COATED VICRYL PLUS VCP775D", "code_information": [{"code": "VCP775D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2-0 VICRYL UR-6 ETHVCP602H", "code_information": [{"code": "ETHVCP602H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.17, "discounted_cash": 3.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2.0 PROLENE 36 INCH RB-1", "code_information": [{"code": "8559H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CHROMIC GUT CT 801H", "code_information": [{"code": "801H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CHROMIC GUT CT-1 811H", "code_information": [{"code": "811H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CHROMIC GUT PS-2 1621H", "code_information": [{"code": "1621H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CHROMIC GUT SH G123H", "code_information": [{"code": "G123H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 COAT VICRYL PLS UND BR CR VCPP42D", "code_information": [{"code": "VCPP42D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 COATED VICRYL PLS UND BR VCP269H", "code_information": [{"code": "VCP269H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC UND BR CP- J266H", "code_information": [{"code": "J266H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC UND BR CT J275H", "code_information": [{"code": "J275H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC UND BR CT- J259H", "code_information": [{"code": "J259H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC UND BR CTB JB259", "code_information": [{"code": "JB259", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC UND BR FS- J443H", "code_information": [{"code": "J443H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC UND BR OS- J533H", "code_information": [{"code": "J533H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC UND BR PSL J596H", "code_information": [{"code": "J596H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC UND BR SH J417H", "code_information": [{"code": "J417H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.31, "discounted_cash": 5.71, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC UND BR X-1 J459H", "code_information": [{"code": "J459H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC VIO BR CT3 J328H", "code_information": [{"code": "J328H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC VIO BR UR J375H", "code_information": [{"code": "J375H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 CTD VIC VIO BR UR- J602H", "code_information": [{"code": "J602H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 MONOCRYL UND MONO Y266H", "code_information": [{"code": "Y266H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 MONOCRYL UND MONO Y417H", "code_information": [{"code": "Y417H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.18, "discounted_cash": 2.86, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 MONOCRYL VIO MONO Y317H", "code_information": [{"code": "Y317H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 MONOCRYL VIO MONO Y333H", "code_information": [{"code": "Y333H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 MONOCRYL VIO MONO Y339H", "code_information": [{"code": "Y339H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 PDS II CLR MONO FS Z443H", "code_information": [{"code": "Z443H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 PDS II VIO MONO CT Z333H", "code_information": [{"code": "Z333H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 PDS II VIO MONO CT Z339H", "code_information": [{"code": "Z339H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 PDS II VIO MONO SH Z317H", "code_information": [{"code": "Z317H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 PDS PLUS CLR MONO CT1 PDP259H", "code_information": [{"code": "PDP259H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 PDS PLUS VIO MONO CT1 PDP339H", "code_information": [{"code": "PDP339H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 PDS PLUS VIO MONO CT2 PDP333H", "code_information": [{"code": "PDP333H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 PDS PLUS VIO MONO SH PDP317H", "code_information": [{"code": "PDP317H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 PL GUT CT3/FN2 N863H", "code_information": [{"code": "N863H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 27 PL GUT CTX 872H", "code_information": [{"code": "872H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 36 CHROMIC GUT CT 913H", "code_information": [{"code": "913H", "type": "CDM"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 36 CHROMIC GUT CT-1 923H", "code_information": [{"code": "923H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 36 CTD VIC UND BR CT J957H", "code_information": [{"code": "J957H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 36 CTD VIC UND BR CT- J945H", "code_information": [{"code": "J945H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.57, "discounted_cash": 6.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 36 MONOCRYL UND MONO Y917H", "code_information": [{"code": "Y917H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 36 MONOCRYL UND MONO Y945H", "code_information": [{"code": "Y945H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.97, "discounted_cash": 7.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 36 PDS II VIO MONO CT Z357H", "code_information": [{"code": "Z357H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.75, "discounted_cash": 4.11, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 8-18 CTD VIC UND BR C J723D", "code_information": [{"code": "J723D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 8-18 CTD VIC UND BR C J762D", "code_information": [{"code": "J762D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 8-18 CTD VIC UND BR C J839D", "code_information": [{"code": "J839D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.46, "discounted_cash": 17.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 8-18 CTD VIC UND BR C JB839", "code_information": [{"code": "JB839", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 8-18 CTD VIC VIO BR C J726D", "code_information": [{"code": "J726D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.56, "discounted_cash": 24.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 8-18 CTD VIC VIO BR S J775D", "code_information": [{"code": "J775D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 8-18 PDS II VIO MONO Z739D", "code_information": [{"code": "Z739D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 8-18 PDS II VIO MONO Z775D", "code_information": [{"code": "Z775D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 2/0 8-27 CTD VIC UND BR C JJ42G", "code_information": [{"code": "JJ42G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3 0 27 CHROMIC GUT SH-1", "code_information": [{"code": "G182H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3 0 36 VICRYL SH 26MM VIOLET J527H", "code_information": [{"code": "J527H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3 27 CTD VIC UND BR CCS-1 J808T", "code_information": [{"code": "J808T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3-0 27IN COATED VICRYL PLUS UND VCP427H", "code_information": [{"code": "VCP427H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.47, "discounted_cash": 15.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3-0 27IN COATED VICRYL PLUS UND VCP442H", "code_information": [{"code": "VCP442H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3-0 27IN COATED VICRYL PLUS VIO VCP316H", "code_information": [{"code": "VCP316H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3-0 60CM MONO STRATAFIX UNDYED SXMP1B103", "code_information": [{"code": "SXMP1B103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3-0 8-18IN COATED VICRYL PLUS VCP864D", "code_information": [{"code": "VCP864D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3-0 VICRYL 37IN COATED", "code_information": [{"code": "J784G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3-0 VLOC V20 6 VLOCM0604", "code_information": [{"code": "VLOCM0604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3-0 VLOC90 P-12 23 VLOCM0034", "code_information": [{"code": "VLOCM0034", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 18 CTD VIC UND BR PS- J497G", "code_information": [{"code": "J497G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 18 CTD VIC UND BR PS- J683H", "code_information": [{"code": "J683H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 18 CTD VIC UND BR PS-2 J497H", "code_information": [{"code": "J497H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 18 PDS II CLR MONO PS Z497G", "code_information": [{"code": "Z497G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 18 PDS II CLR MONO PS Z683G", "code_information": [{"code": "Z683G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CHROMIC GUT CT-1 810H", "code_information": [{"code": "810H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CHROMIC GUT FS-2 636H", "code_information": [{"code": "636H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CHROMIC GUT PS-2 1638H", "code_information": [{"code": "1638H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CHROMIC GUT RB-1 U204H", "code_information": [{"code": "U204H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.96, "discounted_cash": 12.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CHROMIC GUT SH G122H", "code_information": [{"code": "G122H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 COATED VICRYL PLS UND BR VCP258H", "code_information": [{"code": "VCP258H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CTD VIC UND BR CT- J232H", "code_information": [{"code": "J232H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.86, "discounted_cash": 2.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CTD VIC UND BR CT- J258H", "code_information": [{"code": "J258H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CTD VIC UND BR FS-1", "code_information": [{"code": "J442H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CTD VIC UND BR PS- J427H", "code_information": [{"code": "J427H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.45, "discounted_cash": 6.46, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CTD VIC UND BR PS- J936H", "code_information": [{"code": "J936H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CTD VIC UND BR X-1 J458H", "code_information": [{"code": "J458H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CTD VIC VIO BR CT- J332H", "code_information": [{"code": "J332H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 CTD VIC VIO BR SH J316H", "code_information": [{"code": "J316H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 MONOCRYL UND MONO Y215H", "code_information": [{"code": "Y215H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 MONOCRYL UND MONO Y416H", "code_information": [{"code": "Y416H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 MONOCRYL UND MONO Y427H", "code_information": [{"code": "Y427H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.5, "discounted_cash": 18.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 MONOCRYL VIO MONO Y305H", "code_information": [{"code": "Y305H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 MONOCRYL VIO MONO Y316H", "code_information": [{"code": "Y316H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 MONOCRYL VIO MONO Y338H", "code_information": [{"code": "Y338H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 PDS II CLR MONO SH Z416H", "code_information": [{"code": "Z416H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 PDS II VIO MONO SH Z316H", "code_information": [{"code": "Z316H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 PDS PLUS VIO MONO CT1 PDP338H", "code_information": [{"code": "PDP338H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 PL GUT CT 852H", "code_information": [{"code": "852H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 PL GUT CT-1 842H", "code_information": [{"code": "842H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.64, "discounted_cash": 12.12, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 27 PL GUT PS-2 1630H", "code_information": [{"code": "1630H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 36 CTD VIC UND BR CT- J944H", "code_information": [{"code": "J944H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 36 CTD VIC VIO BR CP- J471H", "code_information": [{"code": "J471H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 8-18 CTD VIC UND BR C J838D", "code_information": [{"code": "J838D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 8-18 CTD VIC UND BR S JB864", "code_information": [{"code": "JB864", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 8-18 CTD VIC VIO BR R J713D", "code_information": [{"code": "J713D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 8-18 CTD VIC VIO BR S J774D", "code_information": [{"code": "J774D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 8-18 MONOCRYL VIO MON Y738D", "code_information": [{"code": "Y738D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 3/0 SILK BLACK BRAIDED LA54G", "code_information": [{"code": "LA54G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 30 36IN COATED VICRYL UND CT1 VCP944H", "code_information": [{"code": "VCP944H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4 0 18 CTD VIC UND BR P-3", "code_information": [{"code": "J494G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4 0 18 CTD VIC UND BR PS- J656G", "code_information": [{"code": "J656G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4 0 18 PDS II CLR MONO PS Z682G", "code_information": [{"code": "Z682G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4-0 27IN COATED VICRYL PLUS UND VCP214H", "code_information": [{"code": "VCP214H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4-0 27IN COATED VICRYL PLUS UND VCP422H", "code_information": [{"code": "VCP422H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 CHROMIC GUT 1654G", "code_information": [{"code": "1654G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.53, "discounted_cash": 8.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 CHROMIC GUT G-2 798G", "code_information": [{"code": "798G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.02, "discounted_cash": 17.86, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 CHROMIC GUT PS-2 1637G", "code_information": [{"code": "1637G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 CHROMIC GUT PS-4 1643G", "code_information": [{"code": "1643G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 CTD VIC RAPIDE BR VR494", "code_information": [{"code": "VR494", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.48, "discounted_cash": 16.97, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 CTD VIC UND BR P-3 J494H", "code_information": [{"code": "J494H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.69, "discounted_cash": 15.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 CTD VIC UND BR PS- J496H", "code_information": [{"code": "J496H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 MONOCRYL UND MONO Y682H", "code_information": [{"code": "Y682H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 MONOCRYL VIO MONO Y464G", "code_information": [{"code": "Y464G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 MONOCRYL VIO MONO Y513G", "code_information": [{"code": "Y513G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 PDS II CLR MONO P- Z494G", "code_information": [{"code": "Z494G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 PDS II CLR MONO PS Z496G", "code_information": [{"code": "Z496G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 PL GUT 1644G", "code_information": [{"code": "1644G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 PL GUT PS-2 1627H", "code_information": [{"code": "1627H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 PL GUT SC-1 1824H", "code_information": [{"code": "1824H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.08, "discounted_cash": 12.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18 PL GUT SC-1 1828H", "code_information": [{"code": "1828H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 18IN CHROMIC GUT G-3 793G", "code_information": [{"code": "793G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 27 CHROMIC GUT SH G121H", "code_information": [{"code": "G121H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 27 CHROMIC GUT SH-1 G181H", "code_information": [{"code": "G181H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 27 CTD VIC RAPIDE BR VR426", "code_information": [{"code": "VR426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 27 CTD VIC UND BR PS- J426H", "code_information": [{"code": "J426H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.69, "discounted_cash": 7.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 27 CTD VIC UND BR RB- J214H", "code_information": [{"code": "J214H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.85, "discounted_cash": 5.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 27 CTD VIC UND BR SH J415H", "code_information": [{"code": "J415H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 27 CTD VIC VIO BR RB- J304H", "code_information": [{"code": "J304H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 27 MONOCRYL VIO MONO Y315H", "code_information": [{"code": "Y315H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 4/0 27 PL GUT FS-2 H821H", "code_information": [{"code": "H821H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5 ETHIBOND 30 LR B499", "code_information": [{"code": "B499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5-0 VICRYL 18 P3 VR493", "code_information": [{"code": "VR493", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 CHROMIC GUT BL P-3 687G", "code_information": [{"code": "687G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 CHROMIC GUT BL PS- 1636G", "code_information": [{"code": "1636G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 CTD VIC UND BR P-2 J503G", "code_information": [{"code": "J503G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 CTD VIC UND BR P-3 J493G", "code_information": [{"code": "J493G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.13, "discounted_cash": 15.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 CTD VIC UND BR P-3 J493H", "code_information": [{"code": "J493H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 CTD VIC UND BR PS- J495G", "code_information": [{"code": "J495G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 CTD VIC UND BR PS- J495H", "code_information": [{"code": "J495H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 CTD VIC UND BR S-1 J671G", "code_information": [{"code": "J671G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 CTD VIC VIO BR S-1 J571G", "code_information": [{"code": "J571G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 MONOCRYL UND MONO Y490G", "code_information": [{"code": "Y490G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 PDS II CLR MONO P- Z493G", "code_information": [{"code": "Z493G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.98, "discounted_cash": 18.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 PDS II CLR MONO PS Z495G", "code_information": [{"code": "Z495G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 PDS II VIO MONO P- Z463G", "code_information": [{"code": "Z463G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 PL FST ABS GUT PC- 1915G", "code_information": [{"code": "1915G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.01, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 PL GUT P-3 686G", "code_information": [{"code": "686G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 18 PL GUT PS-3 1626G", "code_information": [{"code": "1626G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 27 CHROMIC GUT BL RB- U202H", "code_information": [{"code": "U202H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.9, "discounted_cash": 4.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 27 MONOCRYL UND MONO Y213H", "code_information": [{"code": "Y213H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 27 MONOCRYL VIO MONO Y303H", "code_information": [{"code": "Y303H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 30 PDS II VIO MONO C- Z126H", "code_information": [{"code": "Z126H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 30 PDS II VIO MONO RB Z148H", "code_information": [{"code": "Z148H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 30 PDS VIO MONO RB1 D/A PDP320H", "code_information": [{"code": "PDP320H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6 0 18 CTD VIC VIO BR TG1 J544G", "code_information": [{"code": "J544G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6 0 18 PL GUT G-1 774G", "code_information": [{"code": "774G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 12 CTD VIC VIO BR J552G", "code_information": [{"code": "J552G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 CHROMIC GUT G-1 796G", "code_information": [{"code": "796G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 CHROMIC GUT PS-4 1641G", "code_information": [{"code": "1641G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 CTD VIC UND BR P-1 J489G", "code_information": [{"code": "J489G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 CTD VIC UND BR P-3 J492G", "code_information": [{"code": "J492G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 CTD VIC VIO BR S-1 J570G", "code_information": [{"code": "J570G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 PDS II CLR MONO PC Z833G", "code_information": [{"code": "Z833G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 PL GUT BL G-6 775G", "code_information": [{"code": "775G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 PL GUT G-1 770G", "code_information": [{"code": "770G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 PL GUT TG140-8 1735G", "code_information": [{"code": "1735G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.84, "discounted_cash": 52.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 SUTURE CHROMIC GUT G-1 790G", "code_information": [{"code": "790G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 VICRYL 12 S-29 DBL ARM NDL J556G", "code_information": [{"code": "J556G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 7/0 12 CTD VIC VIO BR TG1 J566G", "code_information": [{"code": "J566G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 7/0 18 CHROMIC GUT CS175- 1745G", "code_information": [{"code": "1745G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 7/0 18 CTD VIC UND BR P-1 J488G", "code_information": [{"code": "J488G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 7/0 18 CTD VIC VIO BR TG1 J546G", "code_information": [{"code": "J546G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 8/0 12 CTD VIC VIO BR TG1 J548G", "code_information": [{"code": "J548G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 8/0 5 CTD VIC VIO BR BV13 J405G", "code_information": [{"code": "J405G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 9/0 5 VIC VIO MONO BV100- V402G", "code_information": [{"code": "V402G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ABSORBABLE SYNTHETIC SURGICAL PDS1 CT-1 Z341H", "code_information": [{"code": "Z341H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ACCU-PASS SUT SHUTTLE MONOFILAMENT #1 72201361", "code_information": [{"code": "72201361", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR #2 2.5MM", "code_information": [{"code": "1000-10-235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR 2.5MM WITH 1.4MM WHITE/BLUE SUTURE TAPE OF1032553S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1032553S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1490.0, "discounted_cash": 521.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR 4.75 HELICOIL REGENSORB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72203705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 766.8, "discounted_cash": 268.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR 4.75MM WITH SUTURE SNARE OF1034751S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1034751S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1390.0, "discounted_cash": 486.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR 5.5 HEALICOIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72203801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 731.0, "discounted_cash": 255.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR 5.5 X 12.7MM ENDO GRAVITY TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "86TAN255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 812.0, "discounted_cash": 284.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR 5.5MM HELIACOIL ULTRATAPE/ ULTRABRAID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72203708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1280.0, "discounted_cash": 448.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR BIOCOMPOSIT PUSH LOCK SHORT DX 2.9 X 12.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8923BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1178.0, "discounted_cash": 412.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR BIOCOMPOSITE SWIVELOCK DOUBLE LOADED 4.75MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324BCC-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1228.0, "discounted_cash": 429.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR DBL LOADED 5.5MM X 22MM SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2323BCT-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR DX FIBERTAK #2 MTS AR-8991", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1329.0, "discounted_cash": 465.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR GEKUCIUK 4.75MM REGEBESIRB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72203697", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 766.8, "discounted_cash": 268.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR HEALICOIL PK 4.5MM W/ONE ULTRATAPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72203981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 711.0, "discounted_cash": 248.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR KIT SONIC 2.5 X 10MM FORCE FIBER #2 C-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1910-1273S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1112.0, "discounted_cash": 389.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR KIT SONIC 2.5 X 10MM FORCE FIBER #2-0 C-2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1910-1271S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1112.0, "discounted_cash": 389.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR KIT SONIC 2.5 X 10MM FORCE FIBER#0 C-2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1910-1272S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1100.0, "discounted_cash": 385.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR KNOTLESS MICRORAPTOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72205020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR KNOTLESS SUTURE TAK AR-8934BCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8934BCK", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1138.2, "discounted_cash": 398.37, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR MORPHIX W/ NEEDLES #2 3.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-04-245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 432.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR MORPHIX XT 1000-05-245", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-05-245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1617.0, "discounted_cash": 565.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR MORPHIX XT W/ NEEDLE #0 3.5MM 1000-05-035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1000-05-035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 414.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR OSSIO FIBER 4.75MM W/ BLACK TAPE OF1034754S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1034754S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1490.0, "discounted_cash": 521.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR PEEK SWLVK 4.75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324PCT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1252.0, "discounted_cash": 438.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR ST & NDLS DX FIBERTAK AR-8990ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8990ST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1038.0, "discounted_cash": 363.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR SWIVELOCK DBL LOADED 4.75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324BCT-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 949.0, "discounted_cash": 332.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR SYSTEM OSSIOFIBER 4.75MM W/TAPE #2 SUTURES OF2034756S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF2034756S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3390.0, "discounted_cash": 1186.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR Y-KNOT RC NEEDLES ALL NO. 2 HIFI SUTURES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "YRC02N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE AND NEEDLE ASSEMBLY COBRAID 7210915", "code_information": [{"code": "7210915", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE BILE DUCT INJURY", "code_information": [{"code": "47900", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE BRAIDED 8-18 GREEN MO-6 CX45D", "code_information": [{"code": "CX45D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE BRAIDED POLY 26IN FIBERLINK CLOSED LOOP", "code_information": [{"code": "AR-8235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CAPIO SZ 0 36IN TC-43 TAPER NDL POLYESTER", "code_information": [{"code": "833-114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CAPIO SZ 0 48IN 2 TAPERCUT NDL POLYESTER", "code_information": [{"code": "833-113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CAPIO SZ 0 48IN VIOLET MONO ABSORBL MONODEK", "code_information": [{"code": "833-137", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC 3-0 UR-6", "code_information": [{"code": "N877H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.05, "discounted_cash": 4.92, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC 7-0 18IN ABSORBL MONO", "code_information": [{"code": "1797G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 0 18IN UNDYED SNGL ARM SNGL PK CONTROL RELEASE W/ CT-1 NDL", "code_information": [{"code": "CC41G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 0 27IN UNDYED CT-2 NDL SNGL ARM SNGL PK ABSORB SURG GUT STRL", "code_information": [{"code": "884H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 0 36IN UNDYED SNGL ARM SNGL PK W/ V-34 NDL", "code_information": [{"code": "944H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 1 27IN UNDYED GUT CT-1 NDL SNGL ARM SNGL PK STRL", "code_information": [{"code": "813H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 2-0 27IN CLR SNGL ARM UR-5 NDL", "code_information": [{"code": "U245H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 2/0 27 CT2 1/2CIRCLE 883H", "code_information": [{"code": "883H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 3-0 27IN UNDYED KS NDL SNGL ARM SNGL PK ABSORB SURG GUT STRL", "code_information": [{"code": "654H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 3-0 36IN ABSORBL", "code_information": [{"code": "932H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 5-0 12IN CLR UNDYED S-14 NDL DOUBLE ARM SNGL PK ABSORB SURG G", "code_information": [{"code": "1766G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 5-0 18IN CLR UNDYED P-2 NDL SNGL ARM SNGL PK ABSORB SURG GUT", "code_information": [{"code": "1658G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 5-0 18IN UNDYED GUT G-3 NEEDLE DOUBLE ARMED SINGLE PACK STERILE", "code_information": [{"code": "792G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 6-0 18IN BLUE DYED TG140-8 NDL DOUBLE ARM SNGL PK ABSORB SURG", "code_information": [{"code": "1731G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 6-0 18IN CLR UNDYED PS-3 NDL SNGL ARM SNGL PK ABSORB SURG GUT", "code_information": [{"code": "1635G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 6-0 18IN CLR UNDYED PS-6 NDL SNGL ARM SNGL PK ABSORB SURG GUT", "code_information": [{"code": "1816G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT C1637N", "code_information": [{"code": "C1637N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.29, "discounted_cash": 9.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT P-3 5-0 18IN C687N", "code_information": [{"code": "C687N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.03, "discounted_cash": 5.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT U246 U246", "code_information": [{"code": "U246", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT WITH 16 MM 3/8 CIRCLE PS-3 FINE REVERSE CUTTING NEEDLE 18\" LONG SIZE 5-0 C1636N", "code_information": [{"code": "C1636N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.7, "discounted_cash": 10.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATD VICRYL+ 4-0 PS-2 27 UNDYED VCP426H", "code_information": [{"code": "VCP426H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.8, "discounted_cash": 15.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL + ANTIBAC UND BR 1 VCP371H", "code_information": [{"code": "VCP371H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS 1 118 VIL B VCP741D", "code_information": [{"code": "VCP741D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS 2 0 27 VCP VCP266H", "code_information": [{"code": "VCP266H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS 2 0 8-1 VC VCP839D", "code_information": [{"code": "VCP839D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.56, "discounted_cash": 26.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP327H", "code_information": [{"code": "VCP327H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP332H", "code_information": [{"code": "VCP332H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP333H", "code_information": [{"code": "VCP333H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP334H", "code_information": [{"code": "VCP334H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.47, "discounted_cash": 2.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP345H", "code_information": [{"code": "VCP345H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP376H", "code_information": [{"code": "VCP376H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP415H", "code_information": [{"code": "VCP415H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP458H", "code_information": [{"code": "VCP458H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP459H", "code_information": [{"code": "VCP459H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP466H", "code_information": [{"code": "VCP466H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP683G", "code_information": [{"code": "VCP683G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP762D", "code_information": [{"code": "VCP762D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS ANTIBACTERIAL VCP917H", "code_information": [{"code": "VCP917H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS UND BR VCP260H", "code_information": [{"code": "VCP260H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS UND BR VCP603H", "code_information": [{"code": "VCP603H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.39, "discounted_cash": 3.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD VICRYL + ANTIBAC UND BR 3/0 VCP497H", "code_information": [{"code": "VCP497H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD VICRYL + ANTIBAC UND BR 4/0 VCP494G", "code_information": [{"code": "VCP494G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD VICRYL + ANTIBAC UND BR 4/0 VCP496H", "code_information": [{"code": "VCP496H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD VICRYL + ANTIBAC UND BR 5/0 VCP493G", "code_information": [{"code": "VCP493G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD VICRYL + ANTIBAC UND BR M VCPP80D", "code_information": [{"code": "VCPP80D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD VICRYL + ANTIBAC UND BR VCP493H", "code_information": [{"code": "VCP493H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD VICRYL + ANTIBAC UND BR VCP496G", "code_information": [{"code": "VCP496G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD VICRYL PLUS UND BR 36 VCP947H", "code_information": [{"code": "VCP947H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD VICRYL PLUS VIL BR 18 VCP841D", "code_information": [{"code": "VCP841D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD VICRYL PLUS VIL BR 3/0 45CM VCP104G", "code_information": [{"code": "VCP104G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 259.0, "discounted_cash": 90.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD VICRYL+ANTIBCTRL UND BR 1 VCP718T", "code_information": [{"code": "VCP718T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CUTTER W/ PORTAL SKID KNOT PUSHER", "code_information": [{"code": "AR-5845", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 661.0, "discounted_cash": 231.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE DEPLOYING TIGHTROPE II BTB AR-1588BTB-2J", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588BTB-2J", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1123.0, "discounted_cash": 393.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE DEVICE V-LOC 180 ABS CLOS 0-GR VLOCL0326", "code_information": [{"code": "VLOCL0326", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE DEXON 3/0 54 UNDYED TIE 135 CM J285G", "code_information": [{"code": "J285G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE DEXON VICRYL PLY POLYSYN J757 J757T", "code_information": [{"code": "J757T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ENDO 0 18IN VIOLET LIGA TIES MONO ABSORB VICRYL SYNTH ENDOLOOP", "code_information": [{"code": "EJ10G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ENDO STITCH SOFSILK BLACK O 48 170003", "code_information": [{"code": "170003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ENDOLOOP 18IN VIOLET ETHICON ENDOLOOP PDS II", "code_information": [{"code": "EZ10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ENDOSTITCH SURGIDAC GRN O 48 170043", "code_information": [{"code": "170043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 337.0, "discounted_cash": 117.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ENDOSTITCH SZ 0 7IN GRN COATED BRAIDED ES9 NDL", "code_information": [{"code": "173026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ENDOSTITCH SZ 2 TO 0 7IN UNDYED W/ POLYSORB", "code_information": [{"code": "170055", "type": "CDM"}], "standard_charges": [{"gross_charge": 115.0, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ENDOSTITCH SZ 2/0 7 NDL", "code_information": [{"code": "170051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETH 3-0 KS 30IN MFL BLK NABS", "code_information": [{"code": "627H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHI PK 1 18IN UNDYED STEEL LIGA TIES NON STRL MONO SURG STEEL B & S25", "code_information": [{"code": "DS25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHI PK 2-0 18IN UNDYED STEEL LIGA TIES NON STRL MONO SURG STEEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DS28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHI PK 4 18IN UNDYED STEEL LIGA TIES NON STRL MONO SURG STEEL B & S22", "code_information": [{"code": "DS22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHI PK 5 18IN UNDYED STEEL LIAGTURE TIRES NON STRL MONO SURG STEEL B & S", "code_information": [{"code": "DS20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 2-0 SH 36IN EXCEL POLY BRAIDED TAPER POINT DOUBLE ARM WHITE", "code_information": [{"code": "X513H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 3-0 GRN BRAIDED EXCEL", "code_information": [{"code": "X622H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 4 X 30IN EXCEL 2 V-37", "code_information": [{"code": "MX69", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 4-0 30IN BLACK DYED KS NDL SNGL ARM SNGL PK NON ABSORBL MONO NYL", "code_information": [{"code": "626H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 5 20IN GRN SNGL ARM SNGL PK BRAIDED POLY W/ LR NDL", "code_information": [{"code": "B409T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 5 30IN GRN DOUBLE ARM SNGL PK BRAIDED POLY W/ LR NDL", "code_information": [{"code": "B499T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND EXCEL 0 30IN GRN OS-4 NDL SNGL ARM BRAIDED POLYESTER", "code_information": [{"code": "X517H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND EXCEL 0 36IN GRN V-7 NDL DOUBLE ARM BRAIDED POLYESTER", "code_information": [{"code": "X905H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND EXCEL 2 30IN GRN LR NDL DOUBLE ARM BRAIDED SYNTH", "code_information": [{"code": "X496T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND EXCEL 2-0 27IN GRN STP-10 NDL DOUBLE ARM BRAIDED POLY", "code_information": [{"code": "X997G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND EXCEL 2-0 30IN GRN RB-1 NDL SNGL ARM BRAIDED POLYESTER", "code_information": [{"code": "X873H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND EXCEL 2-0 30IN GRN SH-2 NDL DOUBLE ARM BRAIDED POLYESTER", "code_information": [{"code": "X582H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND EXCEL 3-0 30IN GRN SH NDL SNGL ARM BRAIDED POLYESTER", "code_information": [{"code": "X832H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND EXCEL 3-0 36IN GRN RB-1 NDL DOUBLE ARM BRAIDED POLYESTER", "code_information": [{"code": "X558H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND EXCEL 5-0 18IN GRN P-3 NDL SNGL ARM BRAIDED POLYESTER", "code_information": [{"code": "X698G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND EXCEL SUTUPAK 2-0 18IN GRN LIGA TIES PRE CUT TWELVE STRANDS BRAI", "code_information": [{"code": "X185H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND SH 2-0", "code_information": [{"code": "PXX86", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND SZ 0 18IN GRN CTX NDL SNGL ARM MULTI PK CONTROL RELEASE EIGHT ST", "code_information": [{"code": "CX31D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND SZ 0 18IN GRN SIX STRAND BRAIDED NON ABSORBL POLY ETHIBOND STRL", "code_information": [{"code": "X186H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND SZ 2 27IN GRN MO-7 NDL SNGL ARM SNGL PK BRAIDED POLY", "code_information": [{"code": "D7485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.0, "discounted_cash": 35.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND SZ 2 TO 0 30IN HALF CIRC WHT BRAIDED SH2 NDL", "code_information": [{"code": "PX83H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND SZ 2-0 18IN GRN MO-6 NDL 1/2 CIRC SNGL ARM MULTI ACK CONTROL REL", "code_information": [{"code": "CX46D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND SZ 2-0 30IN WHT SNGL ARM MULTI PK BRAIDED TAPER POINT POLY W/ SH", "code_information": [{"code": "MX823", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND SZ 3-0 30IN WHT V5 TAPERCUT DOUBLE ARMED", "code_information": [{"code": "X916H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 0 30 CT-2 X412H", "code_information": [{"code": "X412H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 0 30 SH X834H", "code_information": [{"code": "X834H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 0 36 SH X524H", "code_information": [{"code": "X524H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 1 30 CT-1 X425H", "code_information": [{"code": "X425H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 1 30 CTX X865H", "code_information": [{"code": "X865H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 1 30 OS-4 X518H", "code_information": [{"code": "X518H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 1 30 OS-6 X538H", "code_information": [{"code": "X538H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 2 30 OS-4 X519H", "code_information": [{"code": "X519H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 2/0 27 UCL X114H", "code_information": [{"code": "X114H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 2/0 30 CT-1 X423H", "code_information": [{"code": "X423H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 2/0 30 CT-2 X411H", "code_information": [{"code": "X411H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 2/0 30 SH X563H", "code_information": [{"code": "X563H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 2/0 30 SH X833H", "code_information": [{"code": "X833H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 2/0 36 X523H", "code_information": [{"code": "X523H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 4 0 30 SH X831H", "code_information": [{"code": "X831H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GREEN 4/0 30 RB-1 X871H", "code_information": [{"code": "X871H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 0 30 CT-1 X424H", "code_information": [{"code": "X424H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.05, "discounted_cash": 6.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 0 8-18 CT CX21D", "code_information": [{"code": "CX21D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 0 8-18 CT-2 CX27D", "code_information": [{"code": "CX27D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 0 8-18 MO-7 CX41D", "code_information": [{"code": "CX41D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 1 8-18 CTX CX30D", "code_information": [{"code": "CX30D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 2 0 8-18 CT-2 CX26D", "code_information": [{"code": "CX26D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 2 4-30 V-37 MX69G", "code_information": [{"code": "MX69G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 110.62, "discounted_cash": 38.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 2/0 4-30 SH MX833", "code_information": [{"code": "MX833", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 2/0 8-18 MO-7 CX42D", "code_information": [{"code": "CX42D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 2/0 8-18 SH CX12D", "code_information": [{"code": "CX12D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 4/0 30 RB-1 X551H", "code_information": [{"code": "X551H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 5 4-30 CCS MB47G", "code_information": [{"code": "MB47G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.14, "discounted_cash": 47.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 5 4-30 V-37 MB66G", "code_information": [{"code": "MB66G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL GRN 5 4-30 V-40 MB46G", "code_information": [{"code": "MB46G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL WHITE 2/0 30 V-5 X917H", "code_information": [{"code": "X917H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL WHT 4/0 18 PS X695G", "code_information": [{"code": "X695G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND-EXCEL WHT 4/0 18 PS-2 X692G", "code_information": [{"code": "X692G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHICON 3-0 20IN UNDYED CP-1 NDL SNGL ARM SNGL PK NON ABSORBL MONO B&S30", "code_information": [{"code": "497G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHICON 4-0 14IN UNDYED V-26 TS NDL DOUBLE ARM SNGL PK NON ABSORBL MONO B", "code_information": [{"code": "540G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHICON 4-0 14IN UNDYED V-26 TS NDL DOUBLE ARM SNGL PK TAPERCUT NON ABSOR", "code_information": [{"code": "539G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHICON SZ 0 27IN VIOLET PDS PLUS REVERSE CUTTING ANTIBACTERIAL ABSORBL C", "code_information": [{"code": "PDP467H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHICON SZ 1 8IN TO 18IN CHROMIC GUT TAPER POINT ABSORBL MO5 NDL", "code_information": [{"code": "CC03G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHICON SZ 1 8IN TO 18IN HALF CIRC TAPER POINT CHROMIC GUT MO4 NEELDE", "code_information": [{"code": "CC01G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHICON SZ 2 3IN TO 18IN HALF CIRC VIOLET REVERSE CUTTING BRAIDED ANTIBAC", "code_information": [{"code": "VCP719T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHICON SZ 4 TO 0 18IN UNDYED PDS PLUS PRECISION POINT ANTIBACTERIAL ABSO", "code_information": [{"code": "PDP496G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIGUARD 2-0 27IN PLUS ANTIBACTERIAL COATED BRAIDED SYNTH VICRYL", "code_information": [{"code": "VCP417H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIGUARD SZ 0 27IN VIOLET ABSORBL PDS II", "code_information": [{"code": "ZB340", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 0 48IN BLACK SNGL ARM SNGL PK LOOP NYLON MONO W/ TP-1 NDL", "code_information": [{"code": "L880G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 1 60IN DYED BLACK TP-1 NDL SNGL ARM MONO SNGL PK NYLON STRL", "code_information": [{"code": "824G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 10-0 12IN BLACK DYED TG140-8 NDL DOUBLE ARM SNGL PK NON ABSORBL M", "code_information": [{"code": "7718G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 10-0 12IN DYED BLACK DOUBLE ARM SNGL PK MONO NYLON W/ CSB-6 NDL", "code_information": [{"code": "9007G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 20.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 10-0 5IN BLACK DYED BV100-4 NDL SNGL ARM SNGL PK NON ABSORBL MONO", "code_information": [{"code": "2830G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 20.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 10-0 5IN BLACK DYED BV75-4 NDL SNGL ARM SNGL PK NON ABSORBL MONO", "code_information": [{"code": "2850G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 10-0 8IN BLACK DYED TG160-4-3M NDL DOUBLE ARM SNGL PK NONABSORBAB", "code_information": [{"code": "7711G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 3-0 30IN BLACK DYED FSLX NDL SNGL ARM SNGL PK NON ABSORBL MONO NY", "code_information": [{"code": "1673H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 4-0 18IN BLACK DYED FS-2 NDL SNGL ARM SNGL PK NON ABSORBL MONO NY", "code_information": [{"code": "662G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 5-0 18IN BLACK DYED FS-2 NDL SNGL ARM SNGL PK NON ABSORBL MONO NY", "code_information": [{"code": "661H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 5-0 RD-1 18IN NYLON MONOFILAMENT SABRELOC CENTER POINT SPATULA DOUBLE ARM BLACK", "code_information": [{"code": "749G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 5-0 S-22 18IN NYLON MONOFILAMENT SABRELOC SPATULA DOUBLE ARM PLIABILIZED BLACK", "code_information": [{"code": "1740G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 6-0 18IN BLACK DYED C-2 NDL SNGL ARM SNGL PK NON ABSORBL MONO NYL", "code_information": [{"code": "667G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 6-0 18IN BLACK DYED P-1 NDL SNGL ARM SNGL PK NON ABSORBL MONO NYL", "code_information": [{"code": "697H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 6-0 18IN BLACK DYED P-3 NDL SNGL ARM SNGL PK NON ABSORBL MONO NYL", "code_information": [{"code": "1698G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.97, "discounted_cash": 12.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 6-0 18IN BLACK DYED PC-3 NDL SNGL ARM SNGL PK NON ABSORBL MONO NY", "code_information": [{"code": "1866G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 6-0 18IN CLR UNDYED P-1 NDL SNGL ARM SNGL PK NON ABSORBL MONO NYL", "code_information": [{"code": "689G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 8-0 5IN BLACK BV130-3 NDL SNGL ARM SNGL PK NON ABSORBL MONO NYLON", "code_information": [{"code": "2822G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 9-0 12IN BLACK DYED TG160-6 NDL DOUBLE ARM SNGL PK NON ABSORBL MO", "code_information": [{"code": "7760G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON BLACK 2/0 18 PS 585H", "code_information": [{"code": "585H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.99, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON BLACK 2/0 18 PS-2 593H", "code_information": [{"code": "593H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON BLACK 2/0 30 KS 628H", "code_information": [{"code": "628H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON GREEN MONO 5/0 18P-1 G695G", "code_information": [{"code": "G695G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 1 30 CTX 830H", "code_information": [{"code": "830H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 2 20 LR 460T", "code_information": [{"code": "460T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 2 20 LR 470G", "code_information": [{"code": "470G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 2 30 LR 490T", "code_information": [{"code": "490T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 2 60 TP-1 825G", "code_information": [{"code": "825G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 2/0 30 FSLX 1674H", "code_information": [{"code": "1674H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 2/0 30 PSLX 1697H", "code_information": [{"code": "1697H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.65, "discounted_cash": 13.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 3/0 30 PSL 1691H", "code_information": [{"code": "1691H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.09, "discounted_cash": 13.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 4/0 18 FS-1 1629H", "code_information": [{"code": "1629H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 6/0 18 PC-3 1966G", "code_information": [{"code": "1966G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLCK 7/0 18 P-1 1696G", "code_information": [{"code": "1696G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLCK 7/0 18 P-6 1647G", "code_information": [{"code": "1647G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 0 48 CT L886T", "code_information": [{"code": "L886T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 10/0 12 CS160-6 9000G", "code_information": [{"code": "9000G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.7, "discounted_cash": 19.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 10/0 6 CS160-6 9001G", "code_information": [{"code": "9001G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 2/0 18 FS 664G", "code_information": [{"code": "664G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 2/0 18 FS 664H", "code_information": [{"code": "664H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 5/0 18 S-14 7731G", "code_information": [{"code": "7731G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.55, "discounted_cash": 25.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 8/0 12 TG100-8 1714G", "code_information": [{"code": "1714G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.74, "discounted_cash": 15.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 8/0 5 BV130 2808G", "code_information": [{"code": "2808G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 8/0 5 BV130 2815G", "code_information": [{"code": "2815G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 9/0 12 TG140-8 7717G", "code_information": [{"code": "7717G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 9/0 5 BV100-4 2829G", "code_information": [{"code": "2829G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 9/0 5 BV130-3 2819G", "code_information": [{"code": "2819G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 9/0 5 BV130-4 2813G", "code_information": [{"code": "2813G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 9/0 5 BV130-5 2809G", "code_information": [{"code": "2809G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO UNDYED 4/0 18 P-3 691G", "code_information": [{"code": "691G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO UNDYED 4/0 18 PS-2 1611G", "code_information": [{"code": "1611G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO UNDYED 5/0 18 P-3 690G", "code_information": [{"code": "690G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON SZ 5-0 18IN BLACK PC 1 CONVENTIONAL CUTTING PLIABILIZED NYLON", "code_information": [{"code": "1955G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON SZ 9 TO 0 10IN BLACK TAPER POINT NON ABSORBL MONO", "code_information": [{"code": "2800G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIPACK SZ 4-0 18IN PRE CUT MONO TIE NABS NON STRL", "code_information": [{"code": "DS32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHLN MNO BLK 8/0 12 TG175-8 1716G", "code_information": [{"code": "1716G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHYLON 6-0 PC I", "code_information": [{"code": "1856G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERLINK 26IN BLUE NUMBER 2 FIBERWIRE W/ CLOSED LOOP", "code_information": [{"code": "AR-7235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 190.19, "discounted_cash": 66.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERLOOP 20IN NUMBER 2 BLUE SM DIAMETER W/ STRIAGHT NDL 76 MM W/ 7 MM LO", "code_information": [{"code": "AR-7234", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.9, "discounted_cash": 60.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERSTICK 2-0 50IN 12IN BLUE 2-0 FIBERWIRE ONE END STIFFENDND STRL", "code_information": [{"code": "AR-7222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERSTICK NUMBER 2 50IN 12IN BLUE ONE END STIFFENED FOR A MONO SUT OR WI", "code_information": [{"code": "AR-7209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE #5 & TW CUTTING NEEDLE", "code_information": [{"code": "AR-7212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 130.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 18IN 2-0 BLUE 17.9 MM TAPERED NDL 3/8 CIRC MULTI STRANDED ULTRA", "code_information": [{"code": "AR-7220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 18IN 4-0 BLUE SURG WOUND CLOSURE POLY W/ DIAMOND POINT NDL 18.7", "code_information": [{"code": "AR-7228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 3-0 18IN BLUE 26.2 MM DIAMOND POINT NDL 3/8 CIRC ABRASION RESIS", "code_information": [{"code": "AR-7225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 36IN 0 BLUE SURG WOUND CLOSURE ULTRA HIGH WT POLYETHLENE W/ TAP", "code_information": [{"code": "AR-7258", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 97.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 38IN 0 BLUE SURG WOUND CLOSURE ULTRA HIGH WT POLYETHLENE W/ TAP", "code_information": [{"code": "AR-7250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 20.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 38IN 2-0 BLUE ULTRA HIGH MOLECULAR WT POLYETHYLENE STRL DISP", "code_information": [{"code": "AR-7221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 38IN NUMBER 2 BLUE C-13 HALF CIRC ONE STRAND REVERSE CUTTING ND", "code_information": [{"code": "AR-7202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 38IN NUMBER 2 BLUE ULTRA HIGH MOLECULAR WT POLYETHYLENE STRL", "code_information": [{"code": "AR-7200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 38IN NUMBER 2 BLUE WHT BLACK BRAIDED 2 STRANDS ULTRA HIGH MOLEC", "code_information": [{"code": "AR-7201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 38IN NUMBER 5 BLUE ULTRA HIGH MOLECULAR WT POLYETHYLENE W/ CONV", "code_information": [{"code": "AR-7211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE GORE-TEX CV-8 18\" TTC-09 DA 8J02A", "code_information": [{"code": "8J02A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE GROOVE 1.2MM GOLD", "code_information": [{"code": "GOLD-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 503.0, "discounted_cash": 176.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE GUT SZ 3-0 27IN UNDYED SNGL ARM SNGL PK TAPER POINT PLAIN GUT W/ CT-3 NDL", "code_information": [{"code": "N862H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE HEMO-SEAL MONO BLUE 5/0 24 BV-1 9702H", "code_information": [{"code": "9702H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE IMPLANT SYSTEM LOC AR-4551", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4334.2, "discounted_cash": 1516.97, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE KNOTLESS TISSUE CONTROL DEVICE UNDYED UNIDIRECTIONAL (ANTIBACTERIAL) SYNTHETIC ABSORBABLE DEV", "code_information": [{"code": "SXMP1B108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.04, "discounted_cash": 23.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LABRALTAPE 1.5MM 36IN WHT SMOOTH WOUND CLOSURE SURG", "code_information": [{"code": "AR-7276", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 242.06, "discounted_cash": 84.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LARGE INTESTINE", "code_information": [{"code": "44604", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE LIGAPAK 3-0 54IN UNDYED LIGA REEL PLAIN GUT", "code_information": [{"code": "L102G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LIGAPAK SZ 0 54IN UNDYED LIGA REEL CHROMIC GUT", "code_information": [{"code": "L114G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LIGAPAK SZ 2-0 54IN UNDYED LIGA REEL CHROMIC GUT", "code_information": [{"code": "L113G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LIGAPAK SZ 3-0 54IN UNDYED LIGA REEL CHROMIC GUT", "code_information": [{"code": "L112G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LIGAPAK SZ 4-0 144IN BLACK LIGA REEL BRAIDED SILK", "code_information": [{"code": "LA53G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MAXON 1 5X18 GRN T-12/GS-21 DTACH 8886627573", "code_information": [{"code": "8886627573", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERS 12IN 5MM X 30MM WHT MO-4 TAPERED NDL HALF CIRC NON ABSORBL WOVEN", "code_information": [{"code": "RS23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERS 4-0 18IN WHT DYED S-2 NDL DOUBLE ARM SNGL PK NON ABSORBL BRAIDED POL", "code_information": [{"code": "1779G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERS 5-0 18IN WHT P-3 CUTTING SNGL ARM BRAIDED POLY W/ NDL", "code_information": [{"code": "R690G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERS 5MM 36IN OS-8 NEELE CUSTOM D SPECIAL BRAIDED SNGL PK SNGL ARM POLY", "code_information": [{"code": "D9212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 321.0, "discounted_cash": 112.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERS SZ 4-0 18IN WHT BRAIDED SNGL ARM POLYESTER W/ FS-2 NDL", "code_information": [{"code": "R633H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE 2 CT-1 D2052", "code_information": [{"code": "D2052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.0, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE 5-0 S-24 18IN POLYESTER BRAIDED SABRELOC SPATULA DOUBLE ARM GREEN", "code_information": [{"code": "1761G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE 5MM 12IN WHT CTX NDL DOUBLE ARM WOVEN TAPE POLYESTER", "code_information": [{"code": "RS22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE 80MM 12IN WHT BLUNT POINT NON ABSORBL WOVEN", "code_information": [{"code": "RS20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE GRN 0 30 CT-1 R424H", "code_information": [{"code": "R424H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE GRN 0 8-18 CT-1 MR21T", "code_information": [{"code": "MR21T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE GRN 1 30 LR R495T", "code_information": [{"code": "R495T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE GRN 2/0 30 SH R833H", "code_information": [{"code": "R833H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE GRN 3/0 30 SH R832H", "code_information": [{"code": "R832H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE WHITE 5/0 18 S-14 1760G", "code_information": [{"code": "1760G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.0, "discounted_cash": 37.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE WHT 2 0 18 FS R665H", "code_information": [{"code": "R665H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE WHT 3 0 18 FS-1 R647H", "code_information": [{"code": "R647H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE WHT 4 0 18 P-3 R691G", "code_information": [{"code": "R691G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE WHT WOVEN 5MM 12 BP-1 RS21", "code_information": [{"code": "RS21", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 0 27IN VIOLET CT-2 NDL SNGL ARM MONO SYNTH", "code_information": [{"code": "Y334H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 2-0 18IN VIOLET STERNAL ABSORBL MONO", "code_information": [{"code": "Y739D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 27 4-0 3/8 CIRCLE Y426H", "code_information": [{"code": "Y426H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.05, "discounted_cash": 18.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 3-0 18IN PS-2 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Y497G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 3-0 27IN KS NDL SNGL ARM MONO SYNTH", "code_information": [{"code": "Y523H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 3-0 27IN UNDYED PS-1NDL SNGL ARM MONO ABSORB SYNTH Y936H", "code_information": [{"code": "Y936H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.02, "discounted_cash": 18.91, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 3-0 36IN UNDYED W/ CT-1 NDL", "code_information": [{"code": "MCP944H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 4-0 18IN PS-2 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Y496G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 4-0 18IN UNDYED PC-3 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Y845G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 4-0 27IN RB-1 NDL POLIGLECAPRONE MONO", "code_information": [{"code": "Y214H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 4-0 27IN UNDYED PS-1 NDL SNGL ARM MONO SYNTH", "code_information": [{"code": "Y935H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 4-0 27IN UNDYED SH NDL SNGL ARM MONO SYNTH", "code_information": [{"code": "Y415H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 4-0 PC-3 18IN SYNTHETIC MONO CIRCLE 16MM 3/8", "code_information": [{"code": "MCP845G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 5-0 18IN P-3 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Y493G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 5-0 18IN PS-2 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Y495G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.5, "discounted_cash": 18.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 5-0 18IN UNDYED PC-3 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Y844G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 5-0 18IN VIOLET P-3 NDL SNGL ARM MONO SYNTH", "code_information": [{"code": "Y463G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 6-0 18IN P-1 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Y489G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 6-0 18IN P-3 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Y492G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 6-0 18IN PC-1 NDL SYNTH MONO", "code_information": [{"code": "Y833G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS SZ 2-0 27IN VIOLET ANTIBACTERIAL W/ CT-1 NDL", "code_information": [{"code": "MCP339H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 2-0 27 SH MCP417H", "code_information": [{"code": "MCP417H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 2-0 36 CT-1 MCP945H", "code_information": [{"code": "MCP945H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 3-0 18 PS-2 MCP497G", "code_information": [{"code": "MCP497G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.13, "discounted_cash": 18.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 3-0 27 PS-1 MCP936H", "code_information": [{"code": "MCP936H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 3-0 27 PS-2 MCP427H", "code_information": [{"code": "MCP427H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 3-0 27 SH MCP416H", "code_information": [{"code": "MCP416H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 4-0 18 P-3 MCP494G", "code_information": [{"code": "MCP494G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 4-0 18 PS-2 MCP496G", "code_information": [{"code": "MCP496G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 4-0 27 PS-1 MCP935H", "code_information": [{"code": "MCP935H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 4-0 27 PS-2 MCP426H", "code_information": [{"code": "MCP426H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 4-0 27 RB-1 MCP214H", "code_information": [{"code": "MCP214H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 5-0 18 P-3 MCP493G", "code_information": [{"code": "MCP493G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS UD 5-0 27 RB-1 MCP213H", "code_information": [{"code": "MCP213H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS VIO 2-0 27UR-6 MCP605H", "code_information": [{"code": "MCP605H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS VIO 4-0 18 PS-2 MCP513G", "code_information": [{"code": "MCP513G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS VIO 4-0 27 RB-1 MCP304H", "code_information": [{"code": "MCP304H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL PLUS VIO 5-0 18 P-3 MCP463G", "code_information": [{"code": "MCP463G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL SZ 0 36IN VIOLET TAPER POINT ABSORBL COATED", "code_information": [{"code": "Y398H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL SZ 2 TO 0 36IN VIOLET TAPER POINT ABSORB MONO CT2 NDL", "code_information": [{"code": "Y762H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL SZ 2-0 27IN VIOLET TAPER POINT MONO", "code_information": [{"code": "Y351H", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL SZ 3 TO 0 27IN HALF CIRC UNDYED TAPER POINT ANTIBACTERIAL ABSORB", "code_information": [{"code": "MCP416H.", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL SZ 3 TO 0 27IN VIOLET TAPER POINT ABSORBL MONO", "code_information": [{"code": "Y350H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL SZ 4 TO 0 27IN HALF CIRC VIOLET TAPER POINT ABSORB MONO", "code_information": [{"code": "Y304H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL UND RVS CUT 1/2CIRCLE 6-0 PS-6 18\" Y510G", "code_information": [{"code": "Y510G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONODEK 0 48IN M0068331371", "code_information": [{"code": "M0068331371", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOFILAMENT 0 18 NON-STERILE DS26", "code_information": [{"code": "DS26", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOFILAMENT 2 18 NON-STERILE DS24", "code_information": [{"code": "DS24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONYCRYL 4-0 18IN 13MM NDL 3/8 CIRC UNDYED P 3 NDL PRECISION POINT REVERS", "code_information": [{"code": "Y494G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.29, "discounted_cash": 7.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NICE LOOP-WHITE LOOPED SMSL50203", "code_information": [{"code": "SMSL50203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NONABSORBABLE POLYPROPYLENE SYNTHETIC", "code_information": [{"code": "833-123", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NOVAFIL SZ 4 TO 0 18IN 45 CM BLUE MONO", "code_information": [{"code": "8886442033", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON 0 18IN BLACK MO-6 SNGL ARM MULTI PK CONTROL RELEASE EIGHT STRANDS BRAI", "code_information": [{"code": "C545D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON 2-0 18IN BLACK SNGL ARM MULTI PK CONTROL RELEASE EIGHT STRANDS BR", "code_information": [{"code": "C526D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON 3-0 18IN BLACK SNGL ARM CONTROL RELEASE EIGHT STRANDS BRAIDED NYL", "code_information": [{"code": "C553D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON BLACK 0 30 CT-1 5424H", "code_information": [{"code": "5424H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON BLACK 0 8-18 CT-1 C521D", "code_information": [{"code": "C521D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON BLACK 0 8-18 CT-2 C527D", "code_information": [{"code": "C527D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON BLACK 0 8-18 MO-7 C541D", "code_information": [{"code": "C541D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON BLACK 1 30 CT-1 5425H", "code_information": [{"code": "5425H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON BLACK 1 8-18 CT-1 C520D", "code_information": [{"code": "C520D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON BLACK 1 8-18 CTX C550D", "code_information": [{"code": "C550D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON BLACK 3/0 8-18 SH C513D", "code_information": [{"code": "C513D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON BLACK 4/0 8-18 TF C584D", "code_information": [{"code": "C584D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON BLACK 5/0 18 PC-1 5665G", "code_information": [{"code": "5665G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON NONABSORB BLACK 4-0 1/2 CIRCLE 18\" RB-1 C554D", "code_information": [{"code": "C554D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.04, "discounted_cash": 16.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NYLON ETHILON 4-0 NA 18 SILK BLACK 1667ZH", "code_information": [{"code": "1667ZH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.56, "discounted_cash": 4.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE O FIBERWIRE 38\" BLUE AR-7254", "code_information": [{"code": "AR-7254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.16, "discounted_cash": 27.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE OF 1 NERVE; HAND OR FOOT COMMON SENSORY NERVE 64834", "code_information": [{"code": "64834", "type": "CPT"}, {"code": "1482162", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF 1 NERVE; HAND OR FOOT MEDIAN MOTOR THENAR 64835", "code_information": [{"code": "64835", "type": "CPT"}, {"code": "1482163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF 1 NERVE; HAND OR FOOT ULNAR MOTOR 64836", "code_information": [{"code": "64836", "type": "CPT"}, {"code": "1482164", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF BRACHIAL PLEXUS 64861", "code_information": [{"code": "64861", "type": "CPT"}, {"code": "1482165", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF DIGITAL NERVE HAND OR FOOT EA. ADD. DIGITAL NERVE 64832", "code_information": [{"code": "64832", "type": "CPT"}, {"code": "1941674", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 4908.0, "discounted_cash": 1717.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2375.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF DIGITAL NERVE HAND OR FOOT; 1 NERVE 64831", "code_information": [{"code": "64831", "type": "CPT"}, {"code": "1482166", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF INFRAPATELLAR TENDON-PRIMARY 27380", "code_information": [{"code": "27380", "type": "CPT"}, {"code": "1482167", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF IRIS-CILIARY BODY WITH RETRIEVAL OF SUTURE THROUGH SMALL INCISION 66682", "code_information": [{"code": "66682", "type": "CPT"}, {"code": "1482168", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF LUMBAR PLEXUS 64862", "code_information": [{"code": "64862", "type": "CPT"}, {"code": "1482169", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF MAJOR PERIPHERAL NERVE -ARM OR LEG-EXCEPT SCIATIC; INCLUDING TRANSPOSITION 64856", "code_information": [{"code": "64856", "type": "CPT"}, {"code": "1482171", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF MAJOR PERIPHERAL NERVE-ARM OR LEG-EXCEPT SCIATIC; WITHOUT TRANSPOSITION 64857", "code_information": [{"code": "64857", "type": "CPT"}, {"code": "1482170", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF POSTERIOR TIBIAL NERVE 64840", "code_information": [{"code": "64840", "type": "CPT"}, {"code": "1482172", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY 27385", "code_information": [{"code": "27385", "type": "CPT"}, {"code": "1482173", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF RECENT WOUND EYELID/LID MARGIN/TARSUS AND/OR CONJUNCTIVA DIRECT CLOSURE FULL THICK 67935", "code_information": [{"code": "67935", "type": "CPT"}, {"code": "11054954", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OF SCIATIC NERVE 64858", "code_information": [{"code": "64858", "type": "CPT"}, {"code": "1482174", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE OR REPAIR OF TESTICULAR INJURY 54670", "code_information": [{"code": "54670", "type": "CPT"}, {"code": "1482177", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE ORTHOCORD SZ 2 36IN VIOLET BLUE MO7 TAPERED NDL HIGH STRENGTH", "code_information": [{"code": "223114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 182.09, "discounted_cash": 63.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ORTHOCORD VIOLET BLUE ORTHO HIGH STRENGTH SHLDR ULTRA HIGH MOLECULAR WT P", "code_information": [{"code": "223113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 189.0, "discounted_cash": 66.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE OSSIOFIBER ANCHOR 4.75MM W/NEEDLES OF1034752S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF1034752S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1490.0, "discounted_cash": 521.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSER EZ PASS 30 DEGREE RIGHT", "code_information": [{"code": "904055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 490.0, "discounted_cash": 171.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSER EZ PASS 45 DEGREE DOG LEG UP", "code_information": [{"code": "904052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 490.0, "discounted_cash": 171.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSER FIRSTPASS MINI STRAIGHT", "code_information": [{"code": "72290128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSER FIRSTPASS SELF CAPTURE", "code_information": [{"code": "22-4038", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.7, "discounted_cash": 216.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSER FIRSTPASS ST SELF CAPTURE", "code_information": [{"code": "20-4038", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSER KNEE SCORPION LOW PROFILE", "code_information": [{"code": "AR-12990N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSER REVOLUTION FG0008", "code_information": [{"code": "FG0008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 232.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSER SLINGSHOT 45 UP", "code_information": [{"code": "CAT02589", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 790.86, "discounted_cash": 276.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSING WIRE", "code_information": [{"code": "AR-1255-15", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSOR PRO BARIATRIC W/LONG 10/12MM 15MM GUIDES & TRO", "code_information": [{"code": "RSG-18F-XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDO MONODERM QUILL SRS 2.5 CIRC TPR 14X14CM 2 ARM SYNTHETIC ABSORBABLE RA-1005Q", "code_information": [{"code": "RA-1005Q", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS 1 36INC CTXB ZB371", "code_information": [{"code": "ZB371", "type": "CDM"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS 4-0 PS-4", "code_information": [{"code": "Z507G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS 4-0 RB-1 27IN PLUS POLYDIOXANONE MONOFILAMENT TAPER POINT VIOLET", "code_information": [{"code": "PDP304H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 0 27 VIOLET MONO CT2 TAPER Z334H", "code_information": [{"code": "Z334H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 1 54IN VIOLET TP-1 NDL SNGL ARM SNGL PK ABSORBL SYNTH MONO", "code_information": [{"code": "Z879G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 2-0 27IN VIOLET CP-2 NDL SNGL ARM SNGL PK ABSORBL SYNTH MONO", "code_information": [{"code": "Z969H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 2-0 27IN VIOLET STRAIGHT TROCAR POINT DOUBLE ARM ABSORB SYNTH MONO", "code_information": [{"code": "Z997G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 3-0 18IN CLR PC-5 NDL SNGL ARM SNGL PK ABSORBL SYNTH MONO", "code_information": [{"code": "Z824G", "type": "CDM"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 3-0 27IN VIOLET RB-1 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Z305H", "type": "CDM"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 4-0 18IN CLR 1/2 CIRC PRECISION POINT SNGL ARM ABSORBL REVERSE CUT", "code_information": [{"code": "Z504G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 4-0 27IN VIOLET RB-1 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Z304H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 5-0 18IN CLR 1/2 CIRC PRECISION POINT SNGL ARM ABSORBL REVERSE CUT", "code_information": [{"code": "Z503G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 5-0 27IN VIOLET RB-1 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Z303H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 5-0 FS-2 27IN POLY MONO REVERSE CUTTING UNDYED", "code_information": [{"code": "Z421H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 6-0 18IN CLR 3/8 CIRC SNGL ARM PRECISION POINT ABSORBL REVERSE CUT", "code_information": [{"code": "Z489G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 6-0 18IN VIOLET 3/8 CIRC SNGL ARM PRECISION POINT REVERSE CUTTING", "code_information": [{"code": "Z487G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 6-0 30IN VIOLET RB-2 NDL DOUBLE ARM MONO ABSORB SYNTH", "code_information": [{"code": "Z149H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II 96IN VIOLET LOOP ANTIBACTERIAL ABSORBL MONO", "code_information": [{"code": "PDP881G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II CLEAR MONO 2-0 27 CT-1 Z259H", "code_information": [{"code": "Z259H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.54, "discounted_cash": 3.69, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II PLUS SZ 1 48IN VIOLET LOOP ANTIBACTERIAL BLUNT TIP MONO W/ BP-1 ND", "code_information": [{"code": "PDPB880G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II SZ 0 36IN VIOLET CT NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Z358T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II SZ 1 36IN CLR CT NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Z359T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II SZ 1 36IN VIOLET CT-1 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Z347H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II SZ0 CTB-1 18IN POLYDIOXANONE MONOFILAMENT BLUNT POINT CONTROL RELEASE 8 STRAND VIOLET", "code_information": [{"code": "ZB740", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS PLUS 3-0 18IN UNDYED PRECISION POINT REVERSE CUTTING .375 CIRC MONO W", "code_information": [{"code": "PDP497G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS SZ 0 36IN HALF CIRC VIOLET ETHIGUARD ABSORBL MONO", "code_information": [{"code": "ZB370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS SZ 4 TO 0 14IN VIOLET STRAIGHT TAPER POINT MONO ST4 NDL", "code_information": [{"code": "Z420G", "type": "CDM"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS2 3-0 SH 27IN MFL VIOL ABS", "code_information": [{"code": "Z316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA HND SZ 4-0 30IN BLACK SNGL ARM SNGL PK BRAIDED SLK W/ RB-1 NDL", "code_information": [{"code": "K871H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA HND SZ 5-0 30IN BLACK SNGL ARM SNGL PK BRAIDED SLK W/ C-1 NDL", "code_information": [{"code": "K890H", "type": "CDM"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA HND SZ 5-0 30IN BLACK SNGL ARM SNGL PK BRAIDED SLK W/ RB-1 NDL", "code_information": [{"code": "K870H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND 0 10X30 BLK BRAIDED SA86G", "code_information": [{"code": "SA86G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND 0 13-24 BLK BRAIDED SA76G", "code_information": [{"code": "SA76G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND 0 6-18 BLK BRAIDED A186H", "code_information": [{"code": "A186H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND 0 6-30 BKL BRAIDED A306H", "code_information": [{"code": "A306H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND 2/0 13-24 BLK BRAIDED SA75H", "code_information": [{"code": "SA75H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND 2/0 17-18 BLK BRAIDED SA65H", "code_information": [{"code": "SA65H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND 3/0 13-24 BLK BRAIDED SA74H", "code_information": [{"code": "SA74H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND 4/0 12-18 BLK BRAIDED A183H", "code_information": [{"code": "A183H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND 4/0 12-30 BLK BRAIDED A303H", "code_information": [{"code": "A303H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND 5-0 18IN BLACK BRAIDED NONABSORBABLE SILK", "code_information": [{"code": "N266H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 0 18 FSL 678G", "code_information": [{"code": "678G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 0 18 PSL 580H", "code_information": [{"code": "580H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 0 30 CT-1 424H", "code_information": [{"code": "424H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 0 30 PSL 590H", "code_information": [{"code": "590H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 2/0 18 FS 685G", "code_information": [{"code": "685G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 2/0 18 PS-2 583H", "code_information": [{"code": "583H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 2/0 18 X-1 737G", "code_information": [{"code": "737G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 2/0 30 CT-1 423H", "code_information": [{"code": "423H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 2/0 5-18 SH C0125", "code_information": [{"code": "C0125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 2/0 8-18 SH C012D", "code_information": [{"code": "C012D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 2/0 8-30 SH C016D", "code_information": [{"code": "C016D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 3/0 18 PS-1 1684G", "code_information": [{"code": "1684G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 3/0 18 PS-2 1679H", "code_information": [{"code": "1679H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 3/0 5-18 SH C013D", "code_information": [{"code": "C013D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 3/0 8-30 SH C017D", "code_information": [{"code": "C017D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 4/0 12 C-3 735G", "code_information": [{"code": "735G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 4/0 18 FS-2 683G", "code_information": [{"code": "683G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 4/0 18 P-3 641G", "code_information": [{"code": "641G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.96, "discounted_cash": 14.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 4/0 18 P-3 783G", "code_information": [{"code": "783G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 4/0 18 PS-2 1677G", "code_information": [{"code": "1677G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 4/0 5-18 SH C0145", "code_information": [{"code": "C0145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 4/0 8-18 RB-1 C054D", "code_information": [{"code": "C054D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 5/0 18 P-3 640G", "code_information": [{"code": "640G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 6 0 18 S-14 1780G", "code_information": [{"code": "1780G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 6/0 18 G-1 780G", "code_information": [{"code": "780G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 6/0 18 P-1 639G", "code_information": [{"code": "639G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLACK 6/0 18 TG14 1732G", "code_information": [{"code": "1732G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLK 0 30 SH K834H", "code_information": [{"code": "K834H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLK 0 4-30 SH M834G", "code_information": [{"code": "M834G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLK 1 30 SH K835H", "code_information": [{"code": "K835H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLK 2/0 30 SH K833H", "code_information": [{"code": "K833H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLK 3/0 30 RB-1 K872H", "code_information": [{"code": "K872H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLK 3/0 30 SH K832H", "code_information": [{"code": "K832H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLK 3/0 30 ST-1 K852H", "code_information": [{"code": "K852H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLK 4/0 18 TF-4 N272H", "code_information": [{"code": "N272H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMA-HAND BLK 6/0 18 BV-1 K802H", "code_information": [{"code": "K802H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND 0 30INC BLACK BRAIDED SNGL ARM SNGL PK SILK STRL", "code_information": [{"code": "624H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND 2-0 FSL BLACK BRAIDED SNGL ARM SNGL PK SILK STRL", "code_information": [{"code": "677G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND 2-0 KS BLACK BRAIDED SNGL ARM SNGL PK SILK STRL", "code_information": [{"code": "623H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND 3-0 FS-1 BLACK BRAIDED SNGL ARM SNGL PK SILK STRL", "code_information": [{"code": "684H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND 4-0 C-1 BLACK BRAIDED SNGL ARM SNGL PK SILK STRL", "code_information": [{"code": "7734G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND 4-0 J-1 BLACK BRAIDED SNGL ARM SNGL PK SILK STRL", "code_information": [{"code": "734G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND 6-0 C-1 BLACK BRAIDED DOUBLE ARM SNGL PK SILK STRL", "code_information": [{"code": "706G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND 6-0 G-1 BLACK BRAIDED SNGL ARM SNGL PK SILK STRL", "code_information": [{"code": "786G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND 6-0 G-6 BLACK BRAIDED DOUBLE ARM SNGL PK SILK STRL", "code_information": [{"code": "769G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND SZ 2 TO 0 18IN BLACK PRECISION POINT NON ABSORBL PSL", "code_information": [{"code": "673H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND SZ 2 TO 0 8IN TO 18IN BLACK TAPER POINT NON ABSORBL CT2 NDL", "code_information": [{"code": "C026D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND SZ 3 TO 0 10IN TO 30IN BLACK SUTUPAK PRECUT NON ABSORBL BRAIDED", "code_information": [{"code": "SA84H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND SZ 3 TO 0 30IN BLACK SLK PRECISION POINT NON ABSORBL BRAIDED PS", "code_information": [{"code": "1690H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND SZ 4 TO 0 8IN TO 18IN BLACK SLK TAPER POINT NON ABSORBL BRAIDED", "code_information": [{"code": "M104T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND SZ 4 TO 0 8IN TO 30IN BLACK TAPER POINT NON ABSORBL BRAIDED", "code_information": [{"code": "C018D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PERMAHAND SZ 5 TO 0 18IN BLACK TAPER POINT NON ABSORBL BRAIDED TF4 NDL", "code_information": [{"code": "N271H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT 2-0 27IN UNDYED GUT CT-1 NDL SNGL ARM SNGL PK STRL", "code_information": [{"code": "843H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT 3-0 27IN UNDYED FS-2 NDL SNGL ARM SNGL PACK", "code_information": [{"code": "H822H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT 3-0 27IN UNDYED SH NDL SNGL ARM SNGL PACK", "code_information": [{"code": "G322H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT 3-0 X-1 18IN", "code_information": [{"code": "612G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT 4-0 18IN CLR UNDYED PS-4 NDL SNGL ARM SNGL PK FAST ABSORBING SU", "code_information": [{"code": "1633G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT 4-0 27IN CLR RB-1 NDL TAPER POINT", "code_information": [{"code": "U207H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT 5-0 18IN UNDYED P-2 NDL SNGL ARM SNGL PK FAST ABSORBING SURG GU", "code_information": [{"code": "658G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT 5-0 27IN UNDYED FS-2 NDL SNGL ARM SNGL PACK", "code_information": [{"code": "H820G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT 6-0 18IN CLR UNDYED PC-1 NDL SNGL ARM SNGL PK FAST ABSORBING MO", "code_information": [{"code": "1916G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT MONOFILAMENT MICROPOINT REVERSE SIZE:4-0 NEEDLE:G-3 LENGTH:18IN", "code_information": [{"code": "773G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT MONOFILAMENT MICROPOINT REVERSE SIZE:5-0 NEEDLE:G-3 LENGTH:18IN", "code_information": [{"code": "772G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN REEL 2-0", "code_information": [{"code": "L103G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 3/0 18 FS-1 663G", "code_information": [{"code": "663G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 3/0 18 FS-1 663H", "code_information": [{"code": "663H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 3/0 18 PC-5 1993G", "code_information": [{"code": "1993G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 3/0 18 PS- 1663H", "code_information": [{"code": "1663H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 3/0 18 PS- 1669H", "code_information": [{"code": "1669H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.38, "discounted_cash": 13.43, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 3/0 18 PS-1 1663G", "code_information": [{"code": "1663G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 3/0 18 X-1 642G", "code_information": [{"code": "642G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 4/0 18 FS-2 662H", "code_information": [{"code": "662H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 4/0 18 P-3 699G", "code_information": [{"code": "699G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 4/0 18 P-3 699H", "code_information": [{"code": "699H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 4/0 18 PC-3 1864G", "code_information": [{"code": "1864G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 4/0 18 PS- 1667G", "code_information": [{"code": "1667G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 4/0 18 PS- 1667H", "code_information": [{"code": "1667H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.65, "discounted_cash": 13.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 5/0 18 1965G", "code_information": [{"code": "1965G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 5/0 18 P-3 698G", "code_information": [{"code": "698G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 5/0 18 P-3 698H", "code_information": [{"code": "698H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.52, "discounted_cash": 4.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 5/0 18 PC-3 1865G", "code_information": [{"code": "1865G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 5/0 18 PS-2 1666G", "code_information": [{"code": "1666G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 5/0 18 PS-2 1666H", "code_information": [{"code": "1666H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 5/0 18 PS-3 1668G", "code_information": [{"code": "1668G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.94, "discounted_cash": 13.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 6/0 18 P-1 697G", "code_information": [{"code": "697G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLIABILIZED MONO BLK 6/0 18 PC-1 1956G", "code_information": [{"code": "1956G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLOYSORB 2-0 P-12 GS-21", "code_information": [{"code": "CL13MG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE POLYPROPYLENE CAPIO TAPERCUT 0 36IN 2 ARM MONIFILAMENT PELVIC M0068332351", "code_information": [{"code": "M0068332351", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.61, "discounted_cash": 59.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE POLYSORB 3-0 P-14", "code_information": [{"code": "SL5640G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE POLYSORB SZ 0 21IN VIOLET LOOP LIGATING LOOP", "code_information": [{"code": "EL21L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 83.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE POLYSORB SZ 2 TO 0 ES9 ENDOSTITCH", "code_information": [{"code": "170057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PRECISON-POINT BLACK 2/0 18 PS 1588H", "code_information": [{"code": "1588H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 0 18IN BLUE SNGL ARM MULTI PK CONTROL EIGHT STRANDS MONO PLYPRPLN", "code_information": [{"code": "C827G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 0 30IN BLUE DYED FSLX NDL SNGL ARM SNGL PK NON ABSORBL MONO PLYPR", "code_information": [{"code": "8690H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 0 30IN BLUE DYED SH NDL SNGL ARM SNGL PK NON ABSORBL MONO PP POLY", "code_information": [{"code": "8834H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 1 30IN DYED BLUE CTX NDL SNGL ARM MONO SNGL PK PLYPRPLN STRL", "code_information": [{"code": "8455H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 10-0 4IN DYED BLUE DOUBLE ARM SNGL PK MONO PLYPRPLN W/ CS160-6 ND", "code_information": [{"code": "9090G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 10-0 8IN BLUE DYED CIF-4 DOUBLE ARM SNGL PK NON ABSORBL MONO POLY", "code_information": [{"code": "788G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 10-0 8IN BLUE DYED STC-6 NDL DOUBLE ARM SNGL PK MONO PLYPRPLN STR", "code_information": [{"code": "1713G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 2-0 30IN BLUE DYED FSLX SNGL ARM SNGL PK NON ABSORBL MONO PP POLY", "code_information": [{"code": "8689H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 2-0 30IN DYED BLUE CT-1 NDL SNGL ARM MONO SNGL PK PLYPRPLN STRL", "code_information": [{"code": "8423H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 2-0 30IN DYED BLUE MO-6 NDL SNGL ARM MONO SNGL PK PLYPRPLN STRL", "code_information": [{"code": "8417H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 3-0 18IN BLUE DYED FS-1 NDL SNGL ARM SNGL PK NON ABSORBL MONO PP", "code_information": [{"code": "8684G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 3-0 18IN BLUE DYED PC-5 NDL SNGL ARM SNGL PK NON ABSORBL MONO PP", "code_information": [{"code": "8632G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 3-0 30IN BLUE DYED KS NDL SNGL ARM SNGL PK NON ABSORBL MONO PP PO", "code_information": [{"code": "8622H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 3-0 DNR", "code_information": [{"code": "8649H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 4-0 18IN BLUE DYED PC-5 NDL SNGL ARM SNGL PK NON ABSORBL MONO PP", "code_information": [{"code": "8631G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 4-0 18IN BLUE DYED RB-1 NDL DOUBLE ARM SNGL PK NON ABSORBL MONO P", "code_information": [{"code": "8757H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 4-0 18IN CLR UNDYED PS-4 NDL SNGL ARM SNGL PK NON ABSORBL MONO PP", "code_information": [{"code": "8603G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 4-0 36IN BLUE C1 MONO", "code_information": [{"code": "8519H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 4-0 36IN DYED BLUE SH NDL SNGL ARM MONO SNGL PK PLYPRPLN STRL", "code_information": [{"code": "8521H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 4IN X 24IN SZ 7 TO 0 BLUE DOUBLE ARMED", "code_information": [{"code": "M8702", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.0, "discounted_cash": 46.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 5-0 12IN BLUE DYED SM-1 NDL DOUBLE ARM SNGL PK NON ABSORBL MONO P", "code_information": [{"code": "7740G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 5-0 18IN BLUE DYED PC-1 NDL SNGL ARM SNGL PK NON ABSORBL MONO PP", "code_information": [{"code": "8618G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 5-0 24 INCH C1-C1", "code_information": [{"code": "8325H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 5-0 24IN BLUE DYED C-1 NDL DOUBLE ARM SNGL PK NON ABSORBL MONO PP", "code_information": [{"code": "8725H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 5-0 24IN BLUE RB1 MONO", "code_information": [{"code": "8555H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 5-0 24IN BLUE TF MONO", "code_information": [{"code": "8205H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 6-0 18IN BLUE DYED BV-1 NDL DOUBLE ARM SNGL PK NON ABSORBL MONO P", "code_information": [{"code": "8806H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 6-0 18IN BLUE DYED C-1 NDL DOUBLE ARM SNGL PK NON ABSORBL MONO PP", "code_information": [{"code": "8718H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 6-0 18IN CLR UNDYED P-1 NDL SNGL ARM SNGL PK NON ABSORBL MONO PP", "code_information": [{"code": "8606G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 6-0 3/8 CIRC BLUE DOUBLE ARM MONO W/ BV-1 NDL 9.3 MM", "code_information": [{"code": "M8205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 6-0 30IN BLUE C-1 NDL SNGL PK SNGL ARM NON ABSORBL MONO PP POLYME", "code_information": [{"code": "8889H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 6-0 30IN BLUE DYED C-1 NDL DOUBLE ARM SNGL PK NON ABSORBL MONO PP", "code_information": [{"code": "8706H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 7-0 18IN BLUE DYED P-1 NDL SNGL ARM SNGL PK NON ABSORBL MONO PP P", "code_information": [{"code": "8696G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 7-0 18IN BLUE DYED P-6 NDL SNGL ARM SNGL PK NON ABSORBL MONO PP P", "code_information": [{"code": "8648G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 7-0 24IN BLUE DYED BV-1 NDL DOUBLE ARM SNGL PK NON ABSORBL MONO P", "code_information": [{"code": "8702H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 8-0 24IN BLUE BV175 8", "code_information": [{"code": "8753H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 9-0 6IN BLUE DYED TG140-8 NDL DOUBLE ARM SNGL PK MONO PLYPRPLN ST", "code_information": [{"code": "1754G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLACK 0 8-18 MO-6 C845G", "code_information": [{"code": "C845G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLU 6/0 4-24 BV-1 M8805", "code_information": [{"code": "M8805", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 0 30 CT-1 8424H", "code_information": [{"code": "8424H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 0 30 CT-2 8412H", "code_information": [{"code": "8412H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 0 30 MO-6 8418H", "code_information": [{"code": "8418H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 1 30 CT-1 8425H", "code_information": [{"code": "8425H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 1 60 TP-1 8824G", "code_information": [{"code": "8824G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 1 60 XLH 8845G", "code_information": [{"code": "8845G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 2 60 T 8825G", "code_information": [{"code": "8825G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 2/0 18 FS 8685H", "code_information": [{"code": "8685H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 2/0 30 CT-2 8411H", "code_information": [{"code": "8411H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 2/0 30 KS 8623H", "code_information": [{"code": "8623H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 2/0 30 SH 8833H", "code_information": [{"code": "8833H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.22, "discounted_cash": 9.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 2/0 36 SH 8523H", "code_information": [{"code": "8523H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 2/0 48 MH 8853H", "code_information": [{"code": "8853H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 2/0 48 SH 8533H", "code_information": [{"code": "8533H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 3 0 30 CT-1 8422H", "code_information": [{"code": "8422H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 3/0 18 FS-2 8665G", "code_information": [{"code": "8665G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 3/0 18 PS-1 8663G", "code_information": [{"code": "8663G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 3/0 18 PS-2 8687H", "code_information": [{"code": "8687H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.49, "discounted_cash": 16.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 3/0 30 CT-2 8410H", "code_information": [{"code": "8410H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 3/0 30 RB-1 8872H", "code_information": [{"code": "8872H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 3/0 30 SH 8832H", "code_information": [{"code": "8832H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.21, "discounted_cash": 10.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 3/0 36 RB-1 8558H", "code_information": [{"code": "8558H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 3/0 36 SH 8522H", "code_information": [{"code": "8522H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 3/0 36 V-5 8936H", "code_information": [{"code": "8936H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 3/0 48 SH 8534H", "code_information": [{"code": "8534H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 4 0 30 SH 8831H", "code_information": [{"code": "8831H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 4/0 18 FS-2 8683G", "code_information": [{"code": "8683G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 4/0 18 P-3 8699G", "code_information": [{"code": "8699G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 4/0 18 PC-1 8619G", "code_information": [{"code": "8619G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 4/0 18 PS-2 8682G", "code_information": [{"code": "8682G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 4/0 18 PS-2 8682H", "code_information": [{"code": "8682H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.81, "discounted_cash": 18.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 4/0 30 RB-1 8871H", "code_information": [{"code": "8871H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 4/0 36 RB-1 8357H", "code_information": [{"code": "8357H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 4/0 36 RB-1 8557H", "code_information": [{"code": "8557H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5 0 30 C-1 8890H", "code_information": [{"code": "8890H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5 0 36 RB-1", "code_information": [{"code": "8356H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5/0 18 C-1 8717H", "code_information": [{"code": "8717H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5/0 18 P-3 8698G", "code_information": [{"code": "8698G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.03, "discounted_cash": 7.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5/0 18 PC-3 8635G", "code_information": [{"code": "8635G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5/0 18 PS-2 8686G", "code_information": [{"code": "8686G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.49, "discounted_cash": 6.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5/0 18 PS-3 8681G", "code_information": [{"code": "8681G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5/0 18 RB-1 8756H", "code_information": [{"code": "8756H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5/0 30 RB-2 8710H", "code_information": [{"code": "8710H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5/0 36 BB 8580H", "code_information": [{"code": "8580H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5/0 36 C-1 8720H", "code_information": [{"code": "8720H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5/0 36 CC-1 8721H", "code_information": [{"code": "8721H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 5/0 36 RB-1 8556H", "code_information": [{"code": "8556H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 6 0 30 RB-2", "code_information": [{"code": "8711H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 6/0 18 P-1 8697G", "code_information": [{"code": "8697G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.25, "discounted_cash": 7.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 6/0 18 P-3 8695G", "code_information": [{"code": "8695G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 6/0 18 PC-1 8617G", "code_information": [{"code": "8617G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 6/0 18 PC-3 8636G", "code_information": [{"code": "8636G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 6/0 18 PS-3 8680G", "code_information": [{"code": "8680G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 6/0 18 RB-2 8714H", "code_information": [{"code": "8714H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 6/0 30 BV 8776H", "code_information": [{"code": "8776H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 6/0 30 BV-1 8709H", "code_information": [{"code": "8709H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO BLUE 7/0 18 BV-1 8301H", "code_information": [{"code": "8301H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO UNDYED 4/0 18 P-3 8604G", "code_information": [{"code": "8604G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE MONO UNDYED 5/0 18 P-3 8605G", "code_information": [{"code": "8605G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE POLYPROPYLENE MONOFILAMENT SIZE:10-0 NEEDLE:TG140-8 LENGTH:12IN", "code_information": [{"code": "1771G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE POLYPROPYLENE MONOFILAMENT SIZE:10-0 NEEDLE:TG140-8 LENGTH:6IN", "code_information": [{"code": "1757G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE POLYPROPYLENE MONOFILAMENT SIZE:5-0 NEEDLE:PC-5 LENGTH:18IN", "code_information": [{"code": "8630G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE POLYPROPYLENE MONOFILAMENT TAPER SIZE:6-0 NEEDLE:BV-1 LENGTH:24IN", "code_information": [{"code": "8805H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE SZ 0 36IN BLUE NON ABSORBL MONO V7 NDL", "code_information": [{"code": "8978H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE SZ 4 TO 0 4IN TO 36IN BLUE TAPER POINT NON ABSORBL MONO RB1 NDL L", "code_information": [{"code": "M8557", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE SZ 5 TO 0 2IN TO 36IN BLUE TAPER POINT NON ABSORBL MONO C1 NDL", "code_information": [{"code": "M8220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE SZ 6 TO 0 24IN BLUE TAPER POINT MONO BV NDL", "code_information": [{"code": "M8610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 46.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE SZ 6 TO 0 BLUE TAPER POINT NON ABSORBL MONO C1 NDL", "code_information": [{"code": "8726H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE SZ 7 TO 0 19IN BLUE TAPER POINT MONO C1 NDL", "code_information": [{"code": "8800H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE SZ 7-0 24IN BLUE NONABSORBABLE MONO SS STRL", "code_information": [{"code": "8735H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE QUADLINK KIT 10MM AR-1288QAI-100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1288QAI-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6189.64, "discounted_cash": 2166.37, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE QUILL SZ 1 T9 NDL POLYDIOXANONE", "code_information": [{"code": "RA-1031Q", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RAPIDE 2-0 36IN UNDYED CT-1 NDL SNGL ARM BRAIDED ABSORBL VICRYL SYNTH", "code_information": [{"code": "VR945", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RAPIDE 3-0 18IN UNDYED PS-2 NDL SNGL ARM BRAIDED ABSORBL VICRYL SYNTH", "code_information": [{"code": "VR497", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RAPIDE 4-0 18IN UNDYED PC-3 NDL SNGL ARM BRAIDED ABSORBL VICRYL SYNTH", "code_information": [{"code": "VR845", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RAPIDE 4-0 18IN UNDYED PS-2 NDL SNGL ARM BRAIDED ABSORBL VICRYL SYNTH", "code_information": [{"code": "VR496", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RECENT WOUND; EYELID PARTIAL THICKNESS 67930", "code_information": [{"code": "67930", "type": "CPT"}, {"code": "45890200", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE RELOAD PERMANENT W/VLOC 2-0 6 VLOCN206L", "code_information": [{"code": "VLOCN206L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 277.0, "discounted_cash": 96.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RETRIEVER 10.1IN HEWSON ROUND TIP MALLEABLE UNIV", "code_information": [{"code": "71111579", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.03, "discounted_cash": 113.76, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RETRIEVER HEWSON(REPLACES 71111579)", "code_information": [{"code": "22701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SHARP SHOOTER SURGICAL UHMWPE", "code_information": [{"code": "HS4704", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SHARPSHOOTER SURGICAL PE PB4704", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PB4704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 52.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SHUTTLE ACCUPASS XL DIRECT", "code_information": [{"code": "23-2005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.75, "discounted_cash": 402.41, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 1 18IN DYED BLACK LIAGTURE TIES PRE CUT SIX STRAND BRAIDED SUTUPAK", "code_information": [{"code": "A187H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 2-0 PSLX", "code_information": [{"code": "591H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 4-0 C-1 30IN PERMA-HAND BRAIDED TAPER POINT STERILE BLACK", "code_information": [{"code": "K891H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 5-0 30IN PERMA-HAND BRAIDED SUTUPAK PRECUT TIE LABYRINTH 12 STRAND BLACK", "code_information": [{"code": "A302H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 7-0 G6 18IN BRAIDED MICROPOINT REV CUT DBL ARM BLACK", "code_information": [{"code": "768G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK BLACK 1 30 BR MH K845H", "code_information": [{"code": "K845H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK C-1 6-0 30IN", "code_information": [{"code": "K889H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK PERMA-HAND 1 SUTUPAK 10-30IN BRAIDED BLACK", "code_information": [{"code": "SA87G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLEEVE 1CM SPLIT", "code_information": [{"code": "SC.4301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK 2-0 20IN BLACK DYED CT-3 NDL SNGL ARM SNGL PK NON ABSORBL BRAIDED ANO", "code_information": [{"code": "413H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK 3-0 18IN BLACK SNGL ARM MULTI PK CONTROL RELEASE EIGHT STRANDS BRIADE", "code_information": [{"code": "C053D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK 4-0 18IN TF BLACK SNGL ARM MULTI PK CONTROL RELEASE EIGHT STRANDS BRAIDE", "code_information": [{"code": "C084D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK 5-0 18IN DYED BLACK LIGA TIES PRE CUT LENS TWELVE STRANDS BRAIDED SUT", "code_information": [{"code": "A182H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK 6-0 18IN BLACK DYED P-3 NDL SNGL ARM SNGL PK BRAIDED NON ABSORBL ANOR", "code_information": [{"code": "1639G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK PRMHND 2-0 MH 24IN BRAID BLK NABS", "code_information": [{"code": "M72T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SMALL INTESTINE", "code_information": [{"code": "44602", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE SMALL INTESTINE", "code_information": [{"code": "44603", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE SOFSILK SZ 2-0 BLACK ES9 TAPER ENDO STITCH", "code_information": [{"code": "170004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SPEEDTRAP 20MM G/W", "code_information": [{"code": "223751", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SPEEDTRAP 20MM WHITE", "code_information": [{"code": "223746", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SPIRAL PDO 30X30 DOUBLE ARM SXPD2B403", "code_information": [{"code": "SXPD2B403", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SPIRAL PGA-PCL 30 X 30 DOUBLE ARM SXMD2B410", "code_information": [{"code": "SXMD2B410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SPIRAL SZ 5 TO 0 7 CM X 7 CM 19MM REVERSE CUTTING PDO FS NDL", "code_information": [{"code": "SXPD2B421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SPIRAL UNDYED MONO 3-0 PS-1 45 CM SXMP1B102", "code_information": [{"code": "SXMP1B102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SPIRAL VIOLET MONOFILA 2-0 30CM SXPP1B410", "code_information": [{"code": "SXPP1B410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STAINLESS-STEEL MONO 3/0 18 FS-2 607G", "code_information": [{"code": "607G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX 0 DBL ARM", "code_information": [{"code": "SXPD2B409", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX 2-0 CP-2 14X14CM SPIRAL REVERSE CUTTING DOUBLE ARM UNDYED", "code_information": [{"code": "SXMD2B414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX 2-0 SPIRAL PDO TENSILE STRENGTH", "code_information": [{"code": "SXPD1B401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX 3-0 PGA/PCL 26MM 12/BX SXMD2B411", "code_information": [{"code": "SXMD2B411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX 3-0 SPIRAL PGA SXMD1B101", "code_information": [{"code": "SXMD1B101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX KNOTLESS 3-0 PS-2", "code_information": [{"code": "SXMD1B04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX KNOTLESS 4-0 PS-2", "code_information": [{"code": "SXMD1B105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX PDS PLUS 18 45CM 1 VIO SXPP1A400", "code_information": [{"code": "SXPP1A400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX PDS PLUS VIO CT-1 45CM SXPP1A404", "code_information": [{"code": "SXPP1A404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX PDS VIOLET 18 CT-2 SYM SXPP1A407", "code_information": [{"code": "SXPP1A407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX SPIRAL PDO PS-2 DYED 3-0 45CM", "code_information": [{"code": "SXPD1B100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX SPIRAL SZ1 MO-4 36X36CM PDO TAPER POINT DBL ARM VIOLET", "code_information": [{"code": "SXPD2B400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX SYMM PDS PLUS 1 CTX 24 SXPP1A445", "code_information": [{"code": "SXPP1A445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.65, "discounted_cash": 27.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX SZ1 CT 8IN SYMMETRIC PDS PLUS VIOLET", "code_information": [{"code": "SXPP1A405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATFIX 4-0 FS-1 DBL ARMED", "code_information": [{"code": "SXMD2B150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATFIX CT-1 2-0 UNDYED", "code_information": [{"code": "SXPD1B400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATFIX PS-2 4-0 UNDYED", "code_information": [{"code": "SXPD1B101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUPRAMID SZ 3-0 18IN 46 CM WHT CABLE C-1 3/8 CIRC NDL TAPER POINT LF", "code_information": [{"code": "EA-30W", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.61, "discounted_cash": 11.41, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUPRAMID SZ 4-0 18IN 46 CM WHT CABLE C-1 3/8 CIRC NDL TAPER POINT", "code_information": [{"code": "EA-40W", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.68, "discounted_cash": 11.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SURGILON 4-0 CV-22 18IN NYLON BRAIDED TAPER POINT DTACH BLACK", "code_information": [{"code": "8886195732", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUTUPAK 0 18IN CLR CHROMIC GUT LIGA TIES PRECUT 12 STRANDS", "code_information": [{"code": "SG14T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUTUPAK 4-0 18IN BLACK LIGA TIES PRE CUT BRAIDED TWELVE STRANDS SILK", "code_information": [{"code": "SA63H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUTUPAK 4-0 24IN BLACK LIGA TIES PRE CUT BRAIDED SILK", "code_information": [{"code": "SA73H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUTUPAK SZ 0 18IN BLACK LIGA TIES PRE CUT BRAIDED 17 STRANDS SLK", "code_information": [{"code": "SA66G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUTUPAK SZ 2-0 30IN BLACK LIGA TIES PRE CUT BRAIDED TEN STRANDS SLK", "code_information": [{"code": "SA85H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUTUPAK SZ 3-0 18IN BLACK LIGA TIES PRE CUT BRAIDED 17 STRANDS SLK", "code_information": [{"code": "SA64H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SWIVELOCK BIOCOMP-TENO 6.25MM X 15MM VE5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1562CDS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.0, "discounted_cash": 396.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TALAR-FIT TITANIUM 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "340-0001-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5181.0, "discounted_cash": 1813.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TAPE 1.3MM W/TAILS WHITE / BLUE", "code_information": [{"code": "AR-7500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.62, "discounted_cash": 45.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TAPE FIBERLINK 0.9MM WH/BL AR-7559", "code_information": [{"code": "AR-7559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 328.51, "discounted_cash": 114.98, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TAPE FIBERTAPE 2MM X 36MM BLUE TAPERED TO NUMBER 2 FIBERWIRE POLYETHYLENE STRL D", "code_information": [{"code": "AR-7237", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 130.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TAPE TIGERLOOP 1.3MM WH/BL", "code_information": [{"code": "AR-7535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 303.0, "discounted_cash": 106.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TAPE XBRAID TT 1.4MM PASSING LOOP NON-NEEDLED 24 3910-900-043", "code_information": [{"code": "3910-900-043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 267.96, "discounted_cash": 93.79, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TENSIONER/CUTTER FOR KNEES", "code_information": [{"code": "AR-5815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TICRON 2-0 27IN W/ 10IN STRAIGHT MENISCAL STITCHING NDL", "code_information": [{"code": "12615", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TICRON BLUE 3/0 18 PR-2/P-22 8886310943", "code_information": [{"code": "8886310943", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TICRON BLUE 5 30 C-20/HOS-14 8886302779", "code_information": [{"code": "8886302779", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TICRON STRAIGHT 254MM SC-250 8886294753", "code_information": [{"code": "8886294753", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TICRON SZ 2 TO 0 DT19 NDL", "code_information": [{"code": "8886311381", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TIGERLINK 0.9MM WH/BL AR-7559T", "code_information": [{"code": "AR-7559T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 328.51, "discounted_cash": 114.98, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TIGERLOOP 20IN 2 GRN SM DIAMETER BRAIDED SURG POLYBLEND W/ STRAIGHT NDL", "code_information": [{"code": "AR-7234T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.9, "discounted_cash": 60.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TIGERWIRE 38IN NUMBER 2 WHT BLACK 2 TAPERED NDLS HALF CIRC FOR SOFT TISSU", "code_information": [{"code": "AR-7205T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TIGERWIRE 50IN #2 12IN WHT BLACK ONE END STIFFENED SURG TIGERSTICK", "code_information": [{"code": "AR-7209T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TIGHTROPE ABS BUTTON ROUND 17MM CONCAVE AR-1588TB-17", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-17", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 596.7, "discounted_cash": 208.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TRUSHOT 1.3MM ANCHOR W/Y-KNOT", "code_information": [{"code": "Y13TN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1205.0, "discounted_cash": 421.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TRUSHOT W/Y-KNOT 1.8MM ANCHOR W/#2 HIFI SUTURE", "code_information": [{"code": "Y18TN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1205.0, "discounted_cash": 421.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ULTRATAPE 2MM COBRAID BLUE", "code_information": [{"code": "72203897", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.88, "discounted_cash": 18.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE UNDYED BRAIDED 3.0 18 LONG J864D", "code_information": [{"code": "J864D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.04, "discounted_cash": 25.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE UNDYED BRAIDED 3.0 27 LONG J416H", "code_information": [{"code": "J416H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.03, "discounted_cash": 2.46, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE UNIDIR 2-0 PDS 45CM CT-1 SXPP1B411", "code_information": [{"code": "SXPP1B411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE USP #2 ANCHOR MORPHIX 3.5MM", "code_information": [{"code": "L2-1000-03-235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1468.0, "discounted_cash": 513.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V LOC 180 2-0 45 CM GS-21 NDL ABSORBL", "code_information": [{"code": "VLOCL0325", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 180 0 ABS RELOAD 15CM VLOCA006L", "code_information": [{"code": "VLOCA006L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.56, "discounted_cash": 66.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 180 ABS 3/0 CL 18 P-14 VLOCL0124", "code_information": [{"code": "VLOCL0124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 3-0 P12 12 9 VLOCM0014", "code_information": [{"code": "VLOCM0014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 90 3-0 9 V20 VLOCM0644", "code_information": [{"code": "VLOCM0644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 9020 V-L9GF-21 VLOCM0345", "code_information": [{"code": "VLOCM0345", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC NON ABS 2-0 8 IN B VLOCN208L", "code_information": [{"code": "VLOCN208L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 113.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 0 18IN UNDYED OS-6 NDL SNGL ARM MULTI PK CONTROL RELEASE THREE STRAN", "code_information": [{"code": "J754T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 0 18IN VIOLET CT-1 NDL SNGL ARM MULTI PK CONTROL RELEASE EIGHT STRAN", "code_information": [{"code": "J740D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 0 18IN VIOLET MO-4 NDL SNGL ARM MULTI PK CONTROL RELEASE EIGHT STRAN", "code_information": [{"code": "J701D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 0 27IN UNDYED OS-8 NDL SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J534H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 0 27IN UNDYED SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ CT NDL", "code_information": [{"code": "J280H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 0 27IN VIOLET XLH NDL SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J582G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 0 36IN VIOLET SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ CT NDL", "code_information": [{"code": "J358H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 0 36IN VIOLET SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ CT-1 NDL", "code_information": [{"code": "J346H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 2-0 18IN UNDYED LIGA TIES SHRT LEN LIGA THREE STRANDS BRAIDED ABSORB", "code_information": [{"code": "J645H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 2-0 18IN VIOLET LIGA TIES SHRT LENS THREE STRANDS BRAIDED ABSORBL SY", "code_information": [{"code": "J635H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 2-0 27IN UNDYED FSL NDL SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J589H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 2-0 27IN VIOLET SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ CT-2 NDL", "code_information": [{"code": "J333H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 3-0 18IN VIOLET LIGA TIES PRE CUT LENS TWELVE STRANDS BRAIDED ABSORB", "code_information": [{"code": "J104T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 3-0 18IN VIOLET LIGA TIES SHRT LENS THREE STRANDS BRAIDED ABSORBL SY", "code_information": [{"code": "J634H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 3-0 27IN UNDYED SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J215H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 3-0 27IN UNDYED SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ FS-2 NDL", "code_information": [{"code": "J423H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 3-0 27IN UNDYED SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ SH-1 NDL", "code_information": [{"code": "J219H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 3-0 27IN VIOLET SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ CT-1 NDL", "code_information": [{"code": "J338H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 3-0 27IN VIOLET SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ CT-3 NDL", "code_information": [{"code": "J327H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 4-0 18IN UNDYED PS-2 NDL SNGL PK SNGL ARM BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J504G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 4-0 18IN UNDYED PS-5 NDL SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J594G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 4-0 18IN VIOLET ABSORB TWELVE STRAND BRAIDED VICRYL SUTUPAK STRL", "code_information": [{"code": "J103T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 4-0 27IN UNDYED KS NDL SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J662H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 4-0 27IN UNDYED SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ FS-2 NDL", "code_information": [{"code": "J422H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 4-0 27IN VIOLET SNGL ARM SNGL PK BRAIDED ABSOBABLE SYNTH W/ SH NDL", "code_information": [{"code": "J315H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 5-0 12IN VIOLET S-24 NDL DOUBLE ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J553G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 5-0 18IN UNDYED P-1 NDL SNGL PK SNGL ARM BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J490G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.07, "discounted_cash": 15.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 5-0 18IN UNDYED PS-3 NDL SNGL PK SNGL ARM BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J500G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 5-0 18IN VIOLET P-3 NDL SNGL PK SNGL ARM BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J463G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 5-0 27IN UNDYED SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ RB-1 NDL", "code_information": [{"code": "J213H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 6-0 18IN UNDYED S-14 NDL DOUBLE ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J670G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 6-0 18IN VIOLET S-28 NDL DOUBLE ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J562G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 6-0 27IN UNDYED SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ RB-1 NDL", "code_information": [{"code": "J212H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 7-0 18IN VIOLET TG160-8 NDL SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J576G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.21, "discounted_cash": 31.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 8-0 5IN VIOLET SNGL ARM SNGL PK BRAIDED ABSORBL SYNTH W/ BV130-5 NDL", "code_information": [{"code": "J401G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 8-0 8IN VIOLET TG140-8 NDL DOUBLE ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J547G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL 8-0 8IN VIOLET TG160-8 NDL DOUBLE ARM SNGL PK BRAIDED ABSORBL SYNTH", "code_information": [{"code": "J574G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 0 27IN HALF CIRC VIOLET BRAIDED ABSORBL COATED MO4 NDL", "code_information": [{"code": "J436H", "type": "CDM"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 0 27IN UNDYED ANTIBACTERIAL COATED ABSORBL BRAIDED HALF CIRC", "code_information": [{"code": "VCPB260H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 0 27IN VIOLET TAPER POINT ABSORBL COATED BRAIDED CTX NDL", "code_information": [{"code": "J364H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 0 3-18IN 45CM UNDYED TIE BRAIDED COATED STANDARD SHRT LEN ABSORBL", "code_information": [{"code": "J646H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 0 36IN HALF CIRC VIOLET TAPER POINT ABSORBL BRAIDED COATED", "code_information": [{"code": "J370H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 0 36IN VIOLET BRAIDED COATED ANTIBACTERIAL ABSORBL CT1 NDL", "code_information": [{"code": "VCP346H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 0 36IN VIOLET REVERSE CUTTING ABSORB BRAIDED COATED CP1 NDL", "code_information": [{"code": "J473H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 0 36IN VIOLET TAPER POINT ANTIBACTERIAL ABSORBL BRAIDED CTX NDL", "code_information": [{"code": "VCP370H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 0 8IN TO 18IN CR MO VIOLET TAPER POINT ANTIBACTERIAL ABSORBL COATED BRA", "code_information": [{"code": "VCP701D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 0 8IN TO 18IN CTX VIOLET TAPER POINT ANTIBACTERIAL ABSORBL COATED BRA", "code_information": [{"code": "VCP764D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 1 27IN HALF CIRC UNDYED BRAIDED REVERSE CUTTING COATED ANTIBACTER", "code_information": [{"code": "VCP569H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 1 36IN 36MM VIOLET TAPERCUT ANTIBACTERIAL BRAIDED ABSORBL COATED", "code_information": [{"code": "VCP519H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 1 36IN UNDYED SYNTH SNGL ARM SNGL PK BRAIDED W/ CTX NDL", "code_information": [{"code": "J977H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 1 36IN VIOLET TAPER POINT ANTIBACTERIAL ABSORBL BRAIDED CT1 NDL", "code_information": [{"code": "VCP347H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 1 8IN TO 18IN VIOLET TAPER POINT ANTIBACTERIAL ABSORBL BRAIDED CO", "code_information": [{"code": "VCP702D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 2 TO 0 12IN TO 18IN UNDYED PRE CUT ANTIBACTERIAL ABSORBL BRAIDED", "code_information": [{"code": "VCP111G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 2 TO 0 27IN UNDYED ETHIGUARD ANTIBACTERIAL ABSORBL BRAIDED COATED", "code_information": [{"code": "VCPB259H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 2 TO 0 27IN VIOLET REVERSE CUTTING ABSORB BRAIDED COATED BRX1 NDL", "code_information": [{"code": "J461H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 2 TO 0 36IN VIOLET TAPER POINT ANTIBACTERIAL ABSORBL COATED BRAID", "code_information": [{"code": "VCP369H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 2-0 18IN VIOLET SYNTH SNGL ARM MULTI PK CONTROL RELEASE EIGHT STR", "code_information": [{"code": "J789D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 2-0 27IN VIOLET SYNTH SNGL ARM SNGL PK BRAIDED ABSORBL W/ SH NDL", "code_information": [{"code": "J785G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 3 TO 0 27IN UNDYED PRECISION POINT RAPIDE ABSORBL COATED BRAIDED", "code_information": [{"code": "VR935", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 3 TO 0 27IN VIOLET STRAIGHT CUTTING ABSORB COATED BRAIDED K5 NDL", "code_information": [{"code": "J523H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 3 TO 0 36IN HALF CIRC UNDYED TAPERCUT RAPIDE ABSORB COATED BRAIDE", "code_information": [{"code": "VR916", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 3 TO 0 36IN UNDYED BRAIDED TAPER POINT COATED ABSORBL CT NDL", "code_information": [{"code": "J956H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 3-0 18IN UNDYED SYNTH LIGA TIES PRE CUT LENS TWELVE STRANDS BRAID", "code_information": [{"code": "J910T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 3-0 18IN UNDYED SYNTH SNGL ARM SNGL PK BRAIDED ABSORBL W/ PC-5 ND", "code_information": [{"code": "J824G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 4 TO 0 27IN VIOLET TAPER POINT ABSORB COATED BRAIDED CT NDL", "code_information": [{"code": "J337H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 4-0 18IN 24MM NDL 3/8 CIRC UNDYED PS 1 PRECISION POINT REVERSE CU", "code_information": [{"code": "J682H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 4-0 18IN UNDYED SYNTH SNGL ARM SNGL PK BRAIDED ABSORBL W/ PC-3 ND", "code_information": [{"code": "J845G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 4-0 18IN VIOLET SYNTH SNGL ARM MULTI PK CONTROL RELEASE EIGHT STR", "code_information": [{"code": "J773D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 4-0 27IN UNDYED SYNTH SNGL ARM SNGL PK BRAIDED ABSORBL W/ PS-1 ND", "code_information": [{"code": "J935H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 5-0 18IN UNDYED SYNTH SNGL ARM SNGL PK BRAIDED ABSORBL W/ PC-1 ND", "code_information": [{"code": "J834G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 5-0 18IN UNDYED SYNTH SNGL ARM SNGL PK BRAIDED ABSORBL W/ PC-3 ND", "code_information": [{"code": "J844G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 6-0 18IN UNDYED SYNTH SNGL ARM SNGL PK BRAIDED ABSORBL W/ PC-1 ND", "code_information": [{"code": "J833G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VCRL SZ 8-0 12IN VIOLET SYNTH DOUBLE ARM SNGL PK BRAIDED ABSORBL W/ TG140", "code_information": [{"code": "J974G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VIC 5-0 RB 1", "code_information": [{"code": "J303H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 0 12X18 UNDYED TIES 45 CM J912G", "code_information": [{"code": "J912G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 0 3X18 VIOLET TIES 45 CM J636H", "code_information": [{"code": "J636H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 0 54 UNDYED REEL TIE 135CM J287G", "code_information": [{"code": "J287G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 0 54 UNDYED TIES 135 CM J608H", "code_information": [{"code": "J608H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 0 6X18UNDYED TIES 45 CM J112T", "code_information": [{"code": "J112T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 0 CTXB 18IN", "code_information": [{"code": "JB724", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 0 OCSR-6 18IN CR ANTB UNDTYED", "code_information": [{"code": "VCP754T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 1 PSCR-8 18 IN", "code_information": [{"code": "VCP757T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1754.0, "discounted_cash": 613.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2 54 VIOLET TIES 135 CM J618H", "code_information": [{"code": "J618H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2-0 27IN FS-1 NDL PLUS ANTIBACTERIAL COATED", "code_information": [{"code": "VCP443H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2-0 CT BRAINDED 1/2 CIRCLE", "code_information": [{"code": "VCP751D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2-0 CT-2 27 UNDYED J269H", "code_information": [{"code": "J269H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.4, "discounted_cash": 6.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2-0 CTX", "code_information": [{"code": "J363H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2-0 ON CP-2", "code_information": [{"code": "J869H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2-0 PLUS", "code_information": [{"code": "VCP589H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2-0 PS-2 27 UNDYED J428H", "code_information": [{"code": "J428H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.51, "discounted_cash": 6.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2/0 12X18 UNDYED TIES 45CM J111T", "code_information": [{"code": "J111T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2/0 36IN ABSORBL BRAIDED SS STRL", "code_information": [{"code": "J979H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2/0 54 UNDYED RL TIE 135CM J286G", "code_information": [{"code": "J286G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 3-0 18IN POLYGLACTIN BRAIDED TIE 3 STRAND UNDYED", "code_information": [{"code": "J644H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 3-0 19MM FS-2 NDL PLUS ANTIBACTERIAL COATED", "code_information": [{"code": "VCP423H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 3-0 W/ FS-2 NDL", "code_information": [{"code": "J393H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 3/0 12X18 UNDYED TIES 45CM J110T", "code_information": [{"code": "J110T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 4-0", "code_information": [{"code": "VCP304H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 4-0 54IN UNDYED LIGA REEL BRAIDED ABSORBL SYNTH LIGAPAK", "code_information": [{"code": "J284G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 4-0 PC-3 ANTIMICROBIAL", "code_information": [{"code": "VCP845G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 4-0 PS-2 18 UNDYED J496G", "code_information": [{"code": "J496G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 6-0 PS-3 18IN", "code_information": [{"code": "J499G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS 20 UND BR 27 VCP428H", "code_information": [{"code": "VCP428H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS 3-0 RB-1 18IN POLY BRAIDED TAPER POINT 8 STRAND VIOLET", "code_information": [{"code": "VCP713D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS 3-0 UND BR 27 VCP215H", "code_information": [{"code": "VCP215H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS 40 UND BR 18 VCP835G", "code_information": [{"code": "VCP835G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS COATED 3-0 27 VCP416H", "code_information": [{"code": "VCP416H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.68, "discounted_cash": 6.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS UD BR 0 27 VCP870H", "code_information": [{"code": "VCP870H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS UD BR 0 54 VCP608H", "code_information": [{"code": "VCP608H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS UD BR 3/0 27 VCP868H", "code_information": [{"code": "VCP868H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS UD BR 4 0 18 VCP682G", "code_information": [{"code": "VCP682G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS UND BR 3/0 54 VCP285G", "code_information": [{"code": "VCP285G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS VL BR 1 27 VCP261H", "code_information": [{"code": "VCP261H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS VL BR 1 27 VCP268H", "code_information": [{"code": "VCP268H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS VL BR 1 27 VCP535H", "code_information": [{"code": "VCP535H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS VL BR 1 818 VCP765D", "code_information": [{"code": "VCP765D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS VL BR 2 0 27 VCP478H", "code_information": [{"code": "VCP478H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL PLUS VL BR 2 2-27 VCP849G", "code_information": [{"code": "VCP849G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL POLYGLACTIN BRAIDED PRECUT 12 STRAND UNDYED SIZE:4-0 LENGTH:18IN", "code_information": [{"code": "J109T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL POLYGLACTIN BRAIDED ULTIMA SIZE:10-0 NEEDLE:CS140-6 LENGTH:4IN", "code_information": [{"code": "V960G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL RAPIDE 3-0 27IN COATED BRAIDED ABSORBL SH NDL POLYGLACTIN", "code_information": [{"code": "VR416", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL SZ 0 36IN UNDYED TAPER POINT ABSORBL BRAIDED COATED", "code_information": [{"code": "J958H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL SZ 0 54IN VIOLET POLY BRAID LIGAPAK LIGATING REEL", "code_information": [{"code": "J207G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL SZ 2 3IN TO 18IN VIOLET REVERSE CUTTING ABSORBL BRAIDED", "code_information": [{"code": "J719T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL SZ 2 TO 0 12IN TO 18IN VIOLET BRAIDED PRECUT", "code_information": [{"code": "J105T", "type": "CDM"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL SZ 2 TO 0 54IN VIOLET ABSORBL STANDARD SHRT TIES BRAIDED", "code_information": [{"code": "J615H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL SZ 3 TO 0 36IN VIOLET TAPERCUT ABSORBL BRAIDED BRV3 NDL", "code_information": [{"code": "J516H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL SZ 4 TO 0 18IN UNDYED COATED BRAIDED ABSORBL", "code_information": [{"code": "J714D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL SZ 8 TO 0 9IN VIOLET TAPERCUT ABSORBL BRAIDED COATED", "code_information": [{"code": "J409G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL ULTIMA COATED 10-0 CS160-8.5MM", "code_information": [{"code": "V450G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 24.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL UNDYED 5/0 18\" ETJ493G", "code_information": [{"code": "ETJ493G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC 180 4-0 18 INCH P14", "code_information": [{"code": "VLOCL0123", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC 180 4-0 18IN P-12 CLEAR 9MM", "code_information": [{"code": "VLOCL0023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC 180 ABS 0 GRN 24 GS21 VLOCL0336", "code_information": [{"code": "VLOCL0336", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC 3-0 ABS UD 12IN P14 VLOCM0114", "code_information": [{"code": "VLOCM0114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC 3-0 ABS UD 6IN P2 VLOCM0004", "code_information": [{"code": "VLOCM0004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC 3-0 V-20 BLUE NON ABSORB VLOCN0644", "code_information": [{"code": "VLOCN0644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 56.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC 90 2/0 VL 9 GS-22 VLOCM2145", "code_information": [{"code": "VLOCM2145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC NON ABS DVC 1 BL 18 GS-21 VLOCN0327", "code_information": [{"code": "VLOCN0327", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC SZ 2 TO 0 23IN ABSORBL COATED P14 NDL", "code_information": [{"code": "VLOCM0135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC SZ 3 TO 0 19MM CLR ABSORBL W/ WOUND CLOSURE DEV", "code_information": [{"code": "VLOCL0014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC SZ 3 TO 0 6IN CLR ABSORBL POLYGLYCONATE P12 NDL", "code_information": [{"code": "VLOCL0004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE WASHER WITH #2 FIBERWIRE WITH CURVED NEEDLE AR-7000-18T", "code_information": [{"code": "AR-7000-18T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE WHT/BL COBRD LOOPED NDLE 72205181", "code_information": [{"code": "72205181", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 244.0, "discounted_cash": 85.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE XBRAID TT 1.4MM WHITE BLUE 3910-900-128", "code_information": [{"code": "3910-900-128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.72, "discounted_cash": 98.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE: PRECISION POINT NONABSORBABLE NYLON SURGICAL MONOFILAMENT SUTURE BLACK 3/0 30\" PSLX NEEDLE 1", "code_information": [{"code": "1683H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE CORKSCREW FT PEEK 4.75MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1927PST-475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE REPAIR MENISCUS NEEDLES 2-0", "code_information": [{"code": "AR-7523", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 132.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE S-TAK 3.0 SINGLE ASSY AR-8934BCST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8934BCST", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SV DOULA BRTH WRK PER 15 MIN", "code_information": [{"code": "T1032", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.75, "maximum": 519.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 519.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 519.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 519.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SV DOULA BRTH WRK PER DIEM", "code_information": [{"code": "T1033", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.75, "maximum": 519.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 519.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 519.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 519.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SVNT SARSCOV2 ELISA PLSM SRM", "code_information": [{"code": "226U", "type": "CPT"}], "standard_charges": [{"minimum": 60.89, "maximum": 169.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 107.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 169.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 169.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 169.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 60.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 60.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWAB MICRO TIP BIODEGRADABLE ENDOTRIG DISP", "code_information": [{"code": "1060S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SWAB PROCTO STERILE 16\"", "code_information": [{"code": "32-046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.67, "discounted_cash": 11.43, "setting": "both", "billing_class": "facility"}]}, {"description": "SWABSTICK ANTIMICROBIAL 4IN TRIPLES POVIDONE IODINE LF", "code_information": [{"code": "MDS093902", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SWANSON FINGER JOINT 1 W/O GROMMETS 4700001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4700001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1959.0, "discounted_cash": 685.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SWANSON FLEX TOE LATERAL 2-0 W/O GROMMETS 4260020", "code_information": [{"code": "L8642", "type": "HCPCS"}, {"code": "4260020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1718.0, "discounted_cash": 601.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SWANSON FLEX TOE REGULAR COLOR CODED SIZING SET 4460001", "code_information": [{"code": "4460001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1793.0, "discounted_cash": 627.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SWIVELOCK 4.75MM BC KNOTLESS AR-2324KBCC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324KBCC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1027.0, "discounted_cash": 359.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SWIVELOCK SP BC KL 4.75MM AR-2324KBCSP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2324KBCSP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1072.5, "discounted_cash": 375.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SYFLS TST NONTREPONEMAL ANTB", "code_information": [{"code": "65U", "type": "CPT"}], "standard_charges": [{"minimum": 26.05, "maximum": 72.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYMBIOS PAIN PUMPS: SENSORCAINE 0.125% WITH EPI. KETOROLAC .1MG/ML, KETAMINE .5MG/ML", "code_information": [{"code": "MED0198", "type": "CDM"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY DIGITAL ARTERY", "code_information": [{"code": "64820", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY SUPFC PALMAR", "code_information": [{"code": "64823", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY; CERVICAL 64802", "code_information": [{"code": "64802", "type": "CPT"}, {"code": "1482178", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY; LUMBAR 64818", "code_information": [{"code": "64818", "type": "CPT"}, {"code": "1482127", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 735.9, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 735.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYN POR HO FEM COM SZ 17 71306117", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71306117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3667.0, "discounted_cash": 1283.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SYNCOPE AND COLLAPSE", "code_information": [{"code": "312", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5101.81, "maximum": 8758.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5101.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7296.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8026.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8758.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYNDACTYLIZATION TOES 28280", "code_information": [{"code": "28280", "type": "CPT"}, {"code": "1482179", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNDESMOSIS #5 SUTURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "86SYN005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2386.0, "discounted_cash": 835.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SYNDESMOSIS SUTURE NO 5 86SYN205", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "86SYN205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4500.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYNOVECTOMY CARPOMETACARPAL JOINT 26130", "code_information": [{"code": "26130", "type": "CPT"}, {"code": "1482180", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNOVECTOMY CARPOMETACARPAL JOINT W/RECONSTRUCTION/EACH 26135", "code_information": [{"code": "26135", "type": "CPT"}, {"code": "1482181", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNOVECTOMY EXTENSOR TENDON SHEATH-FOOT 28088", "code_information": [{"code": "28088", "type": "CPT"}, {"code": "1482210", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNOVECTOMY FLEXOR TENDON SHEATH FOOT 28086", "code_information": [{"code": "28086", "type": "CPT"}, {"code": "1482183", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNOVECTOMY INTERTARSAL OR TARSOMETATARSAL JOINT EACH 28070", "code_information": [{"code": "28070", "type": "CPT"}, {"code": "1482184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNOVECTOMY METATARSALPHALANGEAL JOINT EACH 28072", "code_information": [{"code": "28072", "type": "CPT"}, {"code": "1482185", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNOVECTOMY PROXIMAL INTERPHALANGEAL JOINT 26140", "code_information": [{"code": "26140", "type": "CPT"}, {"code": "1482186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNOVECTOMY WRIST 25118", "code_information": [{"code": "25118", "type": "CPT"}, {"code": "1482187", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNOVECTOMY WRIST W /RESECTION DISTAL ULNA 25119", "code_information": [{"code": "25119", "type": "CPT"}, {"code": "1482188", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNOVECTOMY-TENDON SHEATH-RADICAL-FLEXOR TENDON-PALM AND OR FINGER-EACH 26145", "code_information": [{"code": "26145", "type": "CPT"}, {"code": "1482209", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNTHETIC BIOACTIVE MATRIX LARGE", "code_information": [{"code": "MAD-12100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6994.0, "discounted_cash": 2447.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SYNTHETIC BIOACTIVE MATRIX SMALL", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "MAD-03100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2668.0, "discounted_cash": 933.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SYNTHETIC BIOACTIVE MATRIX STANDARD", "code_information": [{"code": "MAD-06100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4522.0, "discounted_cash": 1582.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYNTHETIC SENTENCE TEST", "code_information": [{"code": "92576", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNVISC-ONE GM-F 20 8 MG/ML 6ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7325", "type": "HCPCS"}, {"code": "MED0589", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1218.0, "discounted_cash": 426.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYNVISC-ONE GM-F 20 8 MG/ML 6ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7325", "type": "HCPCS"}, {"code": "MED0589", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1218.0, "discounted_cash": 426.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYPHILIS TEST NON-TREP QUAL", "code_information": [{"code": "86592", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYPHILIS TEST NON-TREP QUANT", "code_information": [{"code": "86593", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYPHILIS TST ANTB IA QUAN", "code_information": [{"code": "210U", "type": "CPT"}], "standard_charges": [{"minimum": 26.83, "maximum": 72.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 72.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYRINGE 2 OZ. STERILE EAR/ULCER DYND70280", "code_information": [{"code": "DYND70280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE 20ML LL STERILE LATX FREE 50 303310", "code_information": [{"code": "303310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE ALLOGRAFT PUTTY DBM 10CC OSDBMP10", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "OSDBMP10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3255.0, "discounted_cash": 1139.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE BULB BLUE EAR ULCER ASPIRATION STRL", "code_information": [{"code": "35820 (d)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE CONTROL LL FINGER GRIP 8881512977", "code_information": [{"code": "8881512977", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.76, "discounted_cash": 2.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE DOUBLE AUTOLOGOUS CONDITIONED PLASMA W/ SYRNG CAP ACP STRL", "code_information": [{"code": "ABS-10010S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 482.0, "discounted_cash": 168.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE EAR 2OZ ULCER STRL DISP", "code_information": [{"code": "35820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE ENDOINK ENDOSCOPIC MARKER 10ML 1392221", "code_information": [{"code": "1392221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 34.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE EPI 7 ML PULSATOR LUER SLIP TIP PRELUBRICATED PLASTIC", "code_information": [{"code": "4900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE FLUSH LATEX FREE PREFILLED 10ML SALINE EMZE010001", "code_information": [{"code": "EMZE010001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE GENERAL USE 20 ML LUER-LOK LF STRL", "code_information": [{"code": "302830", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE GLOBAL TIP ADAPTER GG-NTA-04", "code_information": [{"code": "GG-NTA-04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 605.25, "discounted_cash": 211.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE IMPLANT INJECTABLE 1ML COAPTITE BULK AGENT", "code_information": [{"code": "L8603", "type": "HCPCS"}, {"code": "M0068903000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 741.0, "discounted_cash": 259.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE IRR CONTROL-BULB SYRNG TIP PROTECTOR SOFT TRAY AND TYVEK LIDDING LF STRL", "code_information": [{"code": "DYND20125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE IRRIGATION 50CC BULB FLASK STRL", "code_information": [{"code": "35280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE OCUCOAT 1ML SINGLE CC050S", "code_information": [{"code": "CC050S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 42.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE PLATLET RICH PLASMA STANDARD STREAM TIP", "code_information": [{"code": "51452", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE TREATMENT 2.5ML COLLAGEN IMPLANT", "code_information": [{"code": "651005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 656.0, "discounted_cash": 229.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGEINFLATION DIGITALGA KYPHX ZPANDER STRL DISP", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "A08A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGENORMAL SALINE FLUSH EMZE010001 EMZE010301", "code_information": [{"code": "EMZE010301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGES LOW-PRESSURE MEDICATION CONTROL DYNJPOLYCON1Z", "code_information": [{"code": "DYNJPOLYCON1Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYS BP > OR = 140", "code_information": [{"code": "G8753", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYS BP LESS 140", "code_information": [{"code": "G8752", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYS RSN NO DOC SPIRO", "code_information": [{"code": "M1217", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYS RSN NO PRESC BRONCHDIL", "code_information": [{"code": "G9698", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYS<140 AND DIA<90", "code_information": [{"code": "G9273", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYSRSN NO DICOM SRCH", "code_information": [{"code": "G9344", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYSTEM 1 STRIP CLOSURE SKIN 1-7/8X5 W8512", "code_information": [{"code": "W8512", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM 3R LAPIPLASTY SK23", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK23", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15553.0, "discounted_cash": 5443.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 11MM X 100MM BLADED SHIELDED TROCAR KII", "code_information": [{"code": "CFB33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 11MM X 100MM CANNULA SEAL Z THREADED SLEEVE KII", "code_information": [{"code": "CTS12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 11MM X 100MM FIRST ENTRY Z THREAD SLEEVE KII FIOS", "code_information": [{"code": "CTF33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 11MM X 100MM OPTICAL THREADED Z THREAD SLEEVE KII", "code_information": [{"code": "CTR33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 11MM X 100MM SHIELDED BLADED Z THREADED SLEEVE KII", "code_information": [{"code": "CTB33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 12MM X 100MM CANNULA SEAL Z THREADED SLEEVE KII", "code_information": [{"code": "CTS22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 12MM X 100MM FIRST ENTRY Z THREADED SLEEVE KII FIOS", "code_information": [{"code": "CTF73", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 12MM X 100MM OPTICAL Z THREAD SLEEVE TROCAR KII", "code_information": [{"code": "CTR73", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 12MM X 150MM OPTICAL TROCAR NON THREADED", "code_information": [{"code": "CTR71", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 15MM X 100MM OPTICAL THRD W/ OPTICAL SEPARATOR TECHNOLOGY KII", "code_information": [{"code": "C0R37", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 403.0, "discounted_cash": 141.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 5MM X 100MM FIRST ENTRY Z THREAD SLEEVE KII FIOS", "code_information": [{"code": "CTF03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 5MM X 100MM OPTICAL THREADED Z THREAD SLEEVE KII", "code_information": [{"code": "CTR03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 5MM X 100MM SHIELDED BLADED Z THREADED KII", "code_information": [{"code": "CTB03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 5MM X 150MM OPTICAL TROCAR THREADED KII", "code_information": [{"code": "CTR01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ACCESS 8MM X 100MM OPTICAL THREADED KII", "code_information": [{"code": "C0Q19", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ANCHORAGE 3.0MM X 12MM T8 BONE SCREW LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PLSL3012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ANCHORAGE CROSS PLATE REAMER", "code_information": [{"code": "XFR006100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1575.0, "discounted_cash": 551.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ANCHORING BI WING SILICONE FOR SPINAL CORD STIMULATIONINJEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "97792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM BALLOON DILATION 6 X 24MM SINUPLASTY RELIEVA SCOUT FRONTAL", "code_information": [{"code": "STR005252", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3778.0, "discounted_cash": 1322.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM BONE CEMENT OD11GA VERTIPORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "306510000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 199.0, "discounted_cash": 69.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM CANNULA CLEAR DISTAL RIB SMOOTH 7MM X 75MM", "code_information": [{"code": "214115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 22.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM CANNULA SLF RETAINING W/ OBTURATOR DISP", "code_information": [{"code": "AR-6572", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.6, "discounted_cash": 41.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM CEMENT MIXING ACCUMIX", "code_information": [{"code": "311.1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM CHARGING EXTERNAL FOR IMPLANTABLE NEUROSTIMULATOR", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "37754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4923.0, "discounted_cash": 1723.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM CHARGING PATIENT EXTERNAL SPINAL CORD STIMULATION", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "97754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 1442.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM CLAVICLE PLATES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CLA-002-SUP6", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2629.0, "discounted_cash": 920.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM CLSR ENDO FASCIAL SURGERY NOTCHED DETAIL DEPTH CONTROL PAD GUIDE CHANNEL", "code_information": [{"code": "EFX001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 435.0, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM COAXIAL BONE AND VERT BIOPSY 11GA X 12CM ACCESS CANNULA 14GA X 15CM BIOPS", "code_information": [{"code": "JBC1211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 99.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM COLLECTION ASPIRATION BOTTLES CAPS TOPS SAFE TOUCH LF STRL", "code_information": [{"code": "3987-901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM COLLECTION SAFETOUCH 003984-901", "code_information": [{"code": "3984-901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM DEL 3CC MIXING FOR CARTILAGE STRL", "code_information": [{"code": "ABS-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 183.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM DEL IMPLANT PECTORIAL REPAIR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3473.0, "discounted_cash": 1215.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM DISSECTOR 10 MM TO 12 MM OVAL BLLN SPACEMAKER PLUS", "code_information": [{"code": "SMSBTOVL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1245.0, "discounted_cash": 435.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM DISSECTOR ROUND BLLN BLUNT TIP TROCAR SPACEMAKER PLUS", "code_information": [{"code": "SMBTTRND", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1259.0, "discounted_cash": 440.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ENCORE HYOID & TONGUE SUSPENSION FG0002", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "FG0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5026.0, "discounted_cash": 1759.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ENDOSCOPIC BLADE AND CANNULA", "code_information": [{"code": "9900-99B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1568.0, "discounted_cash": 548.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ESOPHAGEAL ENDO CAP MIVU MI-ESO-CAP-3L", "code_information": [{"code": "MI-ESO-CAP-3L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1180.41, "discounted_cash": 413.14, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM FIXATION HAMMERTOE 2.9 X 19MM STRAIGHT 0 degree OF20029190", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF20029190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM FXTN 15MM X 15MM FUSEFORCE IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS-1515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4917.0, "discounted_cash": 1720.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM FXTN 5MM X 75MM ADVANCED SLEEVE BLADED SHIELDED KII", "code_information": [{"code": "CFS02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 37.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM GENERATOR PULSE IMPLANTABLE PRECISION PLUS", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1110-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44830.0, "discounted_cash": 15690.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM GENERATOR PULSE IMPLANTABLE W/ CHARGING KIT PRECISION PLUS", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1010C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 38724.0, "discounted_cash": 13553.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM GRAFT PREP SPEEDTRAP 30MM WHITE", "code_information": [{"code": "223749", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 95.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM GUIDE STANDARD OSTEOTOMY BLADE ACCU CUT", "code_information": [{"code": "19505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM HAMMER TOE 10MM REAMING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "220-10-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM HEAD 24MM RADIAL W/ LOCK SCREW ALIGN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ALN-RHI-240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4841.0, "discounted_cash": 1694.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM HEAD 26MM RADIAL W/ LOCK SCREW ALIGN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "ALN-RHI-260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5342.0, "discounted_cash": 1869.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM HERNIA EXTENDED PROLENE 4 CM PHSE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PHSE", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 805.0, "discounted_cash": 281.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM HERNIA LARGE PROLENE 4 CM PHSL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PHSL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 539.0, "discounted_cash": 188.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM HERNIAL ULTRAPRO LARGE 4 UHSL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UHSL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 842.0, "discounted_cash": 294.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM HERNIAL ULTRAPRO LARGE 4 UHSL6", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UHSL6", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 842.0, "discounted_cash": 294.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM HERNIAL ULTRAPRO MEDIUM 3 UHSM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UHSM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 841.0, "discounted_cash": 294.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM HERNIAL ULTRAPRO OVAL 4X4.7 UHSOV", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UHSOV", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 842.0, "discounted_cash": 294.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM HIP GENERAL UC IMP", "code_information": [{"code": "7205435", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.0, "discounted_cash": 387.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLANT 7.5MM SINUS TARSI GAITWAY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GTW-0075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8642.0, "discounted_cash": 3024.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLANT 9MM SINUS TARSI GAITWAY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "GTW-0090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7488.0, "discounted_cash": 2620.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLANT ANKLE RECONSTRUCTION LATERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-1675BC-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5834.0, "discounted_cash": 2041.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLANT BIOCOMPOSITE ACHILLES PLLA AND PEEK SPEEDBRIDGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8928BC-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3556.0, "discounted_cash": 1244.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLANT CPR MINI SCORPION DX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8690DS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3650.0, "discounted_cash": 1277.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLANT DELTOID LIGAMENT RECONSTRUCTION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8918CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5754.0, "discounted_cash": 2013.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLANT ROTATOR CUFF REPAIR W/ BIOCOMPOSITE SWIVELOCK C SPEEDBRIDGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2600SBS-4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3584.0, "discounted_cash": 1254.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLANT SZ 2 HEMI PHALANGEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HPI-0002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8642.0, "discounted_cash": 3024.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLANT SZ3 HEMI PHALANGEAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HPI-0003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8642.0, "discounted_cash": 3024.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLANTATION PENILE WILSON RETRACTOR FRAME BLUT TIP STAY HOOK SHARP TIP S", "code_information": [{"code": "TLC5042-M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 995.0, "discounted_cash": 348.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLNT 1.1MM SUT PASSING KWIRE SKIN MARKING PEN W/ RULER SUT PASSING WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8914DS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2046.0, "discounted_cash": 716.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLNT 20MM X 20MMFT AND ANKLE PROCEDURE FIRST METATARSOPHALANGEAL SPEED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "SE-2020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4060.0, "discounted_cash": 1421.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLNT ELBW TOGGLELOC FXTN DEV 2.4 MM GUIDE PIN 2 NUMBER 2 MAXBRAID SUT W", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2101.0, "discounted_cash": 735.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLNT MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION ORTHO BICOMPOSITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1360C-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3063.0, "discounted_cash": 1072.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IMPLNT ROTATOR CUFF SLF PUNCHING ARTHROSCOPIC W/ FIBERTAPE SPEEDBRIDGE BI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2600SBS-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3975.0, "discounted_cash": 1391.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM IRR BATTERY OPERATED SMOKEVAC TRUMPET VALVE CONJOINED SUCTION IRRIGATION", "code_information": [{"code": "26880", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 40.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM KNEE REPLACE STANDARD CEMENTED FEMORAL TIBL PATELLA VIVACIT E VITAMINE E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "98-0002-415-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8484.0, "discounted_cash": 2969.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM LAP HND DEV W/ GELSEAL CAP ALEXIS WOUND PROTECTOR RETRACTOR MARKING PEN A", "code_information": [{"code": "C8XX2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1220.0, "discounted_cash": 427.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM LASER SUGICAL ENT OMNIGUIDE", "code_information": [{"code": "10160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 710.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM MANAGEMENT 0.9MM 45DEG FLUID ULTRA MINI FLAREDINTREPID PLUS", "code_information": [{"code": "8065752087", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 787.0, "discounted_cash": 275.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM MIXING ADVANCED CEMENT BASE BREAKAWAY FEMORAL NOZZLE STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "306573000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM MIXING VACUUM VORTEX", "code_information": [{"code": "71270070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM NEUROSTIMULATION W/ SURESCAN MRI TECHNOLOGY PRIME ADVANCED", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "97702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24720.0, "discounted_cash": 8652.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM ORTHO-GLASS SPLINTING 4 X 15 SCSOG4L2", "code_information": [{"code": "SCSOG4L2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.4, "discounted_cash": 61.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM PIN 3.3MM CROSS SOFT TISSUE RIGIDFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1178.0, "discounted_cash": 412.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM REP MENISCAL STRAIGHT NDL POLYDIOXANONE W/ 2/0 PANACRYL LNG TERM BRAIDED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 204.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM REPAIR ELEVATE ANT APICAL PROLAPSE W/INTERPRO LITE", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "720093-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4311.0, "discounted_cash": 1508.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM REPAIR MENISCAL 0 DEGREE OMNISPAN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 692.0, "discounted_cash": 242.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM REPAIR MENISCAL 12 DEGREE OMNISPAN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228141", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 470.0, "discounted_cash": 164.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM REPAIR MENISCAL 27 DEGREE OMNISPAN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 727.0, "discounted_cash": 254.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM REPAIR POST ELEVATE APICAL W/INTEXEN LP BIOLOGIC", "code_information": [{"code": "720129-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2571.0, "discounted_cash": 899.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM REPAIR TISSUE ANCHORS SUT XCLOSE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XC-200-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.0, "discounted_cash": 1438.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM RETRACTOR DEEP SCROTAL", "code_information": [{"code": "72403867", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1198.0, "discounted_cash": 419.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM RETRIEVAL 10MMINZII", "code_information": [{"code": "CD001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM RETRIEVAL 5MM UNIVERSALINZII", "code_information": [{"code": "CD003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 118.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SCS CHARGING 36700", "code_information": [{"code": "36700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10621.5, "discounted_cash": 3717.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SHLDR 25MM MINI BASEPLATE TAPER ADAPTER GLENOSHPERE POROUS COAT COMPREHEN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "10000589", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1050.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SINUPLASTY 6MM X 16MM TIP SHAPE F-70 BLLN FRONTAL RELIEVA SPIN", "code_information": [{"code": "RS0616F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3778.0, "discounted_cash": 1322.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SINUPLASTY 6MM X 16MM TIP SHAPE M-110 BLLN MAXILLARY RELIEVA SPIN", "code_information": [{"code": "RS0616M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3589.0, "discounted_cash": 1256.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SINUPLASTY FRONTAL SINUS GUIDE CATH TIP BLLN RELIEVA", "code_information": [{"code": "RSF70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 686.0, "discounted_cash": 240.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SINUPLASTY MAXILLARY SINUS GUIDE BLLN CATH TIP RELIEVA", "code_information": [{"code": "RSM110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 46.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SINUPLASTY SPHENOID SINUS GUIDE CATH TIP BLLN RELIEVA", "code_information": [{"code": "RSS0", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 887.0, "discounted_cash": 310.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SINUPLASTY W/ MAXILLARY FRONTAL SPHENOID GUIDES 5MM", "code_information": [{"code": "RS0516MFS", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4399.0, "discounted_cash": 1539.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SINUS ILLUMINATION 100 CM LIGHTED DIST TIP DETACHABLE CONNECTOR RELIEVA L", "code_information": [{"code": "SIS-100B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1189.0, "discounted_cash": 416.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SLING FEMALE SUBFACIAL HAMMOCK MONARC", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "72404193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1705.0, "discounted_cash": 596.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SLING SINGLE INCISION ALTIS", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "519650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3022.0, "discounted_cash": 1057.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SLING SNGLINCISION CONTINENCE FEMALE MINIARC", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "720046-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2418.0, "discounted_cash": 846.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SLING TRANSOBTURATOR MID URETHRAL OBTRYX II", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "M0068505110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3497.24, "discounted_cash": 1224.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SLING W/ TENSIONING SUT", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "72403656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1640.0, "discounted_cash": 574.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SLINGINCISIONLESS W/ ONE DEL DEV AND ONE MESH ASSEMBLY SOLYX", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "M0068507000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2782.0, "discounted_cash": 973.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SPACER 10MM X 13MM X 24MM OPAL", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "8.803.053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5356.0, "discounted_cash": 1874.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SPRTN PLATELET SNGL KIT ONE DISPOSABLE SEPERATION TUBE 2 30 ML SYRNGS ONE", "code_information": [{"code": "800-1003A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 927.0, "discounted_cash": 324.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SUCTION DRY CHEST DRAIN EXIT VALVE SAHARA LF PEDI ADLT", "code_information": [{"code": "S-1100-08LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 490.52, "discounted_cash": 171.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SUPPORT VAGINAL UPHOLD", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "831-708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3464.0, "discounted_cash": 1212.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM SUPPORT VAGINAL UPHOLD LITE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "831-717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4606.0, "discounted_cash": 1612.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM THERAPY UTERINE BLLN THERAPY SYS THERMACHOICE LF", "code_information": [{"code": "1105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1269.0, "discounted_cash": 444.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM TIP 12MM X 100MM BLUNT BLLN TROCAR KII", "code_information": [{"code": "COR47", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM TRCR 12MM X 100MM BLUNT TIP BLLN W/ KII SEAL SUT TIES AND GELSEAL BOLSTER", "code_information": [{"code": "C0R47", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM TRCR 12MM X 130MM BLUNT TIP BLLN W/ KII SEAL SUT TIES AND GELSEAL BOLSTER", "code_information": [{"code": "C0R50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM YANKAUER SUCTION VITAL VUEINSTR DISP", "code_information": [{"code": "8886828006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 161.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEMIC ANTIMICRO NOT PRESC", "code_information": [{"code": "G9959", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYSTEMIC ANTIMICRO PRESC", "code_information": [{"code": "G9961", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYSTEMINFUSION 20CC DRUG PROGRAMMABLE SYNCHROMED II", "code_information": [{"code": "C1772", "type": "HCPCS"}, {"code": "8637-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23582.0, "discounted_cash": 8253.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEMINFUSION 40CC DRUG PROGRAMMABLE SYNCROMED II", "code_information": [{"code": "C1772", "type": "HCPCS"}, {"code": "8637-40", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23072.0, "discounted_cash": 8075.2, "setting": "both", "billing_class": "facility"}]}, {"description": "Safety planning interventions, each 20 minutes personally performed by the billing practitioner, including assisting the patient in the identification of the following personalized elements of a safety plan: recognizing warning signs of an impending suici", "code_information": [{"code": "G0560", "type": "HCPCS"}], "standard_charges": [{"minimum": 189.81, "maximum": 298.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 189.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 298.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 298.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 298.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Sarscov2 Vac 10 Mcg Trs-Sucr", "code_information": [{"code": "91307", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Sarscov2 Vac 50mcg/0.25ml Im", "code_information": [{"code": "91306", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Screening Hearing Loss Test", "code_information": [{"code": "92560", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Screw Reversed Peripheral 5.0mm x 38mm", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWJ338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "Sedimentation Rate", "code_information": [{"code": "85651", "type": "CPT"}, {"code": "633830", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 63.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia (ie, general anesthesia, moderate sedation), including patient monitoring, scalp, neck, hands, feet, and/or multiple digits; each additional 100 sq ", "code_information": [{"code": "976T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia (ie, general anesthesia, moderate sedation), including patient monitoring, scalp, neck, hands, feet, and/or multiple digits; first 100 sq cm", "code_information": [{"code": "975T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia (ie, general anesthesia, moderate sedation), including patient monitoring, trunk, arms, legs; each additional 100 sq cm (List separately in addition", "code_information": [{"code": "974T", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia (ie, general anesthesia, moderate sedation), including patient monitoring, trunk, arms, legs; first 100 sq cm", "code_information": [{"code": "973T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Serum Amylase", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "631567", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Serum Magnesium", "code_information": [{"code": "83735", "type": "CPT"}, {"code": "633781", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 17.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 26.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, DNA, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5x1010 Viral Particles/0.5ml Dosage, For Intramuscular Use", "code_information": [{"code": "91303", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, DNA, Spike Protein, Chimpanzee Adenovirus Oxford 1 (Chadox1) Vector, Preservative Free, 5x1010 Viral Particles/0.5ml Dosage, For Intramuscular Use", "code_information": [{"code": "91302", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 100 Mcg/0.5ml Dosage, For Intramuscular Use", "code_information": [{"code": "91301", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 30 Mcg/0.3ml Dosage, Diluent Reconstituted, For Intramuscular Use", "code_information": [{"code": "91300", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 10 mcg/0.2 mL dosage, for intramuscular use", "code_information": [{"code": "91323", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Sex Hormone Binding Globulin", "code_information": [{"code": "84270", "type": "CPT"}, {"code": "6934290", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 38.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 87.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 87.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 87.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 31.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 31.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Short-lat EP upper & lower limbs 95938", "code_information": [{"code": "95938", "type": "CPT"}, {"code": "10122568", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"minimum": 1346.15, "maximum": 8450.0, "gross_charge": 689.0, "discounted_cash": 241.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1346.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2115.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2115.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2115.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Short-latency EP trunk/head 95927", "code_information": [{"code": "95927", "type": "CPT"}, {"code": "10122569", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"minimum": 470.46, "maximum": 8450.0, "gross_charge": 1194.0, "discounted_cash": 417.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 470.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 739.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 739.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 739.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Shortwave infrared radiation imaging, surgical pathology specimen, to assist gross examination for lymph node localization in fibroadipose tissue, per specimen (List separately in addition to code for primary procedure)", "code_information": [{"code": "961T", "type": "CPT"}], "standard_charges": [{"minimum": 124.06, "maximum": 195.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 124.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 195.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 195.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 195.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Shuntogram-Non Vascular 75809", "code_information": [{"code": "75809", "type": "CPT"}, {"code": "36352090", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 933.0, "discounted_cash": 326.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 382.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 382.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 472.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 346.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 480.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 579.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 140.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 149.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Sigmoidoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for colonic stricture, including fluoroscopic guidance, when performed", "code_information": [{"code": "886T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Single Measurement Of Remaining Air Or Lung Capacity After Exhalation", "code_information": [{"code": "94250", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Special Stain; Group I for microorganisms 88312", "code_information": [{"code": "88312", "type": "CPT"}, {"code": "32071585", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 205.0, "discounted_cash": 71.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 134.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 142.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Specialty Room, Other Rooms", "code_information": [{"code": "769", "type": "RC"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 85.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Specialty Services General", "code_information": [{"code": "760", "type": "RC"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 85.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Specialty Services Observation Hours", "code_information": [{"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 85.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2", "code_information": [{"code": "C9803", "type": "HCPCS"}, {"code": "45662611", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 38.99, "gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 38.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Spinal Fusion Except Cervical With MCC", "code_information": [{"code": "459", "type": "MS-DRG"}], "standard_charges": [{"minimum": 40959.88, "maximum": 70317.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40959.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 58581.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64439.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 70317.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Fusion Except Cervical Without MCC", "code_information": [{"code": "460", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23910.45, "maximum": 41048.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23910.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34197.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37616.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 41048.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Sputum Culture 87070", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "45450230", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 167.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Stages I-III breast cancer", "code_information": [{"code": "M1394", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Stages I-III breast cancer", "code_information": [{"code": "M1401", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions", "code_information": [{"code": "G0563", "type": "HCPCS"}], "standard_charges": [{"minimum": 16389.69, "maximum": 25765.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16389.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25765.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25765.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25765.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Streptococcus pneumoniae antibody (IgG), serotypes, multiplex immunoassay, quantitative", "code_information": [{"code": "86581", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Subacute Care General", "code_information": [{"code": "190", "type": "RC"}], "standard_charges": [{"minimum": 1784.0, "maximum": 2260.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1784.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Subacute Care Level I", "code_information": [{"code": "191", "type": "RC"}], "standard_charges": [{"minimum": 1784.0, "maximum": 2260.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1784.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Subacute Care Level Ii", "code_information": [{"code": "192", "type": "RC"}], "standard_charges": [{"minimum": 1784.0, "maximum": 2260.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1784.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Subacute Care Other", "code_information": [{"code": "199", "type": "RC"}], "standard_charges": [{"minimum": 1784.0, "maximum": 2260.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2260.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1784.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Submucosal cryolysis therapy; base of tongue and lingual tonsil only", "code_information": [{"code": "980T", "type": "CPT"}], "standard_charges": [{"minimum": 1674.17, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1674.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Submucosal cryolysis therapy; soft palate only", "code_information": [{"code": "979T", "type": "CPT"}], "standard_charges": [{"minimum": 1674.17, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1674.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Submucosal cryolysis therapy; soft palate, base of tongue, and lingual tonsil", "code_information": [{"code": "978T", "type": "CPT"}], "standard_charges": [{"minimum": 1674.17, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1674.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2630.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Subsequent Cardiac Output Measurements", "code_information": [{"code": "93562", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 15187.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7311.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 15187.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Subsequent Observation Care, Typically 15 Minutes Per Day", "code_information": [{"code": "99224", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Subsequent Observation Care, Typically 25 Minutes Per Day", "code_information": [{"code": "99225", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Subsequent Observation Care, Typically 35 Minutes Per Day", "code_information": [{"code": "99226", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Surgical Pathology Level I 88300", "code_information": [{"code": "88300", "type": "CPT"}, {"code": "21844966", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 148.0, "discounted_cash": 51.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 54.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 20.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Surgical Pathology Level II 88302", "code_information": [{"code": "88302", "type": "CPT"}, {"code": "21533353", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 41.57, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 44.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Surgical Pathology Level III Complexity 88304", "code_information": [{"code": "88304", "type": "CPT"}, {"code": "3927419", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 195.0, "discounted_cash": 68.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 72.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 49.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 52.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Surgical Pathology Level IV 88305", "code_information": [{"code": "88305", "type": "CPT"}, {"code": "21533352", "type": "CDM"}, {"code": "314", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 302.0, "discounted_cash": 105.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 112.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 55.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 59.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Surgical Pathology Level V 88307", "code_information": [{"code": "88307", "type": "CPT"}, {"code": "21549775", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 427.0, "discounted_cash": 149.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 158.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 323.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 344.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Surgical Pathology Level VI 88309", "code_information": [{"code": "88309", "type": "CPT"}, {"code": "22802302", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 429.0, "discounted_cash": 150.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 159.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2519.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 449.99, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 478.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1179.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Surgical care MIPS value pathway", "code_information": [{"code": "M1425", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Surgical pathology,for prostate needle biopsy G0416", "code_information": [{"code": "G0416", "type": "HCPCS"}, {"code": "38744050", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 1136.47, "gross_charge": 720.0, "discounted_cash": 252.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 267.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 466.25, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 496.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the ", "code_information": [{"code": "98011", "type": "CPT"}], "standard_charges": [{"minimum": 693.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 693.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1089.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1089.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1089.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the d", "code_information": [{"code": "98009", "type": "CPT"}], "standard_charges": [{"minimum": 334.76, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 334.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 526.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 526.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 526.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on ", "code_information": [{"code": "98010", "type": "CPT"}], "standard_charges": [{"minimum": 527.52, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 527.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 828.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 828.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 828.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total t", "code_information": [{"code": "98008", "type": "CPT"}], "standard_charges": [{"minimum": 192.76, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 192.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 302.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 302.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 302.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total tim", "code_information": [{"code": "98015", "type": "CPT"}], "standard_charges": [{"minimum": 564.88, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 564.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 887.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 887.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 887.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time", "code_information": [{"code": "98013", "type": "CPT"}], "standard_charges": [{"minimum": 258.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 258.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 406.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 406.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 406.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total", "code_information": [{"code": "98014", "type": "CPT"}], "standard_charges": [{"minimum": 382.57, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 382.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 601.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 601.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 601.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When usin", "code_information": [{"code": "98012", "type": "CPT"}], "standard_charges": [{"minimum": 141.96, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 141.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 223.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 223.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 223.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 60", "code_information": [{"code": "98003", "type": "CPT"}], "standard_charges": [{"minimum": 759.18, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 759.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1193.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1193.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1193.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 30 ", "code_information": [{"code": "98001", "type": "CPT"}], "standard_charges": [{"minimum": 348.21, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 547.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 547.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 547.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection", "code_information": [{"code": "98002", "type": "CPT"}], "standard_charges": [{"minimum": 564.88, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 564.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 887.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 887.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 887.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code se", "code_information": [{"code": "98000", "type": "CPT"}], "standard_charges": [{"minimum": 201.76, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 317.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 317.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 317.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code sele", "code_information": [{"code": "98007", "type": "CPT"}], "standard_charges": [{"minimum": 564.88, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 564.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 887.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 887.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 887.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selec", "code_information": [{"code": "98005", "type": "CPT"}], "standard_charges": [{"minimum": 280.96, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 280.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 441.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 441.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 441.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code ", "code_information": [{"code": "98006", "type": "CPT"}], "standard_charges": [{"minimum": 418.42, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 418.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 657.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 657.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 657.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter fo", "code_information": [{"code": "98004", "type": "CPT"}], "standard_charges": [{"minimum": 150.95, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 150.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 237.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 237.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 237.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T 15 QUICK RELEASE DRIVE", "code_information": [{"code": "320-2400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1320.0, "discounted_cash": 462.0, "setting": "both", "billing_class": "facility"}]}, {"description": "T CELL ABSOLUTE COUNT", "code_information": [{"code": "86361", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 41.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 107.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 107.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 107.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T CELL ABSOLUTE COUNT/RATIO", "code_information": [{"code": "86360", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 72.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 119.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 188.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 188.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 188.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 67.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 67.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T CELLS TOTAL COUNT", "code_information": [{"code": "86359", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 58.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 96.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T-CELL DEPLETION OF HARVEST", "code_information": [{"code": "38210", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T-PLIF 9X27X0 DEG 7MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-092700-7", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "T-PLIF 9X27X0 DEG 9MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "100-092700-9", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9270.0, "discounted_cash": 3244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "T3 REVERSE", "code_information": [{"code": "84482", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 63.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 63.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T3 Uptake", "code_information": [{"code": "84479", "type": "CPT"}, {"code": "633835", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 312.0, "discounted_cash": 109.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 115.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TA MV RPR W/ARTIF CHORD TEND", "code_information": [{"code": "543T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAB IRRIGATION 1000ML", "code_information": [{"code": "MED0256", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 241.0, "discounted_cash": 84.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TACK PLATE HOLDING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PL-PTACK", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.26, "discounted_cash": 33.69, "setting": "both", "billing_class": "facility"}]}, {"description": "TACK PLATE HOLDING 1.8MM", "code_information": [{"code": "K60-18L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TACTILE BREAST IMG UNI/BI", "code_information": [{"code": "422T", "type": "CPT"}], "standard_charges": [{"minimum": 348.77, "maximum": 548.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAH RAD DEBULK/LYMPH REMOVE", "code_information": [{"code": "58954", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAH RAD DISSECT FOR DEBULK", "code_information": [{"code": "58953", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAK HOLDING .045IN X 6IN PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-0004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TAK-BB IMPLANT MTP AR-13227", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-13227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TAK-BB IMPLANT MTP THREADED AR-13227T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-13227T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 66.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TAKE HOME SUPPLY 8MG PER 0.1", "code_information": [{"code": "G1028", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.09, "maximum": 0.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAKING STATIN OR REC'D ORDER", "code_information": [{"code": "G9664", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TALECTOMY 28130", "code_information": [{"code": "28130", "type": "CPT"}, {"code": "1482189", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAMP BONE 15/2INFLATABLE KYPHX EXPRESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K15B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1724.0, "discounted_cash": 603.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TANDEM BIPOLAR COCR 53OD 28ID 71322053", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71322053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2322.0, "discounted_cash": 812.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN EA SEP/ADDL", "code_information": [{"code": "11103", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN SINGLE LES", "code_information": [{"code": "11102", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP 2.5", "code_information": [{"code": "P20-920-2500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 729.0, "discounted_cash": 255.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 4.0MM JONES CANNULATED P25-920-4000", "code_information": [{"code": "P25-920-4000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1094.0, "discounted_cash": 382.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 6.5MM GUIDEWIRE REVERSE", "code_information": [{"code": "804-03-008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8.0MM", "code_information": [{"code": "702812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 687.0, "discounted_cash": 240.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP ALTIVATE GLENOID CANN 6.5MM 804-06-318", "code_information": [{"code": "804-06-318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1314.0, "discounted_cash": 459.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BLOCK BI BY INFUSION", "code_information": [{"code": "64489", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK BI INJECTION", "code_information": [{"code": "64488", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNI BY INFUSION", "code_information": [{"code": "64487", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNIL BY INJECTION", "code_information": [{"code": "64486", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BONE 5.5MM 3-7CM TRIALTIS SPINE LNG 5161000055", "code_information": [{"code": "5161000055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 581.04, "discounted_cash": 203.36, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP CANNULATED 4.5MM", "code_information": [{"code": "P06N0261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.51, "discounted_cash": 262.68, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP CANNULATED DISP 4.5MM", "code_information": [{"code": "JF1013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.0, "discounted_cash": 363.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP CANNULATED FPR 4 MM CANNULATED SCREW", "code_information": [{"code": "311.63", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1052.0, "discounted_cash": 368.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP FOR 3.5MM CORTEX SCREWS REP100685", "code_information": [{"code": "REP100685", "type": "CDM"}], "standard_charges": [{"gross_charge": 186.0, "discounted_cash": 65.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP REUNITE FIXATION SYSTEM 2.0MM", "code_information": [{"code": "950101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 693.0, "discounted_cash": 242.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SCREW 20MM BIOCOMPRESSION CANNULATED DILATOR", "code_information": [{"code": "AR-5025TBC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SCREW 57 MM TAP DEPTH FOR 4.5 MM CORTEX SHAFT SCREW", "code_information": [{"code": "311.46", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 471.0, "discounted_cash": 164.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SCREW FOR 4 MM CANCELLOUS BONE SCREW", "code_information": [{"code": "311.34", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 281.0, "discounted_cash": 98.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SCRW 2.7MM X 100MMIN HARD BONE GOLD FOR NON TAPPING SCREWS FOR USE W/ 2.5 MM", "code_information": [{"code": "311.32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 162.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SIZE 2.3 X 10MM 8801-90044", "code_information": [{"code": "8801-90044", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 398.75, "discounted_cash": 139.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE BROADBAND CM-0322", "code_information": [{"code": "CM-0322", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE CASTING 2IN X 4 SCOTCHCAST PLUS LF FIBERGLASS POLY POROUS ROLL BRIGHT PINK", "code_information": [{"code": "82002X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE CASTING 2IN X 4YD WHT WATER ACTIVATED FIBERGLASS SCOTCHCAST LF", "code_information": [{"code": "82002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE CASTING 3IN X 4 YARDS BR GREEN WATER ACTIVATED RESIN WT BEARINGIN 20 MINUTES P", "code_information": [{"code": "82003V", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE CASTING 4IN X 4YD WHT LIGHTWEIGHT STRONG DURABLE SCOTCHCAST PLUS", "code_information": [{"code": "82004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE CASTING BRIGHT GREEN 2 X 4 YDS", "code_information": [{"code": "82002V", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE CASTING PURPLE 2 X 4 YDS", "code_information": [{"code": "82002U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE CASTING PURPLE 3 X 4 YDS", "code_information": [{"code": "82003U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE FIBERTAPE 2MM X 7IN BLUE TAPERED TO NUMBER 2 FIBERWIRE SHOULDER", "code_information": [{"code": "AR-7237-7", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE HLDR 5.25IN X 1.5IN DRAIN TUBE ORGANIZER VELCRO STRIP ADJ 3M STERIDRAPE", "code_information": [{"code": "1115 DRAIN TAPE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE KIND REMOVAL SILICONE 1 X1.5YD 2770S-1", "code_information": [{"code": "2770S-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE MEDIPORE 6\" X 10YD SOFT CLOTH 2860-6", "code_information": [{"code": "2860-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.94, "discounted_cash": 18.18, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE ORTHOPEDIC CASTING 3INX4YD FIBERGLASS SCOTCHCAST GREEN", "code_information": [{"code": "82003G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE SURG 3IN X 10YD HYPOALLERGENIC ADHSV SILK 3M DURAPORE LF", "code_information": [{"code": "1538-3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE SURGICAL DURAPORE 2X10YD 1538-2", "code_information": [{"code": "1538-2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE TIGERTAPE 2MM X 7IN WHT BLACK TAPERED TO NUMBER 2 FIBERWIRE POLYETHYLENE", "code_information": [{"code": "AR-7237-7T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.9, "discounted_cash": 60.52, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE UMB 1/18IN X 24IN WHT RADIOPAQUE COTTON LF STRL DISP", "code_information": [{"code": "U16G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE UMBILICAL 2-30 2 STRANDS U11T", "code_information": [{"code": "U11T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TARSI SINUS SZ 6 HYPOCURE IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HYP-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3255.0, "discounted_cash": 1139.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TAS CONGENITAL CAR ANOMAL", "code_information": [{"code": "33741", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB AG RESPONSE T-CELL SUSP", "code_information": [{"code": "86481", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB INTRADERMAL TEST", "code_information": [{"code": "86580", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB SCR 12 MO PRI FST BIO DZ", "code_information": [{"code": "M1003", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB SCR NO PERF", "code_information": [{"code": "M1005", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB TEST CELL IMMUN MEASURE", "code_information": [{"code": "86480", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 95.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 158.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 248.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 248.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 248.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 89.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 89.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBP GENE DETC ABNOR ALLELES", "code_information": [{"code": "81344", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGG", "code_information": [{"code": "44U", "type": "CPT"}], "standard_charges": [{"minimum": 21.4, "maximum": 59.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGM", "code_information": [{"code": "43U", "type": "CPT"}], "standard_charges": [{"minimum": 21.4, "maximum": 59.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS DXA CAL W/I&R FX RISK", "code_information": [{"code": "77089", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 297.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 297.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 297.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS I&R FX RSK QHP", "code_information": [{"code": "77092", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS TECHL CALCULATION ONLY", "code_information": [{"code": "77091", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 376.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 591.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 591.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 591.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS TECHL PREP&TRANSMIS DATA", "code_information": [{"code": "77090", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 374.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 589.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 589.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 589.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC MAG STIMJ PN 1ST NERVE", "code_information": [{"code": "766T", "type": "CPT"}], "standard_charges": [{"minimum": 641.35, "maximum": 1007.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 641.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1007.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1007.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1007.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC MAG STIMJ PN EA ADDL NRV", "code_information": [{"code": "767T", "type": "CPT"}], "standard_charges": [{"minimum": 810.56, "maximum": 1273.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 810.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1273.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1273.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1273.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC MEAS 5 BMRK SFDI M-S ALYS", "code_information": [{"code": "61U", "type": "CPT"}], "standard_charges": [{"minimum": 36.14, "maximum": 100.65, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 100.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 100.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 100.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC VIS LIT HYPERSPECTRAL IMG", "code_information": [{"code": "631T", "type": "CPT"}], "standard_charges": [{"minimum": 62.91, "maximum": 98.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 62.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 98.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 98.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 98.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT DLVR ENHNCD FIXJ DEV", "code_information": [{"code": "34712", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT IMPL WRLS P-ART PRS SNR", "code_information": [{"code": "33289", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 18935.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18935.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT IMPLTJ C SINS RDCTJ DEV", "code_information": [{"code": "645T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 1CHMBR LDLS PM RA", "code_information": [{"code": "823T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM CMPL", "code_information": [{"code": "795T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RA", "code_information": [{"code": "796T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RV", "code_information": [{"code": "797T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INSJ/RPL PERM LDLS PM", "code_information": [{"code": "33274", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INTRA-C NFS SUPERSAT O2", "code_information": [{"code": "659T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT L VENTR RSTRJ DEV IMPLT", "code_information": [{"code": "643T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT MV ANNULUS RCNSTJ", "code_information": [{"code": "544T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT PLMT&RMVL CEPD PERQ", "code_information": [{"code": "33370", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 1CHMBR LDLS PM RA", "code_information": [{"code": "824T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 2CHMBR LDLS PM CMPL", "code_information": [{"code": "798T", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL 2CHMBR LDLS PM", "code_information": [{"code": "801T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL1CHMB LDLS PM RA", "code_information": [{"code": "825T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RA", "code_information": [{"code": "802T", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RV", "code_information": [{"code": "803T", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RA", "code_information": [{"code": "799T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RV", "code_information": [{"code": "800T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL PERM LDLS PM W/IMG", "code_information": [{"code": "33275", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL/DBLK ICAR MAS PERQ", "code_information": [{"code": "644T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL OPN", "code_information": [{"code": "806T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 7663.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL PRQ", "code_information": [{"code": "805T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 7663.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT TV ANNULUS RCNSTJ", "code_information": [{"code": "545T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/INJ", "code_information": [{"code": "93893", "type": "CPT"}], "standard_charges": [{"minimum": 494.27, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 494.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/O INJ", "code_information": [{"code": "93892", "type": "CPT"}], "standard_charges": [{"minimum": 494.27, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 494.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD VASOREACTIVITY STUDY", "code_information": [{"code": "93890", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRAN MAGN STIM REDETEMINE", "code_information": [{"code": "90869", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX DELI", "code_information": [{"code": "90868", "type": "CPT"}], "standard_charges": [{"minimum": 111.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 174.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX PLAN", "code_information": [{"code": "90867", "type": "CPT"}], "standard_charges": [{"minimum": 810.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 810.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1273.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1273.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1273.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TD VACC NO PRESV 7 YRS+ IM", "code_information": [{"code": "90714", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY HC PRO", "code_information": [{"code": "99368", "type": "CPT"}], "standard_charges": [{"minimum": 168.46, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY PHYS", "code_information": [{"code": "99367", "type": "CPT"}], "standard_charges": [{"minimum": 255.87, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 255.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/PAT BY HC PROF", "code_information": [{"code": "99366", "type": "CPT"}], "standard_charges": [{"minimum": 189.14, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 189.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAR FILM IMG UNI/BI W/I&R", "code_information": [{"code": "330T", "type": "CPT"}], "standard_charges": [{"minimum": 146.09, "maximum": 229.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 146.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEC ODYSSEY TOR II SMPCY 21.5D CYL1.50 DRT1500215", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "DRT1500215", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.0, "discounted_cash": 696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TEE W OR W/O FOL W/CONT, MON", "code_information": [{"code": "C8927", "type": "HCPCS"}], "standard_charges": [{"minimum": 3002.42, "maximum": 4718.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEE W OR W/O FOL W/CONT,CONG", "code_information": [{"code": "C8926", "type": "HCPCS"}], "standard_charges": [{"minimum": 3002.42, "maximum": 4718.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELEHEALTH FACILITY FEE", "code_information": [{"code": "Q3014", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELETHX ISODOSE PLAN CPLX", "code_information": [{"code": "77307", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 565.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 614.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 965.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 965.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 965.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 332.77, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 354.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELETHX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77306", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 565.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 340.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 534.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 534.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 534.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 183.28, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 195.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMP FIX PIN 1.4MM SM 58820006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58820006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMP FIXATION PIN 1.4MM 5882000014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5882000014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 82.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMP FIXATION PIN LG 58820024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58820024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 82.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMP FML IU VALVE-PMP RPLCMT", "code_information": [{"code": "597T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMP FML IU VLV-PMP 1ST INSJ", "code_information": [{"code": "596T", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPERATURE GRADIENT STUDIES", "code_information": [{"code": "93740", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPLATE BENDING 12 HOLE FOR 4.5 MM LCDCP AND DCP PLATE", "code_information": [{"code": "329.92", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMPORARY EXTERNAL PACING", "code_information": [{"code": "92953", "type": "CPT"}], "standard_charges": [{"minimum": 2365.79, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2365.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3717.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3717.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3717.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPORARY FIXATION PIN 10-90-003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-90-003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMPR", "code_information": [{"code": "278T", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON ACHILLES 10 X 180MM W/ BONE BLOCK", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3630.0, "discounted_cash": 1270.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON ACHILLES 10MM X 21.5 CM PRESHAPED IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "FATB10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4695.6, "discounted_cash": 1643.46, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON ACHILLES 11MM DOWEL PRE SHAPED FROZEN FLEXIGRAFT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "FATB11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4695.6, "discounted_cash": 1643.46, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON ACHILLES ALLOGRAFT W/ BONE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "DCT0201603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4435.0, "discounted_cash": 1552.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON ACHILLES W/BONE BLOCK 00201603", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "201603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5800.0, "discounted_cash": 2030.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON ACHILLES W/BONE BLOCK 00201619", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "201619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5800.0, "discounted_cash": 2030.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON ANTERIOR TIBIALIS", "code_information": [{"code": "C9356", "type": "HCPCS"}, {"code": "7804219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5758.0, "discounted_cash": 2015.3, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON LENGTHENING OR SHORTENING OF FLEXOR/EXTENSOR TENDON FOREARM/WRIST 25280", "code_information": [{"code": "25280", "type": "CPT"}, {"code": "1482191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON LENGTHENING UPPER ARM OR ELBOW EACH TENDON 24305", "code_information": [{"code": "24305", "type": "CPT"}, {"code": "1482192", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON SHEATH INCISION (EG. FOR TRIGGER FINGER) 26055", "code_information": [{"code": "26055", "type": "CPT"}, {"code": "1481758", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON STRIPPER BLADE 10MM", "code_information": [{"code": "AR-2385-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 510.29, "discounted_cash": 178.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON STRIPPER QUADPRO HARVESTER 11MM AR-2386-11", "code_information": [{"code": "AR-2386-11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1239.28, "discounted_cash": 433.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON TIBIALIS POSTERIOR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "430340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3811.0, "discounted_cash": 1333.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON TRANSPLANTATION OR TRANSFER FOREARM AND OR WRIST-SINGLE-EACH TENDON 25310", "code_information": [{"code": "25310", "type": "CPT"}, {"code": "1482277", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON TRANSPLANTATION OR TRANSFER-FOREARM AND OR WRIST W/ GRAFTS-EACH TENDON 25312", "code_information": [{"code": "25312", "type": "CPT"}, {"code": "1482276", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [{"code": "557", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8510.73, "maximum": 14610.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8510.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12172.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13389.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14610.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [{"code": "558", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5239.9, "maximum": 8995.6, "estimated_discounted_cash": 25565.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5239.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7494.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8243.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8995.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENODESIS BICEPS TENDON AT ELBOW 24340", "code_information": [{"code": "24340", "type": "CPT"}, {"code": "1482193", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENODESIS LONG TENDON BICEPS 23430", "code_information": [{"code": "23430", "type": "CPT"}, {"code": "1482194", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENODESIS OF PROXIMAL INTERPHALANGEAL JOINT EACH JOINT 26471", "code_information": [{"code": "26471", "type": "CPT"}, {"code": "10710877", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENODESIS PROXIMAL INTERPHALANGEAL JOINT-DISTAL JOINT 26474", "code_information": [{"code": "26474", "type": "CPT"}, {"code": "1482195", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOFOVIR LIQ CHROM UR QUAN", "code_information": [{"code": "25U", "type": "CPT"}], "standard_charges": [{"minimum": 123.5, "maximum": 343.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 218.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 343.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 343.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 343.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 123.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 123.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS COMPLEX HAND 26449", "code_information": [{"code": "26449", "type": "CPT"}, {"code": "1482196", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS EXTENSOR TENDON FOOT MULTIPLE TENDONS 28226", "code_information": [{"code": "28226", "type": "CPT"}, {"code": "1482198", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS EXTENSOR TENDON FOOT SINGLE TENDON 28225", "code_information": [{"code": "28225", "type": "CPT"}, {"code": "1482199", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS EXTENSOR TENDON HAND OR FINGER 26445", "code_information": [{"code": "26445", "type": "CPT"}, {"code": "1482197", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS FLEXOR TENDON FOOT MULTIPLE TENDONS 28222", "code_information": [{"code": "28222", "type": "CPT"}, {"code": "1482200", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS FLEXOR TENDON FOOT SINGLE TENDON 28220", "code_information": [{"code": "28220", "type": "CPT"}, {"code": "1482201", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS FLEXOR TENDON PALM & FINGER 26442", "code_information": [{"code": "26442", "type": "CPT"}, {"code": "1482202", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS FLEXOR TENDON PALM OR FINGER 26440", "code_information": [{"code": "26440", "type": "CPT"}, {"code": "1482203", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS TRICEPS 24332", "code_information": [{"code": "24332", "type": "CPT"}, {"code": "1482206", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS-FLEXOR OR EXTENSOR TENDON LEG AND/OR ANKLE MULTIPLE 27681", "code_information": [{"code": "27681", "type": "CPT"}, {"code": "1482205", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS-FLEXOR OR EXTENSOR TENDON LEG AND/OR ANKLE SINGLE 27680", "code_information": [{"code": "27680", "type": "CPT"}, {"code": "1482204", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS-FLEXOR OR EXTENSOR-FOREARM AND OR WRIST 25295", "code_information": [{"code": "25295", "type": "CPT"}, {"code": "1482207", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOPLASTY ELBOW TO SHO 1", "code_information": [{"code": "24320", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY HIP ABDUCTOR/EXTENSOR 27006", "code_information": [{"code": "27006", "type": "CPT"}, {"code": "1482213", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY HIP FLEXOR(S)-OPEN 27005", "code_information": [{"code": "27005", "type": "CPT"}, {"code": "1482214", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY OPEN TENDON FLEXOR/ FOOT 28230", "code_information": [{"code": "28230", "type": "CPT"}, {"code": "2401709", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY PERCUTANEOUS ; ADDUCTOR OR HAMSTRING / MULTIPLE TENDONS 27307", "code_information": [{"code": "27307", "type": "CPT"}, {"code": "29203949", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1547.76, "maximum": 8450.0, "gross_charge": 3197.87, "discounted_cash": 1119.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1547.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT 26060", "code_information": [{"code": "26060", "type": "CPT"}, {"code": "29616389", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY W/ LENGTHING OR RELEASE OF ABDUCTOR HALLUCIS MUSCLE 28240", "code_information": [{"code": "28240", "type": "CPT"}, {"code": "1482224", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-EXTENSOR-HAND OR FINGER -OPEN-EACH 26460", "code_information": [{"code": "26460", "type": "CPT"}, {"code": "1482211", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-FLEXOR-FINGER-OPEN-EACH TENDON 26455", "code_information": [{"code": "26455", "type": "CPT"}, {"code": "1482212", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-OPEN-ELBOW TO SHOULDER-EACH TENDON 24310", "code_information": [{"code": "24310", "type": "CPT"}, {"code": "1482215", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-OPEN-EXTENSOR-FOOT OR TOE-EACH TENDON 28234", "code_information": [{"code": "28234", "type": "CPT"}, {"code": "1482216", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-OPEN-FLEXOR OR EXTENSOR TENDON-FOREARM AND OR WRIST-SINGLE-EACH TENDON 25290", "code_information": [{"code": "25290", "type": "CPT"}, {"code": "1482217", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-OPEN-TENDON FLEXOR; TOE-SINGLE TENDON 28232", "code_information": [{"code": "28232", "type": "CPT"}, {"code": "1481748", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-PERCUTANEOUS-ACHILLES TENDON-GENERAL ANESTHESIA 27606", "code_information": [{"code": "27606", "type": "CPT"}, {"code": "1482218", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-PERCUTANEOUS-ACHILLES TENDON-LOCAL ANESTHESIA 27605", "code_information": [{"code": "27605", "type": "CPT"}, {"code": "1482221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-PERCUTANEOUS-TOE-MULTIPLE TENDONS 28011", "code_information": [{"code": "28011", "type": "CPT"}, {"code": "1482219", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-PERCUTANEOUS-TOE-SINGLE TENDON 28010", "code_information": [{"code": "28010", "type": "CPT"}, {"code": "1482220", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-SHOULDER AREA-MULTIPLE TENDONS 23406", "code_information": [{"code": "23406", "type": "CPT"}, {"code": "1482222", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOTOMY-SHOULDER AREA-SINGLE TENDON 23405", "code_information": [{"code": "23405", "type": "CPT"}, {"code": "1482223", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENSION RING 28MM TYPE 14C", "code_information": [{"code": "MR-1420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 173.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TENSION RING TYPE 1L 11MM", "code_information": [{"code": "MR-1L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TERT GENE TARGETED SEQ ALYS", "code_information": [{"code": "81345", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 472.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 742.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FECES FOR TRYPSIN", "code_information": [{"code": "84488", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR ACETONE/KETONES", "code_information": [{"code": "82009", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR BLOOD FLOW IN GRAFT", "code_information": [{"code": "15860", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR CHLOROHYDROCARBONS", "code_information": [{"code": "82441", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR G6PD ENZYME", "code_information": [{"code": "82960", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR PORPHOBILINOGEN", "code_information": [{"code": "84106", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR URINE CYSTINES", "code_information": [{"code": "82615", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST HCG PREGNANCY URINE CASS", "code_information": [{"code": "MPH12025HCG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.23, "discounted_cash": 1.48, "setting": "both", "billing_class": "facility"}]}, {"description": "TEST PREG HCG QUICKVUE URINE CASS 20109", "code_information": [{"code": "20109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TEST RBC PROTOPORPHYRIN", "code_information": [{"code": "84203", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 39.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 39.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST SP HCG DIPSTICK RAPID B1077-21", "code_information": [{"code": "B1077-21", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TEST URINE FOR LACTOSE", "code_information": [{"code": "83633", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 28.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 45.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 45.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 45.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST URINE FOR PORPHYRINS", "code_information": [{"code": "84119", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 16.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST URINE UROBILINOGEN", "code_information": [{"code": "84578", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTES PROCEDURES WITH CC/MCC", "code_information": [{"code": "711", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12966.52, "maximum": 22260.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12966.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18544.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20399.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 22260.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESTES PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "712", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6447.98, "maximum": 11069.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6447.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9222.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10144.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11069.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESTICULAR IMAGING W/FLOW", "code_information": [{"code": "78761", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 798.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1255.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1255.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1255.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 388.27, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 413.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE BIOAVAILABLE", "code_information": [{"code": "84410", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 79.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 205.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 205.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 205.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 73.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 73.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE RESPONSE PANEL", "code_information": [{"code": "80414", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 79.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 131.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 207.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 207.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 207.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TETANUS ANTIBODY", "code_information": [{"code": "86774", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 59.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 59.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 59.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TETANUS IG IM", "code_information": [{"code": "90389", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TETRACAINE 0.5% 2ML OPHTHALMIC DROPS/PONTOCAINE", "code_information": [{"code": "MED0199", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TETRACAINE HCL SPINAL 20 mg", "code_information": [{"code": "MED0200", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TGFBI GENE COMMON VARIANTS", "code_information": [{"code": "81333", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 549.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TGSAP NSM LUNG NEO DNA&RNA23", "code_information": [{"code": "22U", "type": "CPT"}], "standard_charges": [{"minimum": 2808.0, "maximum": 7819.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7819.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TGSAP SL OR NEO DNA523&RNA55", "code_information": [{"code": "379U", "type": "CPT"}], "standard_charges": [{"minimum": 7444.98, "maximum": 11707.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7444.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THAW CRYOPRSVRD REPROD TISS", "code_information": [{"code": "89354", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THAW PRESERVED STEM CELLS", "code_information": [{"code": "38208", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED EMBRYO", "code_information": [{"code": "89352", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED OOCYTE", "code_information": [{"code": "89356", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED SPERM", "code_information": [{"code": "89353", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER INDCTJ NTRABRN HYPTHRM", "code_information": [{"code": "776T", "type": "CPT"}], "standard_charges": [{"minimum": 66.77, "maximum": 104.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ 1ST 15 MIN", "code_information": [{"code": "97129", "type": "CPT"}], "standard_charges": [{"minimum": 106.5, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 167.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 167.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 167.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ EA ADDL 15 MIN", "code_information": [{"code": "97130", "type": "CPT"}], "standard_charges": [{"minimum": 103.33, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 103.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 162.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER NMA RDCTJ INTUS/OBSTRCJ", "code_information": [{"code": "74283", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 577.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 908.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 908.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 908.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 385.06, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 409.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER NOT ASSESSED ANNUALLY", "code_information": [{"code": "G8855", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER SPI PNXR CSF FLUOR/CT", "code_information": [{"code": "62329", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER/DIAG CONCURRENT INF", "code_information": [{"code": "96368", "type": "CPT"}], "standard_charges": [{"minimum": 93.76, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER/PROPH/DIAG INJ IA", "code_information": [{"code": "96373", "type": "CPT"}], "standard_charges": [{"minimum": 84.23, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 84.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 132.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER/PROPH/DIAG INJ: EACH ADD SEQUENTIAL IV PUSH OF A NEW SUBSTANCE/DRUG 96375", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "42593851", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 74.71, "maximum": 8450.0, "gross_charge": 960.0, "discounted_cash": 336.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 74.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PNEUMOTHORAX", "code_information": [{"code": "32960", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PROCD STRG ENDUR", "code_information": [{"code": "G0237", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.91, "maximum": 67.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PROPHY./DIAG. INJECTION I.V. PUSH SINGLE OR INITIAL SUB./DRUG 96374", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "7628439", "type": "CDM"}, {"code": "940", "type": "RC"}], "standard_charges": [{"minimum": 174.81, "maximum": 8450.0, "gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 274.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 274.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 274.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PROPHYLACTIC OR DIAGNOSTIC INJ. SUCUTANEOUS OR INTRAMUSCULAR 96372", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "2401824", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 266.67, "maximum": 8450.0, "gross_charge": 960.0, "discounted_cash": 336.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 266.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 419.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC ULTRAFILTRATION", "code_information": [{"code": "692T", "type": "CPT"}], "standard_charges": [{"minimum": 1787.68, "maximum": 2809.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1787.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2809.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2809.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2809.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPY ACTIVATION IPNSS", "code_information": [{"code": "93150", "type": "CPT"}], "standard_charges": [{"minimum": 406.73, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 406.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 639.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 639.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 639.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPY PT MANAGER", "code_information": [{"code": "TH90T01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1324.95, "discounted_cash": 463.73, "setting": "both", "billing_class": "facility"}]}, {"description": "THERMAL DEST. INTRAOSSEOUS NERVE INC. IMAGE 1ST 2 LUMBAR/SACRAL 64628", "code_information": [{"code": "64628", "type": "CPT"}, {"code": "45999709", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "gross_charge": 13873.0, "discounted_cash": 4855.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 6714.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERMAL DEST. INTRAOSSEOUS NERVE INC. IMAGE EA. ADD. LUMBAR/SACRAL 64629", "code_information": [{"code": "64629", "type": "CPT"}, {"code": "46008059", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1029.95, "maximum": 8450.0, "gross_charge": 2128.0, "discounted_cash": 744.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1029.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIN OSTEO BLADE 10 X 5 71369410", "code_information": [{"code": "71369410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.07, "discounted_cash": 108.52, "setting": "both", "billing_class": "facility"}]}, {"description": "THIN OSTEO BLADE 8 X 3 71369208", "code_information": [{"code": "71369208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 88.9, "setting": "both", "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43336", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43337", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC AORTIC GRAFT", "code_information": [{"code": "33875", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38380", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38381", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38382", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC SURGERY SS", "code_information": [{"code": "G4035", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOABDOMINAL GRAFT", "code_information": [{"code": "33877", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOP W/ESOPH MUSC EXC", "code_information": [{"code": "32665", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY BILOBECTOMY", "code_information": [{"code": "32670", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY CONTRL BLEEDING", "code_information": [{"code": "32654", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY DIAGNOSTIC", "code_information": [{"code": "32601", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY FOR LVRS", "code_information": [{"code": "32672", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY LYMPH NODE EXC", "code_information": [{"code": "32674", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY PNEUMONECTOMY", "code_information": [{"code": "32671", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REM TOTL CORTEX", "code_information": [{"code": "32652", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOV FB/FIBRIN", "code_information": [{"code": "32653", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE CORTEX", "code_information": [{"code": "32651", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE SEGMENT", "code_information": [{"code": "32669", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY RESECT BULLAE", "code_information": [{"code": "32655", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/ TH NRV EXC", "code_information": [{"code": "32664", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX INFILTRATE", "code_information": [{"code": "32607", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX MED SPACE", "code_information": [{"code": "32606", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX NODULE", "code_information": [{"code": "32608", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX PLEURA", "code_information": [{"code": "32609", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/LOBECTOMY", "code_information": [{"code": "32663", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/MEDIAST EXC", "code_information": [{"code": "32662", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PERICARD EXC", "code_information": [{"code": "32661", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURECTOMY", "code_information": [{"code": "32656", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURODESIS", "code_information": [{"code": "32650", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC DRAINAGE", "code_information": [{"code": "32659", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC FB REMOVE", "code_information": [{"code": "32658", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/THYMUS RESECT", "code_information": [{"code": "32673", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT ADDL", "code_information": [{"code": "32667", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT DIAG", "code_information": [{"code": "32668", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/WEDGE RESECT", "code_information": [{"code": "32666", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY WBX SAC", "code_information": [{"code": "32604", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/FLAP DRAINAGE", "code_information": [{"code": "32036", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/RIB RESECTION", "code_information": [{"code": "32035", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORAX STEREO RAD TARGETW/TX", "code_information": [{"code": "32701", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THREADED PEG 2.0 MM X 24 MM 0014324", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 146.0, "discounted_cash": 51.1, "setting": "both", "billing_class": "facility"}]}, {"description": "THREE-SPRING EVACUATOR KITS 43610", "code_information": [{"code": "43610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36904", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36905", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36906", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROAT MUSCLE SURGERY", "code_information": [{"code": "43030", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROAT X-RAY & FLUOROSCOPY", "code_information": [{"code": "70370", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 211.43, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 224.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME PLASMA", "code_information": [{"code": "85670", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME TITER", "code_information": [{"code": "85675", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TOPICAL 5,000 IU/5ML", "code_information": [{"code": "MED0201", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMBLYTIC ART/VEN THERAPY", "code_information": [{"code": "37213", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC ART THERAPY", "code_information": [{"code": "37211", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2537.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC THERAPY STROKE", "code_information": [{"code": "37195", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC VENOUS THERAPY", "code_information": [{"code": "37212", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2537.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOMODULIN", "code_information": [{"code": "85337", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOPLASTIN INHIBITION", "code_information": [{"code": "85705", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOPLASTIN TIME PARTIAL", "code_information": [{"code": "85732", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOXANE URINE", "code_information": [{"code": "84431", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 43.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THUNDERBEAT 5MM 35CM FRONT ACTUATED GRIP", "code_information": [{"code": "TB-0535FC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.0, "discounted_cash": 387.8, "setting": "both", "billing_class": "facility"}]}, {"description": "THUNDERBEAT 5MM 35CM FRONT ACUATED GRIP", "code_information": [{"code": "TB-0535FCS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1108.0, "discounted_cash": 387.8, "setting": "both", "billing_class": "facility"}]}, {"description": "THUNDERBEAT 5MM X 20CM ACTUATED FRONT GRIP SHORT", "code_information": [{"code": "TB-0520FC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1297.0, "discounted_cash": 453.95, "setting": "both", "billing_class": "facility"}]}, {"description": "THXP APHERESIS W/HDL DELIP", "code_information": [{"code": "342T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROGLOBULIN ANTIBODY", "code_information": [{"code": "86800", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 24.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 40.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 63.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 63.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 63.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID IMAGING W/BLOOD FLOW", "code_information": [{"code": "78013", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 790.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1242.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1242.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1242.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 364.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 388.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID IMAGING W/BLOOD FLOW", "code_information": [{"code": "78014", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 984.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1547.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1547.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1547.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 459.8, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 489.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING", "code_information": [{"code": "78015", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 869.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1366.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1366.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1366.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 427.64, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 455.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING BODY", "code_information": [{"code": "78018", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 792.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1237.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1946.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1946.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1946.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 581.2, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 618.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING/STUDIES", "code_information": [{"code": "78016", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1126.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1770.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1770.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1770.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 520.08, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 553.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID MET UPTAKE", "code_information": [{"code": "78020", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 255.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 401.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 401.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 401.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 127.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 136.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID UPTAKE MEASUREMENT", "code_information": [{"code": "78012", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 326.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 174.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 186.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC", "code_information": [{"code": "626", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10054.59, "maximum": 17261.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10054.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14380.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15818.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17261.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC", "code_information": [{"code": "625", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17276.94, "maximum": 29660.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17276.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24709.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27180.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29660.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "627", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7194.97, "maximum": 12351.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7194.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10290.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11319.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12351.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROIDECTOMY INCLUDING SUBSTERNAL THYROID; STERNAL SPLIT OR TRANSTHORACIC APPROACH 60270", "code_information": [{"code": "60270", "type": "CPT"}, {"code": "1482234", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1792.56, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1792.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROIDECTOMY SUBTOTAL OR PARTIAL CERVICAL APPROACH 60271", "code_information": [{"code": "60271", "type": "CPT"}, {"code": "1482237", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5229.0, "discounted_cash": 1830.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROIDECTOMY TOTAL OR COMPLETE 60240", "code_information": [{"code": "60240", "type": "CPT"}, {"code": "1482238", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROIDECTOMY TOTAL OR SUBTOTAL FOR MALIGNANCY W/ LIMITED NECK DISSECTION 60252", "code_information": [{"code": "60252", "type": "CPT"}, {"code": "1482235", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROIDECTOMY TOTAL OR SUBTOTAL FOR MALIGNANCY W/ RADICAL NECK DISSECTION 60254", "code_information": [{"code": "60254", "type": "CPT"}, {"code": "1482236", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1792.56, "maximum": 8450.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1792.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROIDECTOMY-REM'L REMAINING THYROID TISSUE FOLLOWING PREVIOUS REM'L 60260", "code_information": [{"code": "60260", "type": "CPT"}, {"code": "1482233", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TI ASNIS III WASHER 5.0MM", "code_information": [{"code": "619906", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 44.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TIB CEMENTED TRAY SIZE 3 IBAL UKA AR-511-T3L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-511-T3L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TIB/PER REVASC ADD-ON", "code_information": [{"code": "37232", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STENT & ATHER", "code_information": [{"code": "37231", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STNT & ATHER", "code_information": [{"code": "37235", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/ATHER", "code_information": [{"code": "37229", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/STENT", "code_information": [{"code": "37230", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/TLA", "code_information": [{"code": "37228", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBA TRIATHLON SZ 5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5536-B-500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 937.3, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBAL BEARING INSERT PS 5532-G-411-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-411-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIA 3 RM/LL JOURNEY UNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7142-2433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2378.0, "discounted_cash": 832.3, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIA FIXED NON-POUROUS SIZE E 42-5420-071-02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5420-071-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4728.0, "discounted_cash": 1654.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIA PLATE SM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "58885110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2896.0, "discounted_cash": 1013.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIA SIZE D FIXED NON-POROUS 42-5420-067-02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5420-067-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4728.0, "discounted_cash": 1654.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL AUGMENT HALF BLOCK RIGHT MEDIAL SIZE CD 5MM THICKNESS 42-5558-034-05", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5558-034-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2039.0, "discounted_cash": 713.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL BASE AFFIXIUM FIXED BEARING SIZE 6 1506-21-006", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1506-21-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL BASE FIXED BEARING SZ 8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1506-00-008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4944.0, "discounted_cash": 1730.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE 10 X 100MM GENISIS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2161.0, "discounted_cash": 756.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71420166", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3599.0, "discounted_cash": 1259.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL BEARING INSERT SIZE 6 5530-G-609-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-609-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL BEARING INSERT X3 SZ 3 12MM 5531-G-312-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-312-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL BEARING INSERT X3 SZ 5 10MM 5531-G-510-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-510-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL INSERT ATTUNE SZ 6 5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-20-605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3856.0, "discounted_cash": 1349.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL INSERT FIXED EARING CR ACX SZ 5 5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "151620505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL INSERT FIXED EARING CR ACX SZ4 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-20-410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7 5M AOX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-20-705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3856.0, "discounted_cash": 1349.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL INSERT X3 POLY 13MM TRIATHLON TS PLUS 5537-G-213-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-213-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3090.0, "discounted_cash": 1081.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL PIN SIMULATOR MARKING HOOK 60 DEG", "code_information": [{"code": "AR-1878GP-60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1092.0, "discounted_cash": 382.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL PREP KIT SIZE 5 KIT TRIATHLON PS 5555-2365", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5555-2365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL PREP KIT SIZE 7 KIT TRIATHLON PS 5555-2367", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5555-2367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL PREP KIT SZE 6 KIT TRIATHLON PS 5555-2366", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5555-2366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL PREP KIT TRIATHLON 5555-2323", "code_information": [{"code": "5555-2323", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL SHAFT FRACTURE WITH IM NAIL 27759", "code_information": [{"code": "27759", "type": "CPT"}, {"code": "2401689", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBPER REVASC W/ATHER ADD-ON", "code_information": [{"code": "37233", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIC-BRN ENCEPH VAC 0.25ML IM", "code_information": [{"code": "90626", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIC-BRN ENCEPH VAC 0.5ML IM", "code_information": [{"code": "90627", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIES SILK BRAIDED 2-0 12-18 BLK A185H", "code_information": [{"code": "A185H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.69, "discounted_cash": 5.84, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGHTROPE ACL RT DEPLOYING SUTURE DOUBLE LOADING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588RT-J", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 266.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGHTROPE FIBERTAG WITH FLIPCUTTER III AR-1288RTT-FC3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1288RTT-FC3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2091.0, "discounted_cash": 731.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGHTROPE II ABS IMPLANT AR-1588TN-21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TN-21", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 230.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGHTROPE SYNDEMOSIS XP SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8925SS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3241.16, "discounted_cash": 1134.41, "setting": "both", "billing_class": "facility"}]}, {"description": "TILT TABLE EVALUATION", "code_information": [{"code": "93660", "type": "CPT"}], "standard_charges": [{"minimum": 292.43, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 292.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 459.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 459.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 459.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TINNITUS ASSESSMENT", "code_information": [{"code": "92625", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIP ABS CENTURION ACTIVE FMS W/ INTREPID 0.9MM 45-DEGREE", "code_information": [{"code": "8065752201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 304.2, "discounted_cash": 106.47, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP APPLICATOR EXTENDED 15CM 205115", "code_information": [{"code": "205115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 655.0, "discounted_cash": 229.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP BERKELEY CURETTE VCM 9MM CANNULATED RIGED CURVED ROUND ASPERATION 022109-10", "code_information": [{"code": "22109-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP CANAL FEMORAL FORINTERPULSE BATTERY POWERED IRRIGATIONINTERPULSE", "code_information": [{"code": "210-8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP CAUT 2.5MM 25GA HEMOSTATIC BIPOLAR FINE TIP CRESCENT STRAIGHT WET FIELD ERAS", "code_information": [{"code": "221267", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 167.0, "discounted_cash": 58.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP CAUTERY 2.5\" BLADE PTFE 0012", "code_information": [{"code": "12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP ENSEAL 5MM ROUND 45 CM NSEAL545RH", "code_information": [{"code": "NSEAL545RH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 205.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP ILM 27G", "code_information": [{"code": "727.44", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 166.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP INSTRUMENT CAP .625", "code_information": [{"code": "3/4/2008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP INTERPULSE HANDPIECE HIGH FLOW 0210-014-000", "code_information": [{"code": "210-014-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.87, "discounted_cash": 16.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP IRRIGATION 0.3MM ASPIRATION BENTINTREPID", "code_information": [{"code": "8065751013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 490.0, "discounted_cash": 171.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP IRRIGATION 0.3MM ASPIRATION MICRO COAXIAL STRAIGHTINTREPID", "code_information": [{"code": "8065751012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 490.0, "discounted_cash": 171.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP IRRIGATION 35DEG ASPIRATION BENT POLYMER", "code_information": [{"code": "8065751511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP IRRIGATION ASPIRATION CURVED POLYMER DISP 0.3MM", "code_information": [{"code": "8065751512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.59, "discounted_cash": 18.41, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP IRRIGATION ASPIRATION STRAIGHT POLYMER DISP", "code_information": [{"code": "8065751510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP IRRIGATION TUBE 0.9MM 45-DEG ABS CENTURION ACTIVE FMS/ INTREPID NANO SLEEVES", "code_information": [{"code": "8065752203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 304.2, "discounted_cash": 106.47, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP MICRO .9MM 30DEG ASPIRATING BYPASS KELMAN", "code_information": [{"code": "8065790022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.23, "discounted_cash": 46.63, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP MIX LUER", "code_information": [{"code": "2110-0031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 856.0, "discounted_cash": 299.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP OPHTH ASPIRATION 25GA GRIESHABER REVOLUTION BACKFLUSH SOFT TIP", "code_information": [{"code": "337.84", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 290.67, "discounted_cash": 101.73, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP PHACO .9MM 45DEG KELMAN MINI ANGLED REPROCESS STRL DISP", "code_information": [{"code": "8065750853R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 33.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP PHACO 1.1MM 30DEG FLARED ROUND ABS ASPIRATING BYPASS SYS", "code_information": [{"code": "8065740806", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP PROTECTIVE 4MM END NAIL HOFFMANN WHITE", "code_information": [{"code": "5027-1-040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.69, "discounted_cash": 56.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SCREWDRIVER", "code_information": [{"code": "220-0021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SHIRAGE 25G BACFLUSH", "code_information": [{"code": "1281.S05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 336.0, "discounted_cash": 117.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCT YANKAUER STANDARD BULB OPERATING ROOM WITHOUT CONTROL VNT LF STRL", "code_information": [{"code": "DYND50130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCTION YANKEUR REG CAP FLEXIBLE W/ VNT STRL DISP", "code_information": [{"code": "8888501023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.22, "discounted_cash": 1.83, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP ULTRASOUND MICRO PERCUTANIEOUS ELBOW REPAIR", "code_information": [{"code": "5541003-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1726.0, "discounted_cash": 604.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL 1ST SHNT", "code_information": [{"code": "33745", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL EA ADDL", "code_information": [{"code": "33746", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ADDL 30 SQ CM", "code_information": [{"code": "14302", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ANY 30.1-60 SQ CM", "code_information": [{"code": "14301", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS EX MOLECUL STUDY ADD-ON", "code_information": [{"code": "88388", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS EXAM MOLECULAR STUDY", "code_information": [{"code": "88387", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 27.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 27.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 27.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS REGEN EDENT NONRESORB", "code_information": [{"code": "D7957", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS REGEN EDENT RESORB", "code_information": [{"code": "D7956", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS TRNSGLTMNASE EA IG CLAS", "code_information": [{"code": "86364", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSEEL 10 ML KIT", "code_information": [{"code": "MED0205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.0, "discounted_cash": 371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSEEL 2ML", "code_information": [{"code": "MED0203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 313.0, "discounted_cash": 109.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSEEL 4ML", "code_information": [{"code": "MED0204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 151.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE 609002 2MM FACET SHIM SRVC FEE 609002", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "609002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 716.0, "discounted_cash": 250.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE 609003 3MM FACET SHIM SERVICE FEE 609003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "609003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 273.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE 609004 4MM FACET SHIM SERVICE FEE 609004", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "609004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 846.0, "discounted_cash": 296.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE ADHESIVE 1.0ML EXOFIN SKIN AFFIX APPLICATORS", "code_information": [{"code": "M1205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE AUTOGRAFT FACE/GENITALIA/HANDS/FEET 1ST 25 SQ/CM OR LESS 15155", "code_information": [{"code": "15155", "type": "CPT"}, {"code": "1482240", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE LYMPHOCYTE", "code_information": [{"code": "88230", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 179.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 297.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 467.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 467.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 467.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 167.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 167.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE PLACENTA", "code_information": [{"code": "88235", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 227.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 383.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 602.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 602.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 602.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 216.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 216.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE SKIN/BIOPSY", "code_information": [{"code": "88233", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 217.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 358.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 564.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 564.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 564.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 202.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 202.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE TUMOR", "code_information": [{"code": "88239", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 227.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 376.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 591.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 591.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 591.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 212.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 212.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXAM FOR FUNGI", "code_information": [{"code": "87220", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE GRAFTJACKET 5X5CM STD THICKNESS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "86005X05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5227.0, "discounted_cash": 1829.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE GRAFTS-OTHER (EG. PARATENON/ FAT/DERMIS) 20926", "code_information": [{"code": "20926", "type": "CPT"}, {"code": "1482245", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE HOMOGENIZATION CULTR", "code_information": [{"code": "87176", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 9.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE IN-SITU HYBRIDIZATION", "code_information": [{"code": "D0479", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE MATRIX GRAFTJACKET -MAXIUM FORCE SIZE 4 X 7CM", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "8600-4X07", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4750.0, "discounted_cash": 1662.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE MATRIX XXL ACTIVE MATRIX PLACENTAL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "AM200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7004.0, "discounted_cash": 2451.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE REGEN NON-RESORBABLE", "code_information": [{"code": "D6107", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE REGEN RESORBABLE", "code_information": [{"code": "D6106", "type": "HCPCS"}], "standard_charges": [{"minimum": 5040.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE REINFORCEMENT 4 X 6 CM 31048", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "31048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5548.0, "discounted_cash": 1941.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE RESECTOR RESECTR 3MM 9FR OD 35CM LONG CANNULA", "code_information": [{"code": "R9-3X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1383.0, "discounted_cash": 484.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE RETRACTOR BROACH MINIMALLY INVASIVE BUNION", "code_information": [{"code": "317-00-007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1247.0, "discounted_cash": 436.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE RMVL DEVICE 4MM X 32CM MYOSURE XL MYOMCMY", "code_information": [{"code": "50-501XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2127.0, "discounted_cash": 744.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE RMVL DEVICE MYOSURE XL MYOMCMY", "code_information": [{"code": "50-503XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 891.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE SEMITENDONOSUS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "53801-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4274.0, "discounted_cash": 1495.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUEBLUE OPHTH 0.025% SOLN 0.5 ML", "code_information": [{"code": "MED0843", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 156.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUES ACHILLES TENDON WITH CALC 430200", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "430200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4241.0, "discounted_cash": 1484.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TIXAGEV AND CILGAV INJ HM", "code_information": [{"code": "M0221", "type": "HCPCS"}], "standard_charges": [{"minimum": 1104.71, "maximum": 1735.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1104.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1735.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1735.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1735.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TLH UTERUS OVER 250 G", "code_information": [{"code": "58572", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 11473.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 11473.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMA/TMAO PRFL MS/MS UR ALG", "code_information": [{"code": "256U", "type": "CPT"}], "standard_charges": [{"minimum": 61.48, "maximum": 230.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 61.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 96.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 96.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 96.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 230.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 230.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMPST AUTO TUBE DLVR SYS", "code_information": [{"code": "583T", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 4382.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMVI PERCUTANEOUS APPROACH", "code_information": [{"code": "483T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMVI TRANSTHORACIC EXPOSURE", "code_information": [{"code": "484T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBACCO NON-USER", "code_information": [{"code": "M1316", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRADEX 0.1%-0.3% OPTH OINT 3.5GM", "code_information": [{"code": "MED0209", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 185.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRADEX OPTH 0.1%-0.3% SUSP 2.5 ML", "code_information": [{"code": "MED0208", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 49.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRAMYCIN (TOBREX) 0.3% OPHTH DROPS 5ML", "code_information": [{"code": "MED0207", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRAMYCIN 1.2 gm POWDER", "code_information": [{"code": "MED0206", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 211.0, "discounted_cash": 73.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TOC TOOL INCL ELEM NOT USED", "code_information": [{"code": "G9658", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOC TOOL INCL KEY ELEM", "code_information": [{"code": "G9655", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOE JOINT COBALT CHROME PC LG 23MM 10414", "code_information": [{"code": "L8630", "type": "HCPCS"}, {"code": "10414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4600.0, "discounted_cash": 1610.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOE JOINT TITANIUM PC MD 20MM 17036", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "17036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6170.0, "discounted_cash": 2159.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOE JOINT TRANSFER", "code_information": [{"code": "26556", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOE RING 180MM DF-R025-180", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DF-R025-180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2554.0, "discounted_cash": 893.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TOE TAC MEDIUM HAMMERTOE FIXATION SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HT-00002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3123.0, "discounted_cash": 1093.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TOGA FLYTE 2XL SURGICOOL ZIPPERED PEELAWAY", "code_information": [{"code": "408-841-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 79.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TOGA SURG XL TALL ZIPPER T4/T5 STRL", "code_information": [{"code": "400-850", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOGA SURG XL ZIPPER STERI SHIELD DISP", "code_information": [{"code": "400850000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOMOSYNTHESIS, MAMMO", "code_information": [{"code": "G0279", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.79, "maximum": 173.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 37.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 40.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONE DECAY HEARING TEST", "code_information": [{"code": "92563", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE AND NECK SURGERY", "code_information": [{"code": "41135", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE BASE VOL REDUCTION", "code_information": [{"code": "41530", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE JAW & NECK SURGERY", "code_information": [{"code": "41155", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH JAW SURGERY", "code_information": [{"code": "41150", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH NECK SURGERY", "code_information": [{"code": "41153", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE REMOVAL NECK SURGERY", "code_information": [{"code": "41145", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE SUSPENSION", "code_information": [{"code": "41512", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE TO LIP SURGERY", "code_information": [{"code": "41510", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONSILLECTOMY AGE 12 OR OVER 42826", "code_information": [{"code": "42826", "type": "CPT"}, {"code": "1482246", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONSILLECTOMY AND ADENOIDECTOMY AGE 12 OR OVER 42821", "code_information": [{"code": "42821", "type": "CPT"}, {"code": "1482247", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONSILLECTOMY AND ADENOIDECTOMY UNDER AGE 12 42820", "code_information": [{"code": "42820", "type": "CPT"}, {"code": "1482248", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1414.24, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONSILLECTOMY UNDER AGE 12 42825", "code_information": [{"code": "42825", "type": "CPT"}, {"code": "1482249", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOOL CRUCIAL 9.5MM KNEE REMOVES OPERATIVE DEBRIS LEADS GRAFTINTO TUNNELS GORE SM", "code_information": [{"code": "14724", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 445.0, "discounted_cash": 155.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL DILATION 6MM X 18MM MULTI SINUS XPRESS RELIEVA", "code_information": [{"code": "JD-106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3262.0, "discounted_cash": 1141.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL PASSING ELEVATOR ACESSORY ACCK2100", "code_information": [{"code": "ACCK2100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL TUNNELING 20\" 1120", "code_information": [{"code": "1120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL TUNNELING 35 CM LNG STRAW FOR PRECISION SPINAL CORD SIMULATOR SYSS", "code_information": [{"code": "SC-4254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 193.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TORPEDO CURVED 4MM", "code_information": [{"code": "AR-8400CTD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 166.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22857", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 2NTRSPC LMBR", "code_information": [{"code": "22860", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOT ESTRADIOL RESPONSE PANEL", "code_information": [{"code": "80415", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 86.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 142.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 224.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 224.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 224.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 80.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 80.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL ABDOMINAL HYSTERECTOMY INC. PARTIAL VAGINECTOMY WITH LYMPH NODE SAMPLING 58200", "code_information": [{"code": "58200", "type": "CPT"}, {"code": "1482252", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL ABDOMINAL HYSTERECTOMY W/ OR W/O REML OF TUBE(S) OR OVARY(S) 58150", "code_information": [{"code": "58150", "type": "CPT"}, {"code": "1482250", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL ABDOMINAL HYSTERECTOMY WITH COLPO-URETHROCYSTOPEXY 58152", "code_information": [{"code": "58152", "type": "CPT"}, {"code": "1482251", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL CORTISOL", "code_information": [{"code": "82533", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL DISC ARTHROGRAPHY ANTERIOR APP. W/DISCECTOMY SECOND LEVEL CERVICAL 22858", "code_information": [{"code": "22858", "type": "CPT"}, {"code": "38612871", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL DISC ARTHROPLASTY CERVICAL ANTERIOR APPROACH; SINGLE INTERSPACE 22856", "code_information": [{"code": "22856", "type": "CPT"}, {"code": "1482253<and>1482253", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 9735.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ARTHROPLASTY", "code_information": [{"code": "27132", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE CAP J2 UNI OXI FEM W/UNI TIB & INSERT 71701810", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71701810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16000.0, "discounted_cash": 5600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL KNEE POLY XE LFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M5725060XE10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19027.0, "discounted_cash": 6659.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL LUNG LAVAGE", "code_information": [{"code": "32997", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER CAP PRICE AEQ PRESS FIT KWSH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAP1001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11600.0, "discounted_cash": 4060.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER REPLACEMENT 23472", "code_information": [{"code": "23472", "type": "CPT"}, {"code": "1482256", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 16063.0, "gross_charge": 9877.0, "discounted_cash": 3456.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 14250.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10038.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14437.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15789.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15789.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 16063.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 4780.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 16063.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL THYROID LOBECTOMY WITH CONTRALATERAL SUBTOTAL LOBECTOMY 60225", "code_information": [{"code": "60225", "type": "CPT"}, {"code": "1482258", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL THYROID LOBECTOMY-UNILATERAL 60220", "code_information": [{"code": "60220", "type": "CPT"}, {"code": "1482257", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOUCH QUANT SENSORY TEST", "code_information": [{"code": "106T", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 231.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOURNI-COT LARGE TCL-3001", "code_information": [{"code": "TCL-3001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNI-COT MEDIUM", "code_information": [{"code": "TCM-2001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.22, "discounted_cash": 6.73, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CFF 12IN SNGL PORT SNGL BLADDER REPROCESS WITHOUT SLEEVE PUMP LINE CO", "code_information": [{"code": "607075102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.08, "discounted_cash": 18.93, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CFF 18IN SNGL HOSE DUAL BLADDER REPROCESS WITHOUT SLEEVE STRL DISP", "code_information": [{"code": "607085102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CFF 18IN SNGL PORT SNGL BLADDER REPROCESS W/ PUMP LINE ATS STRL DISP", "code_information": [{"code": "607075103R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CFF 24IN SNGL PORT SNGL BLADDER REPROCESS W/ PUMP LINE CONNECTOR ATS", "code_information": [{"code": "607075104R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.08, "discounted_cash": 18.93, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CFF 30IN SNGL PORT SNGL BLADDER REPROCESS W/ PUMP LINE WITHOUT SLEEVE", "code_information": [{"code": "60-7075-105R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CFF 42IN SNGL PORT SNGL BLADDER REPROCESS WITHOUT SLEEVE ATS STRL DIS", "code_information": [{"code": "607075107R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET COMPRESSION 30IN X 4IN SNGL PORT QUICK REPROCESS DISP", "code_information": [{"code": "5921-030-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET COMPRESSION 44IN X 4IN SNGL PORT QUICK REPROCESS DISP", "code_information": [{"code": "5921-044-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET COMPRESSION QUICK CONNECT 18IN RED REPROCESSED", "code_information": [{"code": "5921-018-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET COMPRESSION QUICK CONNECT 34IN PURPLE REPROCESSED", "code_information": [{"code": "5921-034-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CUFF 18 STERILE DISP REPROCESSED", "code_information": [{"code": "60-7070-104R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CUFF 18IN REPROCESS STRL DISP", "code_information": [{"code": "60-7070-103R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CUFF 24IN SNGL HOSE DUAL BLADDER", "code_information": [{"code": "60708510300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CUFF 30 STERILE DISP REPROCESSED", "code_information": [{"code": "60-7070-105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET DUAL PORT 18IN SINGL BLADDER CUFF PLC NO SLEEVE", "code_information": [{"code": "60-7070-103-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET DUAL PORT 34IN SINGL BLADDER CUFF PLC NO SLEEVE", "code_information": [{"code": "60-7070-106-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 27.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET DUAL PORT 42IN SINGL BLADDER CUFF PLC NO SLEEVE", "code_information": [{"code": "60-7070-107-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET LF", "code_information": [{"code": "CH6064", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET PNEUMATIC 34IN X 4IN BLACK 2 PART QUICK REPROCESS", "code_information": [{"code": "5921-034-235R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET PNEUMATIC MED RED FINGER RING SILICONE TOURNI COT LF", "code_information": [{"code": "TCM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET STERILE DISP 18 INCH", "code_information": [{"code": "60-7070-103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL OR 17X24 BLUE", "code_information": [{"code": "28700-004X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL OR 17X24IN BLUE STERILE 1/PK", "code_information": [{"code": "28700-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL OR 17X24IN WHITE STERILE 2/PK", "code_information": [{"code": "28300-002", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL OR 17X24IN WHITE STERILE 4/PK", "code_information": [{"code": "28300-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL S O P N-ABSORB 7553 STERILE 7553", "code_information": [{"code": "7553", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL SURG 17IN X 27IN BLUE PRE WASHED DE LINTED FOLDED COTTON LF STRL DISP", "code_information": [{"code": "MDT2168206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.43, "discounted_cash": 33.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL SURGICAL 17 X 27IN COTTON WOVEN GREEN 6PK", "code_information": [{"code": "28200-006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL SURGICAL 6PK BLUE LF DISP", "code_information": [{"code": "28700-006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL SURGICAL ALLEGIANCE 17 X 27IN 8PK COTTON WOVEN STRLBLUE", "code_information": [{"code": "28700-008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL SURGICAL COTTON 17 X 24IN BLUE 4 PACK", "code_information": [{"code": "28700-002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL SURGICAL COTTON 17 X 27IN BLUE 4 PACK", "code_information": [{"code": "28700-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TOXOPLASMA ANTIBODY", "code_information": [{"code": "86777", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOXOPLASMA ANTIBODY IGM", "code_information": [{"code": "86778", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81351", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1636.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2573.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2573.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2573.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 924.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 924.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81353", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 785.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1235.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1235.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1235.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 443.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 443.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE TRGT SEQUENCE ALYS", "code_information": [{"code": "81352", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 700.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1102.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 474.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 474.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPA INITI W/IN 4.5 HR", "code_information": [{"code": "G8600", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPMT GENE COM VARIANTS", "code_information": [{"code": "81335", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 445.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPMT NUDT15 GENES", "code_information": [{"code": "34U", "type": "CPT"}], "standard_charges": [{"minimum": 671.28, "maximum": 1869.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1188.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1869.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1869.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1869.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 671.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 671.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV ADJMT", "code_information": [{"code": "53454", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV BI", "code_information": [{"code": "53451", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV RMVL EA", "code_information": [{"code": "53453", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV UNI", "code_information": [{"code": "53452", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL FOCAL ABLTJ MAL PRST8", "code_information": [{"code": "655T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL LSR ABLT B9 PRST8 HYPR", "code_information": [{"code": "714T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL PLMT BIODEGRDABL MATRL", "code_information": [{"code": "55874", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TR RETINAL LES PRETERM INF", "code_information": [{"code": "67229", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRABECULOPLASTY LASER SURG", "code_information": [{"code": "65855", "type": "CPT"}], "standard_charges": [{"minimum": 869.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 869.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INT LSR W/SCP", "code_information": [{"code": "622T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INTERNO LASER", "code_information": [{"code": "621T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRABECULOTOME SURGICAL INSTRUMENT HANDHELD SION 1-107", "code_information": [{"code": "1-107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1241.0, "discounted_cash": 434.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TRABECULOTOMY LSR W/OCT GDN", "code_information": [{"code": "730T", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACH ESOPHAGEAL COMBITUBE ROLL-UP 41 FR 5-18441", "code_information": [{"code": "5-18441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TRACHELECTOMY (CERVICECTOMY) 57530", "code_information": [{"code": "57530", "type": "CPT"}, {"code": "1482260", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACHELORRHAPHY-PLASTIC REPAIR UTERINE CERVIX-VAGINAL APPROACH 57720", "code_information": [{"code": "57720", "type": "CPT"}, {"code": "1482261", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACHEO-ESOPHAGOPLASTY CONG", "code_information": [{"code": "43314", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMA REVISION COMPLEX W/FLAP ROTATION 31614", "code_information": [{"code": "31614", "type": "CPT"}, {"code": "6983440", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMA REVISION SIMPLE W/O FLAP ROTATION 31613", "code_information": [{"code": "31613", "type": "CPT"}, {"code": "12398900", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.76, "maximum": 8450.0, "gross_charge": 3171.0, "discounted_cash": 1109.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1534.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "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": 23314.92, "maximum": 40025.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23314.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 33345.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36679.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 40025.93, "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": 30545.18, "maximum": 52438.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30545.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 43686.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48054.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52438.48, "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": 16568.88, "maximum": 28444.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16568.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23697.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26066.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28444.64, "methodology": "case rate"}], "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": 72524.57, "maximum": 124506.67, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 72524.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 103725.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 114098.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 124506.67, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRACKER PATIENT AXIEM DISP", "code_information": [{"code": "9733534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 431.0, "discounted_cash": 150.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TRACKERINSTR AXIEM DISP", "code_information": [{"code": "9733533", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 331.76, "discounted_cash": 116.12, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANEXAMIC ACID 100 MG/ML IV SOL 10ML (MEDID)", "code_information": [{"code": "MED0501", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANEXAMIC ACID 1000MG/10ML", "code_information": [{"code": "MED0287", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43332", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43333", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSABDOM AMNIOINFUS W/US", "code_information": [{"code": "59070", "type": "CPT"}], "standard_charges": [{"minimum": 642.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 642.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE OF ASD", "code_information": [{"code": "93580", "type": "CPT"}], "standard_charges": [{"minimum": 2347.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE OF VSD", "code_information": [{"code": "93581", "type": "CPT"}], "standard_charges": [{"minimum": 2347.0, "maximum": 8896.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 5426.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8896.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4218.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH EMBOLIZ MICROSPHER", "code_information": [{"code": "S2095", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 4382.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH INTRAOP MICROINF", "code_information": [{"code": "C9759", "type": "HCPCS"}], "standard_charges": [{"minimum": 1886.0, "maximum": 4208.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2676.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4208.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4208.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4208.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH MTRAL VLVE REPAIR", "code_information": [{"code": "345T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION CNS", "code_information": [{"code": "61624", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION NON-CNS", "code_information": [{"code": "61626", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/EPS", "code_information": [{"code": "37215", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/O EPS", "code_information": [{"code": "37216", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATHETER BIOPSY", "code_information": [{"code": "37200", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCERVICAL INTRO FALLOPIAN TUBE CATH FOR DX OR RE-EST. PATENCY W/ W/O HYSTEROSALPINGOGRAPHY 58345", "code_information": [{"code": "58345", "type": "CPT"}, {"code": "2650539", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCOCHLEAR APPROACH/SKULL", "code_information": [{"code": "61596", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCONDYLAR APPROACH/SKULL", "code_information": [{"code": "61597", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCRV ABLTJ UTRN FIBRD RF", "code_information": [{"code": "58580", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS CARBOXYHB", "code_information": [{"code": "88740", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS METHB", "code_information": [{"code": "88741", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 11.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 37.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 37.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MEASUREMENTS", "code_information": [{"code": "602T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MONITORING", "code_information": [{"code": "603T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSECT ARTERY SINUS", "code_information": [{"code": "61611", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSECT PULMONARY ARTERY", "code_information": [{"code": "33922", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSECTION OR AVULSION OF OTHER SPINAL NERVE-EXTRADURAL 64772", "code_information": [{"code": "64772", "type": "CPT"}, {"code": "1482263", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1037.69, "maximum": 8450.0, "gross_charge": 2144.0, "discounted_cash": 750.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1037.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSESOPH DOPPL CARDIAC MON", "code_information": [{"code": "G9157", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.66, "maximum": 689.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 438.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 689.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 689.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 689.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSEVERSE LINK ASSEMBLY - MEDIUM OSA2420", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OSA2420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5150.0, "discounted_cash": 1802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSFER OF ABDOMINAL MUSCLE", "code_information": [{"code": "27100", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58974", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1475.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58976", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1475.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27110", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27111", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF SPINAL MUSCLE", "code_information": [{"code": "27105", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF TENDON TO RESTORE INTRINSIC FUNCTION-ALL 4 FINGERS 26498", "code_information": [{"code": "26498", "type": "CPT"}, {"code": "1482271", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OR TRANSPLANT SINGLE TENDON-DEEP-LEG 27691", "code_information": [{"code": "27691", "type": "CPT"}, {"code": "1482268", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OR TRANSPLANT SINGLE TENDON-SUPERFICIAL-LEG 27690", "code_information": [{"code": "27690", "type": "CPT"}, {"code": "1482269", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OR TRANSPLANT TENDON CMC AREA/DORSUM OF HAND; W/O FREE GRAFT-EACH TENDON 26480", "code_information": [{"code": "26480", "type": "CPT"}, {"code": "1482283", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OR TRANSPLANT TENDON-PALMAR; W/O FREE TENDON GRAFT 26485", "code_information": [{"code": "26485", "type": "CPT"}, {"code": "1482275", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER TENDON HAND CROSS INTRINSIC-EACH TENDON 26510", "code_information": [{"code": "26510", "type": "CPT"}, {"code": "1482274", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER TENDON RING AND SMALL FINGER 26497", "code_information": [{"code": "26497", "type": "CPT"}, {"code": "1482273", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER TENDON TO PELVIS", "code_information": [{"code": "27098", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER-INTERMEDIATE-ANY PEDICLE FLAP-ANY LOCATION 15650", "code_information": [{"code": "15650", "type": "CPT"}, {"code": "1482267", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFUSION OF BLOOD OR BLOOD COMPONENTS 36430", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "1482278", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC", "code_information": [{"code": "69", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4787.93, "maximum": 8219.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4787.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6847.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7532.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8219.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSJ CARE MGMT HIGH F2F 7D", "code_information": [{"code": "99496", "type": "CPT"}], "standard_charges": [{"minimum": 511.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSJ CARE MGMT MOD F2F 14D", "code_information": [{"code": "99495", "type": "CPT"}], "standard_charges": [{"minimum": 511.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 511.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSLATOR PROSTEP MICA FIRST MET TRANSLATOR", "code_information": [{"code": "57S100MT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.46, "discounted_cash": 149.61, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSLUMINAL DILATION OR AQUEOUS OUTFLOW CANAL WITHOUT RETENTION OR DEVICE OR STENT 66174", "code_information": [{"code": "66174", "type": "CPT"}, {"code": "16830125", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2147.99, "maximum": 9357.0, "gross_charge": 4438.0, "discounted_cash": 1553.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2147.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSMASTOID ANTROTOMY (SIMPLE MASTOIDECTOMY) 69501", "code_information": [{"code": "69501", "type": "CPT"}, {"code": "1482279", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSORAL APPROACH SKULL BASE-BRAIN STEM-UPPER SPINAL CORD FOR BX.-DECOMP.-OR EXC. LESION 61575", "code_information": [{"code": "61575", "type": "CPT"}, {"code": "1482280", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSORL LWR ESOPHGL MYOTOMY", "code_information": [{"code": "43497", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD-EQUINA-NERVE ROOTS-LUMBAR 63056", "code_information": [{"code": "63056", "type": "CPT"}, {"code": "1482281", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3147.45, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPERI NEEDLE PLACE PROS", "code_information": [{"code": "55875", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPETROSAL APPROACH/SKULL", "code_information": [{"code": "61598", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPL ALLOGRAFT PANCREAS", "code_information": [{"code": "48554", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FEMUR RIDGE", "code_information": [{"code": "27140", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT OF THIGH TENDON", "code_information": [{"code": "27396", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT URETER TO SKIN", "code_information": [{"code": "50860", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT HAND TENDON", "code_information": [{"code": "26483", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT PALM TENDON", "code_information": [{"code": "26489", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION HEART/LUNG", "code_information": [{"code": "33935", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF HEART", "code_information": [{"code": "33945", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50360", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50365", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF LIVER", "code_information": [{"code": "47135", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTS OF THIGH TENDONS", "code_information": [{"code": "27397", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLJ HEMATOPOIETIC BOOST", "code_information": [{"code": "38243", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO HCT/DONOR", "code_information": [{"code": "38240", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO LYMPHOCYTES", "code_information": [{"code": "38242", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2783.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLT AUTOL HCT/DONOR", "code_information": [{"code": "38241", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 7528.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORT X-RAY MULTIPL", "code_information": [{"code": "R0075", "type": "HCPCS"}], "standard_charges": [{"minimum": 148.06, "maximum": 232.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 148.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 232.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 232.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 232.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORTABLE X-RAY", "code_information": [{"code": "R0070", "type": "HCPCS"}], "standard_charges": [{"minimum": 344.92, "maximum": 542.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 344.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 542.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 542.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 542.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OF VEIN VALVE", "code_information": [{"code": "34510", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OVARY(S)", "code_information": [{"code": "58825", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTEMPORAL APPROACH/SKULL", "code_information": [{"code": "61595", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR CATH FOR STENT", "code_information": [{"code": "33621", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43334", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43335", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHERAL RESECTION RESIDUAL/REGROWTH OBSTRUCTIVE PROSTATE TISSUE INC POST OP BLEED 52630", "code_information": [{"code": "52630", "type": "CPT"}, {"code": "35197598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL DESTRUCTION PROSTATE BY RADIOFREQUENCY 53852", "code_information": [{"code": "53852", "type": "CPT"}, {"code": "1482284", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL INCISION OF PROSTATE 52450", "code_information": [{"code": "52450", "type": "CPT"}, {"code": "1646740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH CC", "code_information": [{"code": "669", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9510.77, "maximum": 16327.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9510.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13602.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14962.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16327.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH MCC", "code_information": [{"code": "668", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17070.72, "maximum": 29306.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17070.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24414.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 26856.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 29306.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "670", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5952.22, "maximum": 10218.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5952.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8512.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9364.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10218.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITH CC/MCC", "code_information": [{"code": "713", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9084.35, "maximum": 15595.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9084.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14291.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15595.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "714", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5649.89, "maximum": 9699.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5649.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8080.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8888.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9699.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL RESECTION BLADDER NECK 52500", "code_information": [{"code": "52500", "type": "CPT"}, {"code": "1480573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL RESECTION RESIDUAL OR REGROWTH POSTOP BLADDER NECK CONTRACTURE 52640", "code_information": [{"code": "52640", "type": "CPT"}, {"code": "1481745", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL RF TREATMENT", "code_information": [{"code": "53860", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSVAGINAL US OBSTETRIC", "code_information": [{"code": "76817", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 135.87, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 144.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSVRS A-ARCH GRF HYPTHRM", "code_information": [{"code": "33871", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAP DIGIT TRACTION TOWER LARGE", "code_information": [{"code": "9903", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAP DIGIT TRACTION TOWER SMALL", "code_information": [{"code": "9906", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAP F DATEX MONITOR DISP WATER 876446-HEL", "code_information": [{"code": "876446-HEL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAP MUCOUS SPECIMEN 80CC LF", "code_information": [{"code": "45860", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAP SPECIMEN 40CC MUCUS SCREW CAP COLLECTION LF", "code_information": [{"code": "DYND44140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAP TISSUE ENDOSCOPY QUICK CATCH POLYP TRAP", "code_information": [{"code": "H332", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAUMA RESPONS W/HOSP CRITI", "code_information": [{"code": "G0390", "type": "HCPCS"}], "standard_charges": [{"minimum": 3929.97, "maximum": 6175.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3929.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6175.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6175.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6175.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [{"code": "604", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8990.07, "maximum": 15433.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8990.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12857.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14143.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15433.71, "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": 5498.42, "maximum": 9439.43, "estimated_discounted_cash": 5286.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5498.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7863.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8650.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9439.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC INJURY WITH MCC", "code_information": [{"code": "913", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9967.6, "maximum": 17111.9, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9967.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14255.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15681.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17111.9, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC INJURY WITHOUT MCC", "code_information": [{"code": "914", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5395.01, "maximum": 9261.9, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5395.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7716.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8487.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9261.9, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC", "code_information": [{"code": "86", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7752.78, "maximum": 13309.6, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7752.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11088.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12196.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13309.6, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [{"code": "85", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14062.07, "maximum": 24141.08, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14062.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20111.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22122.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24141.08, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "87", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5253.28, "maximum": 9018.57, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5253.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7513.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8264.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9018.57, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC", "code_information": [{"code": "83", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8175.55, "maximum": 14035.39, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8175.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11692.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12862.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14035.39, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [{"code": "82", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13771.3, "maximum": 23641.91, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13771.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19695.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21665.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23641.91, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "84", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5508.76, "maximum": 9457.18, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5508.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7878.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8666.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9457.18, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAY ARTHROGRAM MRI BIOPSY", "code_information": [{"code": "DYNDH1130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY BALLOON AVAFLEX 11G 20MM VERREBRAL", "code_information": [{"code": "AFB1120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5645.0, "discounted_cash": 1975.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY BEAD CERAMENT A0513", "code_information": [{"code": "A0513", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CATH 15FR BILEVEL RED RUBBER", "code_information": [{"code": "772415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CATH 16FR 5CC PRE CONNECTED 2 WAY FOLEY SI 3G GLV THREE PRE SATURATED PVP S", "code_information": [{"code": "DYND11519", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CATH FOLEY 16FR 5.0ML DOVER LF SILICONE 2 WAY FOLEY BALLOON DRAIN BAG", "code_information": [{"code": "6146LL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 19.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CATH PORTACATH", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "21-4591-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1159.0, "discounted_cash": 405.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CATHETER FOLEY 16FR", "code_information": [{"code": "8946", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.64, "discounted_cash": 13.87, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CATHIZATION MULTI LUMEN CV W/ 7 FRENCHINDWELLING CATH SPRING WIRE GUIDE 18G", "code_information": [{"code": "AK-12703", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 46.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CUSTOM PAIN KWSH", "code_information": [{"code": "PAIN0804", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY EPI 17GA X 3.5IN CONTINUOUS WINGED TUOHY NDL PERIFIX SCHLIFF LF", "code_information": [{"code": "332097", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY EPI SNGL SHOT RAMNATH", "code_information": [{"code": "551959", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY EPIDURAL", "code_information": [{"code": "18107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.93, "discounted_cash": 23.08, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY EPIDURAL 17GA X 3.5IN CONTINUOUS WINGED TUOHY NEEDLE SCHLIFF PERIFIX LATEX FREE", "code_information": [{"code": "332079", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY FIRST FRACTURE 15/2 KYPHX EXPRESS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "KPE1003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5939.0, "discounted_cash": 2078.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY FIXATION 5.5MM X 70MM OF2095520S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF2095520S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4290.0, "discounted_cash": 1501.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY FOLEY 14FR CATH LUBRSIL SYRNG DRAIN BAG", "code_information": [{"code": "907314", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY FOLEY 16F 10ML ERASE CAUTI 100% SILICONE", "code_information": [{"code": "DYND160716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5867.0, "discounted_cash": 2053.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY FOLEY 16FR CATH LUBRSIL SYRNG DRAIN BAG", "code_information": [{"code": "907316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY FOLEY CATH 16FR PVP DRAIN BAG LUBRICATH", "code_information": [{"code": "898316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY FOLEY SURESTEP BARD A907316", "code_information": [{"code": "A907316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY IRRIGATION 70 ML PISTON SYRNG LUER ADAPTER", "code_information": [{"code": "750301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY KYPHON EXPRESS II FIRST FRACTURE 2/15", "code_information": [{"code": "KEX152EB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5671.0, "discounted_cash": 1984.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY LACERATION W/INSTR STRL", "code_information": [{"code": "DYNJ03145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY LAVAGE 9FR X 20 CM PERITONEAL", "code_information": [{"code": "C-PLSY-901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 305.0, "discounted_cash": 106.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY MBT SZ 4 MOBILE BEARING TIBL CEMENTED KEEL IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "129433140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6036.0, "discounted_cash": 2112.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY MED 6FRINTRODUCER 5.8FR CATH 76 CM PORTACATH", "code_information": [{"code": "21-4053-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1349.0, "discounted_cash": 472.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY MED SNGL LUMEN LOW PROFILE PORTACATH II", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "21-4483-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.58, "discounted_cash": 412.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY MOLD FLEXIBLE CALCIUM BLOCKS WEDGS AND BEADS", "code_information": [{"code": "92-2010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 703.0, "discounted_cash": 246.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY NERVE BLOCK", "code_information": [{"code": "30301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.37, "discounted_cash": 26.03, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY PREPARATION SKIN SCRUB WET STANDARD LF", "code_information": [{"code": "DYND70672", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.21, "discounted_cash": 8.47, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY REMOVAL SUT W/ METAL IRIS AND ADSON FORCEPS", "code_information": [{"code": "DYNJ07254A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY REVERSED SHOULDER ASCEND FLEX ECCENTRIC OFFSET 3.5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 648.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SHOULDER REVERESED FLEX +0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2697.0, "discounted_cash": 943.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SHOULDER REVERESED FLEX +0 40MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SIZE 1 LM/RL IBAL UKA TIB CEMENTED AR-511-T1L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-511-T1L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SKIN WET SCRUB DYND70668", "code_information": [{"code": "DYND70668", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SPINAL 25G NO PHARM", "code_information": [{"code": "PAIN9016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.49, "discounted_cash": 30.97, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SPINAL 25GA X 3.5IN PENCAN", "code_information": [{"code": "333861", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SPNL W/ 25GA X 3 1/2IN PENCIL POINT NDL .75 PCT BUPIVACAINE SOL 8.25 PCT DE", "code_information": [{"code": "333851", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SPNL W/ 25GA X 3 1/2IN PENCIL POINT NDL EPINEPHRINE 0.1 PCT SOL 1 ML BUPIVA", "code_information": [{"code": "333863", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 22.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY STERILIZATION MODULAR TRANSFIXING THREADED PIN STAINLESS STEEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5030-5-250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 326.0, "discounted_cash": 114.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBIAL INFINITY ANKLE SZ 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "33650002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11676.0, "discounted_cash": 4086.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL SZ 2.5 CEMENTED KEEL MOBILE BEARING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "129433125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6337.0, "discounted_cash": 2217.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TRACHEOSTOMYINTRODUCER PERCUTANEOUS", "code_information": [{"code": "G12513", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 889.0, "discounted_cash": 311.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TRANSFER", "code_information": [{"code": "DYNJTTA1GS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TRANSFER ADHESIVE 375X9X1", "code_information": [{"code": "DYNJTTA1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TRB@ GENE REARRANGE AMPLIFY", "code_information": [{"code": "81340", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 322.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 532.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 837.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 837.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 837.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 300.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 300.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRB@ GENE REARRANGE DIRPROBE", "code_information": [{"code": "81341", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 76.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 71.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 71.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRCATH REPLACE AORTIC VALVE", "code_information": [{"code": "33366", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27840", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27842", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27846", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27848", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28490", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28495", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CHEST LINING", "code_information": [{"code": "32215", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21431", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21432", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21433", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21435", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21436", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT DENTAL RIDGE FRACTURE", "code_information": [{"code": "21440", "type": "CPT"}], "standard_charges": [{"minimum": 1939.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT EACH ADD SPINE FX", "code_information": [{"code": "22328", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59120", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59121", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59130", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59136", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59140", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24600", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24640", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24587", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28540", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28545", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28570", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28575", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28600", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28605", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25520", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26670", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27250", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27252", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27253", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27254", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27256", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27257", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27258", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27259", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27265", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27227", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27228", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27220", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27222", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP WALL FRACTURE", "code_information": [{"code": "27226", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24565", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24577", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27550", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27552", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27556", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27557", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27558", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27536", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27560", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27562", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27566", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26700", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21452", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21454", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21465", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27830", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27831", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27832", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27826", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26607", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28450", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28455", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21421", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21422", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21423", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT NECK SPINE FRACTURE", "code_information": [{"code": "22326", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/GRAFT", "code_information": [{"code": "22319", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/O GRAFT", "code_information": [{"code": "22318", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27216", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27217", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27218", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PLEURODESIS W/AGENT", "code_information": [{"code": "32560", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27175", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27176", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27177", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27178", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27181", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SPINE FRACTURE", "code_information": [{"code": "22325", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21820", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21825", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27200", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27202", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27232", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27235", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27240", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27244", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27245", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27517", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27519", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THORAX SPINE FRACTURE", "code_information": [{"code": "22327", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB DISLOCATION", "code_information": [{"code": "26641", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26645", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28630", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28635", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28660", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL NERVE", "code_information": [{"code": "61790", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINA INFECTION", "code_information": [{"code": "57150", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINAL BLEEDING", "code_information": [{"code": "57180", "type": "CPT"}], "standard_charges": [{"minimum": 1067.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25660", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25670", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25676", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT HUMERAL SHAFT FRACTURE W/ INTRAMEDULLARY IMPLANT 24516", "code_information": [{"code": "24516", "type": "CPT"}, {"code": "1481739", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9735.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT MOUTH ROOF LESION", "code_information": [{"code": "42160", "type": "CPT"}], "standard_charges": [{"minimum": 903.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46940", "type": "CPT"}], "standard_charges": [{"minimum": 546.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46942", "type": "CPT"}], "standard_charges": [{"minimum": 518.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27788", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28435", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CHOROID LESION", "code_information": [{"code": "67220", "type": "CPT"}], "standard_charges": [{"minimum": 985.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 985.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CORNEAL LESION", "code_information": [{"code": "65450", "type": "CPT"}], "standard_charges": [{"minimum": 531.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 531.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF EYELID LESIONS", "code_information": [{"code": "68040", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FOOT INFECTION", "code_information": [{"code": "28003", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF GUM LESION", "code_information": [{"code": "41850", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28405", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF INCOMPLETE ABORTION ANY TRIMESTER COMPLETELY 59812", "code_information": [{"code": "59812", "type": "CPT"}, {"code": "6296908", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISCARRIAGE", "code_information": [{"code": "59821", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISSED ABORTION-SURGICAL-FIRST TRIMESTER 59820", "code_information": [{"code": "59820", "type": "CPT"}, {"code": "1482286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MOUTH LESION", "code_information": [{"code": "40820", "type": "CPT"}], "standard_charges": [{"minimum": 985.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 985.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54110", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54115", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54200", "type": "CPT"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54205", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54220", "type": "CPT"}], "standard_charges": [{"minimum": 788.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 788.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RECTAL PROLAPSE", "code_information": [{"code": "45520", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67208", "type": "CPT"}], "standard_charges": [{"minimum": 1334.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1334.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67210", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67218", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21812", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21813", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF SEPTIC ABORTION-SURGICAL 59830", "code_information": [{"code": "59830", "type": "CPT"}, {"code": "1482287", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27503", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27507", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27508", "type": "CPT"}], "standard_charges": [{"minimum": 627.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27511", "type": "CPT"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27513", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27514", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TOE FRACTURE", "code_information": [{"code": "28510", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53220", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT X10SV RETINOPATHY", "code_information": [{"code": "67228", "type": "CPT"}], "standard_charges": [{"minimum": 1255.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPHINE 7.25", "code_information": [{"code": "K20-2055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE CORNEAL 360DEG 7.75MM KERATOPLASTY RADIAL VACUUM SUCTION CHAMBER", "code_information": [{"code": "K20-2057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 273.0, "discounted_cash": 95.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE CORNEAL 360DEG 8.25MM BARRON RADIAL VACUUM SUCTION CHAMBER", "code_information": [{"code": "K20-2059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 273.0, "discounted_cash": 95.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE CORNEAL 360DEG 8.75MM KERATOPLASTY RADIAL VACUUM SUCTION CHAMBER", "code_information": [{"code": "K20-2061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM", "code_information": [{"code": "86780", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AG IF", "code_information": [{"code": "87285", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 48.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 48.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 48.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRG GENE REARRANGEMENT ANAL", "code_information": [{"code": "81342", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 310.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 513.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 808.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 808.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 808.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 290.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 290.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 311+", "code_information": [{"code": "239U", "type": "CPT"}], "standard_charges": [{"minimum": 5040.0, "maximum": 14035.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8925.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 55-74", "code_information": [{"code": "242U", "type": "CPT"}], "standard_charges": [{"minimum": 1524.67, "maximum": 7200.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2397.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7200.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 83+", "code_information": [{"code": "326U", "type": "CPT"}], "standard_charges": [{"minimum": 7200.0, "maximum": 11707.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7444.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11707.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7200.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL DNA 23", "code_information": [{"code": "171U", "type": "CPT"}], "standard_charges": [{"minimum": 1936.8, "maximum": 3045.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1936.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2187.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2187.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ DNA 194 GENES", "code_information": [{"code": "50U", "type": "CPT"}], "standard_charges": [{"minimum": 4199.9, "maximum": 11695.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7437.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11695.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11695.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11695.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4199.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4199.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ DNA 324 GENES", "code_information": [{"code": "37U", "type": "CPT"}], "standard_charges": [{"minimum": 5040.0, "maximum": 14035.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8925.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14035.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRH STIMULATION PANEL", "code_information": [{"code": "80438", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 77.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 128.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 202.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 202.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 202.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 72.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 72.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRH STIMULATION PANEL", "code_information": [{"code": "80439", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 103.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 269.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 269.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 269.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 96.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 96.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRI BEADED W/PA PATELLA 32MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5554-L-320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1174.0, "discounted_cash": 410.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TRI BEADED W/PA PATELLA 35MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5554-L-350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4952.0, "discounted_cash": 1733.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRI PRESS-FIT STEM 11MM X 100MMS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5565-S-011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3356.0, "discounted_cash": 1174.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRI PRESS-FIT STEM 14MM X 100MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5565-S-014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRI RM/LL TIB AUG SZ2 5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5545-A-202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1646.0, "discounted_cash": 576.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TRI TS BASEPLATE SIZE 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5521-B-200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2369.0, "discounted_cash": 829.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TRI TS FEMUR SZ2 RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5512-F-202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10483.0, "discounted_cash": 3669.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TRI TS FEMUR SZ7 RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5512-F-702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10177.6, "discounted_cash": 3562.16, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIAL IMPLANT 18MM METATARSAL ENCOMPASS", "code_information": [{"code": "386-1318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 568.0, "discounted_cash": 198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIAL IMPLANT 9MM GAITWAY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GTW-1090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 306.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIAL IMPLANT SM HEMI GREAT TOE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "375-0010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 291.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIAL SZR HEMI PHALANGEAL IMPLANT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HPI-1002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 262.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIALS HAND/FOOT 1.0MM/1.5MM", "code_information": [{"code": "FIS-300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIALS OSTEO PLATE STRAIGHT 2.0MM/2.5MM", "code_information": [{"code": "FIS-370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIALS PLATE STRAIGHT FIBULAR", "code_information": [{"code": "FIS-652", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE ACETONIDE (KENALOG-40) 40MG", "code_information": [{"code": "MED0210", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON CR FEM COMPONENT - B 5517-F-802", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-802", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON CR X3 TIBIAL INSERT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 2 RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5541-A-202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1805.0, "discounted_cash": 631.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON FEMORAL PREP KIT SIZE 7", "code_information": [{"code": "5555-2207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR BASEPLATE #2 RM/LL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5620-B-202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3232.0, "discounted_cash": 1131.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR BASEPLATE #3 LM/RL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5620-B-301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3232.0, "discounted_cash": 1131.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR FEMUR #3 LM/RL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5610-F-301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5467.0, "discounted_cash": 1913.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR FEMUR #3 RM/LL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5610-F-302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5467.0, "discounted_cash": 1913.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR INSERT X3 #2 RM/LL -9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5630-G-229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2116.0, "discounted_cash": 740.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PKR INSERT X3 #3 LM/RL -8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5630-G-308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2116.0, "discounted_cash": 740.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PS FEM COMPONENT - B 5516-F-602", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5516-F-602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON PS FEM COMPONENT - B 5516-F-701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5516-F-701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3708.0, "discounted_cash": 1297.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON TIBIAL PREP KIT SIZE 7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5555-2327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIATHLON X3 TIBIAL BEARING INSERT PS SZE 4 THKNS 13MM 5532-G-413-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-413-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRICHINELLA ANTIBODY", "code_information": [{"code": "86784", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICHOGRAM", "code_information": [{"code": "96902", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS ASSAY W/OPTIC", "code_information": [{"code": "87808", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 61.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 61.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 61.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS VAGIN DIR PROBE", "code_information": [{"code": "87660", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS VAGINALIS AMPLIF", "code_information": [{"code": "87661", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICYCLIC & CYCLICALS 6/MORE", "code_information": [{"code": "80337", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT II TRITANIUM CLUSTERHOLE ACETABULAR SHELL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "702-04-58F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2060.0, "discounted_cash": 721.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIDENT PSL HA CLUSTER 48MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "542-11-48D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2440.0, "discounted_cash": 854.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIDENT X3 ECCENTRIC 0 36MM I 663-00-36F", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "663-00-36F", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2853.0, "discounted_cash": 998.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIESENCE (TRIAMCINOLONE) 40MG/ML PF", "code_information": [{"code": "MED0523", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 161.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM NAIL(S)", "code_information": [{"code": "G0127", "type": "HCPCS"}], "standard_charges": [{"minimum": 225.0, "maximum": 2204.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIM NAIL(S) ANY NUMBER", "code_information": [{"code": "11719", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRINITY ELITE SMALL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "410001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1508.0, "discounted_cash": 527.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIPLE-EDGE RELEASE INSTRUMENT SN21", "code_information": [{"code": "SN21", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 970.0, "discounted_cash": 339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST ART", "code_information": [{"code": "37246", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST VEIN", "code_information": [{"code": "37248", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL ART", "code_information": [{"code": "37247", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL VEIN", "code_information": [{"code": "37249", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/ST", "code_information": [{"code": "66175", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ABD AORTA", "code_information": [{"code": "236T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC BRCHIOCPH", "code_information": [{"code": "237T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ILIAC ART", "code_information": [{"code": "238T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC RENAL ART", "code_information": [{"code": "234T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC VISCERAL", "code_information": [{"code": "235T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV BIL", "code_information": [{"code": "339T", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV UNL", "code_information": [{"code": "338T", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ DON-DRV CLL-FR DNA", "code_information": [{"code": "118U", "type": "CPT"}], "standard_charges": [{"minimum": 3964.68, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3964.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3964.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ KDN ALGRFT REJ 1494", "code_information": [{"code": "88U", "type": "CPT"}], "standard_charges": [{"minimum": 4549.56, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4549.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4549.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ PD LVR&BWL CD154+CLL", "code_information": [{"code": "81560", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 922.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 922.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ RNL MEAS CD154+CLL", "code_information": [{"code": "18M", "type": "CPT"}], "standard_charges": [{"minimum": 922.66, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 922.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 922.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSXJ/REPOS ABRRNT RNL VSLS", "code_information": [{"code": "50100", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TROCAR 1.6 150MM", "code_information": [{"code": "A5040.41/1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 12MM OPTIVIEW 150MM 2B12XT", "code_information": [{"code": "2B12XT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 5MMX100MM CANN/SEAL", "code_information": [{"code": "CTS02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 5X150 SMOOTH -ORDR QTY 6 2B5XT", "code_information": [{"code": "2B5XT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADED 11MM STD FIX B11STF", "code_information": [{"code": "B11STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 566.25, "discounted_cash": 198.19, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 12MM 15OMM ENDOPATH XCEL", "code_information": [{"code": "B12XT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 446.0, "discounted_cash": 156.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 15MM X 100MM STABILITY SLEEVE REPROCESS ENDOPATH XCEL", "code_information": [{"code": "B15LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 5 MM TO 12 MM W/ FXTN CANNULA", "code_information": [{"code": "NB15STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 305.0, "discounted_cash": 106.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 5MM X 75MM STABILITY SLEEVE REPROCESS ENDOPATH XCEL", "code_information": [{"code": "B5STR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 419.0, "discounted_cash": 146.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS ENDOPATH XCEL 3 NEW & 3 REPROCESSED 12 X 100MM", "code_information": [{"code": "SUSB12LT33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS ENDOPATH XCEL 3 NEW & 3 REPROCESSED 5 X 100MM", "code_information": [{"code": "SUSB5LT33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS OBTUR OPTICAL 12/100MM B12LT", "code_information": [{"code": "B12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESSS 8MM X 100MM STABILITY SLEEVE LAP BLUNT REPROCESS ENDOPATH XCEL", "code_information": [{"code": "B8LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.82, "discounted_cash": 25.49, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLUNT TIP XCEL 12X100MM RPR H12LP", "code_information": [{"code": "H12LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 61.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR DIALATING TIP STABILITY SLV 5/100 D5LT", "code_information": [{"code": "D5LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR DILATING TIP STABILITY SLV 5X75 D5ST", "code_information": [{"code": "D5ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.0, "discounted_cash": 35.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR DILATING TIP STABLE SLV 12X100MM D12LT", "code_information": [{"code": "D12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO 15MM VERSAPORT PLUS RPF FIXATION CANNULA", "code_information": [{"code": "179078PF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 83.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO 5 TO 12MM VISIPORT PLUS VERSAPORT FIXATION CANNULA", "code_information": [{"code": "176674PF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO 5MM X 100MM RESPOSABLE DILATING TIP OBTURATOR AND HOUSING ENDOPATH", "code_information": [{"code": "35LDA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 286.0, "discounted_cash": 100.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO BLADED OBTURATOR VERSAPORT PLUS", "code_information": [{"code": "179771P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 56.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO KII 12 X 100MM ACCESS SYSTEM SHIELDED BLADED ADVANCED FIXATION", "code_information": [{"code": "CFB73", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO KII 5 X 100MM ACCESS SYSTEM ADVANCED FIXATION SLEEVE SHIELDED BLADED", "code_information": [{"code": "CFB03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO XCEL BLADELESS 15MM 100MM B15LT", "code_information": [{"code": "B15LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 446.0, "discounted_cash": 156.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO XCEL BLDLS 11MM STRL NO HNDL B11LT", "code_information": [{"code": "B11LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDOPATH XCEL BLADELESS 11MM B11LP", "code_information": [{"code": "B11LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDOSCOPY KII ACCESS SYSTEM LATEX FREE SHIELDED BLADED 12 X 100MM", "code_information": [{"code": "CTB73", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR KII FIOS 12MM X 100MM", "code_information": [{"code": "CFF73", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR KII FIOS ADV FIX 5MM X 100MM", "code_information": [{"code": "CFF03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.0, "discounted_cash": 59.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR KII OPTICAL 8 X 100MM COQ19 COQ19", "code_information": [{"code": "COQ19", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP 100MM 5 NN BLADELESS REPROCESS VERSASTEP PLUSINSTR", "code_information": [{"code": "VS101005R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP 11MM 100MM BLADELESS OPTIC TIP STABILITY SLEEVE ENDOPATH XCEL LF STRL", "code_information": [{"code": "ETHB11LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP 12MM X 100MM BLADELESS REPROCESS W/ STABILITY SLEEVE ENDOPATH XCEL", "code_information": [{"code": "B12LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP 5MM TO 10MM W/ 100 MM RADIOLUCENT SLEEVE VERSAPORT PLUS", "code_information": [{"code": "179076P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 68.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP 5MM TO 12MM BLACK BLADED CONVERTERLESS VERSAPORT+ V2 STRL DISP", "code_information": [{"code": "179096PR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 33.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP 5MM TO 12MM BLADED VERSAPORT PLUS STRL DISP", "code_information": [{"code": "179096P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.0, "discounted_cash": 73.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP 5MM X 100MM DILATING TIP STABILITY SLEEVE OBTURATOR REPROCESS ENDOPAT", "code_information": [{"code": "D5LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP KII 100 X 11MM ACCESS FIRST ENTRY ADVANCED FIXATION", "code_information": [{"code": "CFF33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR NO BLADE 5MM SHORT FIX NONB5SHF", "code_information": [{"code": "NONB5SHF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.0, "discounted_cash": 37.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR OPTICAL 12MM X 150MM Z THREAD", "code_information": [{"code": "CTF71", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SLEEVE 12MM XCEL", "code_information": [{"code": "2CB12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.0, "discounted_cash": 108.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR STANDARD 11 MM ONB11STF", "code_information": [{"code": "ONB11STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 99.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 10MM HERNIA BLLN BLUNT TIP", "code_information": [{"code": "OMST10BT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 430.0, "discounted_cash": 150.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 10MM TO 15MM X 5MM TO 12MM W/ 100 MM RADIOLUCENT SLEEVE VERSAPORT PL", "code_information": [{"code": "179078P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 388.0, "discounted_cash": 135.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 11MM BLADELESS REPROCESS ENDOPATH EXCEL STRLINSTR", "code_information": [{"code": "B11LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 39.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 12MM X 100MM BLUNT TIP REPROCESS EXCELINSTR", "code_information": [{"code": "H12LPR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 5MM REPROCESS W/ FXTN CANNULA VERSAPORT V2", "code_information": [{"code": "179094FR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 5MM TO 11MM VERSAPORT V2", "code_information": [{"code": "179095PF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.0, "discounted_cash": 78.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 5MM TO 12MM VERSAPORT PLUS V2", "code_information": [{"code": "179097P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 71.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 5MM TO 12MM W/ ANCHORING DEV BLUNTPORT PLUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "176626P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 233.0, "discounted_cash": 81.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 5MM TO 8MM REPROCESS W/ 100MM RADULUCENT SLEEVE VERSAPORT PLUS RPF", "code_information": [{"code": "179074PR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.0, "discounted_cash": 37.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 5MM TO 8MM W/ 100 MM RADIOLUCENT SLEEVE VERSAPORT PLUS", "code_information": [{"code": "179074P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 5MM W/ FXTN CANNULA VERSAPORT V2", "code_information": [{"code": "179094F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 5MM W/ FXTN CANNULA VERSAPORT V2 ST", "code_information": [{"code": "179093F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 5MM X 100MM BLADELESS STABILITY SLEEVE REPROCESS EXCELINSTR", "code_information": [{"code": "B5LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 136.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG RIGHT 10MM LNG OBTURATOR W/ SAFETY SHIELD VERSAPORT PLUS", "code_information": [{"code": "179777P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 56.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 12MM STD BLUNT BPT12STS", "code_information": [{"code": "BPT12STS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 421.0, "discounted_cash": 147.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 12MM STD OPTICAL ONB12STF", "code_information": [{"code": "ONB12STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.0, "discounted_cash": 87.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 12MM UNIVERSAL STD UNVCA12STF", "code_information": [{"code": "UNVCA12STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 46.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 12MM X 100 STAND BLADED SMOOTH", "code_information": [{"code": "B12STS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 12MM X 150MM BLADED SMOOTH LONG", "code_information": [{"code": "B12LGS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 160.3, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 5MM SHORT BLADED B5SHF", "code_information": [{"code": "B5SHF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.21, "discounted_cash": 46.27, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 5MM STD OPTICAL ONB5STF", "code_information": [{"code": "ONB5STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 58.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 5MM UNIVERSAL SHORT UNVCA5SHF", "code_information": [{"code": "UNVCA5SHF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 5MM UNIVERSAL STD UNVCA5STF", "code_information": [{"code": "UNVCA5STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 164.57, "discounted_cash": 57.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSONE 5MM STD BLADED B5STF", "code_information": [{"code": "B5STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.48, "discounted_cash": 37.97, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR W/ FXTN CANNULA 5 MM VERSAPORT V2", "code_information": [{"code": "179094", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1559.0, "discounted_cash": 545.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL 5MMX75MM -ORDR QTY 6 2B5ST", "code_information": [{"code": "2B5ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 475.0, "discounted_cash": 166.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL BLADELESS STABLE SLV 5/100MM B5LT", "code_information": [{"code": "B5LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.0, "discounted_cash": 39.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL BLADELESS STABLE SLV 5/150MM B5XT", "code_information": [{"code": "B5XT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 143.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL BLADELESS STABLE SLV 5/75MM B5ST", "code_information": [{"code": "B5ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.0, "discounted_cash": 148.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL BLADELESS STABLE SLV 8/100MM B8LT", "code_information": [{"code": "B8LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 242.15, "discounted_cash": 84.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL BLUNT TIP 12MMX100MM 2H12LP", "code_information": [{"code": "2H12LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL W OPTIVIEW BLADELESS 5/100MM 2B5LT", "code_information": [{"code": "2B5LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TRS/REV AF", "code_information": [{"code": "G9929", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRUCLEAR ULTRA RECIPROCATING MORC. 4.0 72203012", "code_information": [{"code": "72203012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1689.0, "discounted_cash": 591.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TRUDI NAV CABLE", "code_information": [{"code": "TDNC001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 179.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TRUMPET VALVE SUCTION TUBING NEZHAT-DORSEY 5MMX33CM PROBE TIP WITH HOLES AND BAG SPIKES", "code_information": [{"code": "5102710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TRURL ABLTJ MAL PRST8 TISS", "code_information": [{"code": "582T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRURL DSTRJ PRST8 TISS RF WV", "code_information": [{"code": "53854", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRYPAN BLUE 0.06% (VISION BLUE) OPHTHALMIC SOLUTION 0.5ML", "code_information": [{"code": "MED0212", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 186.0, "discounted_cash": 65.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TTE F-UP OR LMTD", "code_information": [{"code": "93308", "type": "CPT"}], "standard_charges": [{"minimum": 325.81, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 325.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 511.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 511.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 511.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O CONTR, CONT ECG", "code_information": [{"code": "C8930", "type": "HCPCS"}], "standard_charges": [{"minimum": 3002.42, "maximum": 4718.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CON,STRES", "code_information": [{"code": "C8928", "type": "HCPCS"}], "standard_charges": [{"minimum": 3002.42, "maximum": 4718.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CONT, COM", "code_information": [{"code": "C8921", "type": "HCPCS"}], "standard_charges": [{"minimum": 3002.42, "maximum": 4718.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CONT, F/U", "code_information": [{"code": "C8922", "type": "HCPCS"}], "standard_charges": [{"minimum": 3002.42, "maximum": 4718.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR WO FOL WCON,DOPPLER", "code_information": [{"code": "C8929", "type": "HCPCS"}], "standard_charges": [{"minimum": 3002.42, "maximum": 4718.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3002.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4718.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W/DOPPLER COMPLETE", "code_information": [{"code": "93306", "type": "CPT"}], "standard_charges": [{"minimum": 597.6, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 597.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 939.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 939.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 939.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W/O DOPPLER COMPLETE", "code_information": [{"code": "93307", "type": "CPT"}], "standard_charges": [{"minimum": 427.55, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 427.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 671.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 671.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 671.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTVI/RPLCMT W/PRSTC VLV PERQ", "code_information": [{"code": "646T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ APPR 1ST PROSTH", "code_information": [{"code": "569T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ EA ADDL PROSTH", "code_information": [{"code": "570T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 10849.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 10849.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 8572.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE 9569817 DISP 18MM X 7CM ANGLED 9569817", "code_information": [{"code": "9569817", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.44, "discounted_cash": 149.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE APPLICATOR VISTASEAL LAPAROSCOPIC DUAL VSTL35", "code_information": [{"code": "VSTL35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.07, "discounted_cash": 60.22, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ARMSTRONG BEVELED GROMMETS 1010055", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1010055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ARMSTRONG R VENT 510-311", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "510-311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25.2, "discounted_cash": 8.82, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE BLOOD COLLECTION EDTA KS 9 ML 455036", "code_information": [{"code": "455036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE BREATHING PATIENT HYTREL 900MM/35IN", "code_information": [{"code": "67328004515", "type": "CDM"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 30.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE BYPASS 3.5MM X 16MM LACRIMAL LESTER JONES IMPLANT", "code_information": [{"code": "10000-3516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 33.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE COHEN T CROMMET VENTILATION FIRM SILICONE 24701", "code_information": [{"code": "24701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE DRAIN 10FR TLS ROUND", "code_information": [{"code": "6650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.0, "discounted_cash": 37.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE EAR MYRINGOTOMY 1.14 X 2.6 X 1.0MM RUETER BOBBIN TITANIUM HOLE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1027060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE EAR MYRINGOTOMY 1.27 X 3.0 X 1.55MM SHEEHY COLLAR BUTTON FLUORO BLUE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1013301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE EMG 8.0 NIM", "code_information": [{"code": "8229738", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 947.69, "discounted_cash": 331.69, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE EMG NIM SZ6", "code_information": [{"code": "8229736", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 947.69, "discounted_cash": 331.69, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 25 X 3.5MM RUSCHELIT AGT ORAL PVC PREFORMED CUFFED", "code_information": [{"code": "111780035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 3.5MM NASAL ORAL UNCUFFED MURPHY EYE W/ TIP TO TIP RADIOPAQUE LINE LF", "code_information": [{"code": "86224", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 3MM UNCFFD MURPHY EYE LTX W/ TIP TO TIP RADIOPAQUE LINE STRL PEDI", "code_information": [{"code": "86223", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 3MM UNCUFFED ORAL RAE", "code_information": [{"code": "86263", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.0MM INTERMEDIATE HI-LO CUFFED", "code_information": [{"code": "86444", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM CLR NASAL ORAL UNCUFFED MAGILL CURVE TIP W/ TIP TO TIP RADIOPAQU", "code_information": [{"code": "86465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM MURPHY LO PRO", "code_information": [{"code": "86046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM NASAL RAE MURPHY HOODED 2 EYE UNCFFD LF STRL", "code_information": [{"code": "86286", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM ORAL RAE UNCUFFED DOUBLE MURPHY EYE PREFORMED CURVE LF STRL DISP", "code_information": [{"code": "86221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM RAY MURPHY ORAL PREFORMED CUFFED", "code_information": [{"code": "86199", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM UNCFFD MURPHY EYE W/ TIP TO TIP RADIOPAQUE LINE STRL PEDI", "code_information": [{"code": "86226", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM UNCUFFED ORAL RAE", "code_information": [{"code": "86266", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4MM CLR NASAL ORAL UNCUFFED MAGILL CURVE LF STRL PEDI", "code_information": [{"code": "86464", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4MM MURPHY LO PRO", "code_information": [{"code": "86045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4MM NASAL ORAL UNCFFD MURPHY EYE W/ TIP TO TIP RADIOPAQUE LINE LF STRL", "code_information": [{"code": "86225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4MM NASAL RAE UNCUFFED LF", "code_information": [{"code": "86285", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4MM ORAL RAE MURPHY CUFFED", "code_information": [{"code": "86209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4MM ORAL RAE UNCUFFED PERFORMED CURVE STRL", "code_information": [{"code": "86265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 5.5MM INTERMEDIATE HI-LO CUFFED", "code_information": [{"code": "86447", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 5.5MM NASAL ORAL CFFD MURPHY EYE MAGILL CURVE LASER RESISTANT LASER FL", "code_information": [{"code": "86395", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 48.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 5.5MM ORAL RAE CUFFED MURPHY EYE TIP PREFORMED CURVE LF STRL", "code_information": [{"code": "86201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 5.5MM UNCUFFED ORAL RAE", "code_information": [{"code": "86268", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 5.5MM UNCUFFED REINFORCED MAGILL", "code_information": [{"code": "86467", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 5MM CLR NASAL ORAL UNCUFFED MAGILL CURVE W/ TIP TO TIP RADIOPAQUE ILNE", "code_information": [{"code": "86466", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 5MM NASAL ORAL CUFFED MURPHY EYE MAGILL CURVE LASER RESISTANT LASER FL", "code_information": [{"code": "86394", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 5MM NASAL RAE UNCUFFED PREFORMED CURVE LF", "code_information": [{"code": "86287", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 5MM ORAL RAE MURPHY EYE TIP PREFORMED CURVE LF", "code_information": [{"code": "86200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 5MM ORAL RAE UNCUFFED PREFORMED CURVE LF", "code_information": [{"code": "86267", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 6.0MM INTERMEDIATE HI-LO CUFFED", "code_information": [{"code": "86448", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 6.5MM INTERMEDIATE HI-LO CUFFED", "code_information": [{"code": "86449", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 6.5MM MURPHY HOODED 2 EYE TIP UNCFFD PREFORMED CURVE POLYVINYL CHLORID", "code_information": [{"code": "86270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 6.5MM NASAL RAE CUFFED MURPHY EYE TIP PREFORMED CURVE LF STRL DISP", "code_information": [{"code": "86213", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 6.5MM ORAL RAE MURPHY EYE TIP CUFFED PREFORMED CURVE STRL", "code_information": [{"code": "86203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 6IN 2.5MM STANDARD CLR NASAL ORAL UNCUFFED MURPHY EYE W/ TIP TO TIP RA", "code_information": [{"code": "86222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 6MM MAGILL UNCUFFED", "code_information": [{"code": "86468", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 6MM NASAL ORAL CUFFED MURPHY EYE MAGILL CURVE LASER FLEX SS", "code_information": [{"code": "86398", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 46.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 6MM ORAL RAE MURPHY EYE TIP CUFFED", "code_information": [{"code": "86202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 6MM ORAL RAE UNCUFFED PERFORMED CURVE STRL", "code_information": [{"code": "86269", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 6MM X 8.2MM EMG NIM TRIVANTAGE STRL DISP", "code_information": [{"code": "8229706", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 889.0, "discounted_cash": 311.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 7.0MM HIGH VOLUME LOW PRESSURE SHRT CUFF MAGILL CURVE ORAL OR NASAL PO", "code_information": [{"code": "86450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 7.5MM MURPHY EYE CFFD NASAL RAE LF STRL DISP", "code_information": [{"code": "86215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 7.5MM ORAL RAE MURPHY EYE TIP PREFORMED CURVE LF", "code_information": [{"code": "86205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 79MM 12.2MM 7.6MM SZ 8 CFFDINNER CANNULA LOW PRESSURE SHILEY LF DISP", "code_information": [{"code": "8DCT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 33.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 79MM 127MM 15MM SIZE 9 CUFF DISP INNR CANN", "code_information": [{"code": "9CN90H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 7MM HOD MURPHY EYE CVD RADIOPAQUE NERVEINTEGRITY MONITORING SYS NIM-RE", "code_information": [{"code": "8229507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 913.0, "discounted_cash": 319.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 7MM ORAL RAE MURPHY EYE TIP PREFORMED CURVE LF", "code_information": [{"code": "86204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 7MM X 9.5MM EMG NIM TRIVANTAGE", "code_information": [{"code": "8229737", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 947.69, "discounted_cash": 331.69, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 7MM X 9.5MM EMG NIM TRIVANTAGE STRL DISP", "code_information": [{"code": "8229707", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 977.0, "discounted_cash": 341.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 8.0MM HIGH VOLUME LOW PRESSURE SHRT CUFF ORAL OR NASAL MAGILL CURVE PO", "code_information": [{"code": "86452", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 8.0MM X 11.3MM EMG MONITOR REINFORCED PROTECTED PIN NIM DISP", "code_information": [{"code": "8229308", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 973.05, "discounted_cash": 340.57, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 8.5MM CUFFED HIGH VOLUME LOW PRESSUREINTERMED", "code_information": [{"code": "86453", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 8MM MURPHY NASAL RAE", "code_information": [{"code": "86216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 8MM ORAL RAE MURPHY EYE TIP PREFORMED CURVE", "code_information": [{"code": "86206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 8MM X 10.7MM EMG NIM TRIVANTAGE", "code_information": [{"code": "8229708", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 892.0, "discounted_cash": 312.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 8MM X 11.5MM HOOD MURPHY EYE CVD RADIOPAQUE NERVEINTEGRITY MONITORING", "code_information": [{"code": "8229508", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 913.0, "discounted_cash": 319.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 9MM CUFFED HIGH VOLUME LOW PRESSUREINTERMED LF", "code_information": [{"code": "86454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO ORAL PREFORMED MURPHY CUFFED 3.5 M0535C", "code_information": [{"code": "M0535C", "type": "CDM"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO ORAL RAE W/ TAPERGUARD CUFF 5MM LF", "code_information": [{"code": "76251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO ORAL RAE W/ TAPERGUARD CUFF 6MM LF", "code_information": [{"code": "76260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO ORAL RAE W/ TAPERGUARD CUFF 7MM LF", "code_information": [{"code": "76270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.25, "discounted_cash": 7.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO ORAL RAE W/ TAPERGUARD CUFF 8MM LF", "code_information": [{"code": "76280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO SZ 6 CUFFED LOW PRESSUREINNER CANNULA LF ADLT", "code_information": [{"code": "6DCT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 33.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO SZ 8 CUFFED FENESTRATED SHILEY LF DISP", "code_information": [{"code": "8DFEN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.19, "discounted_cash": 34.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDONTRACHEAL 6MM X 9MM ELECTROMYOGRAPHY EAR NOSE THROAT REINFORCED NIM CON", "code_information": [{"code": "8229506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 730.0, "discounted_cash": 255.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 3.5MM NASAL UNCUFFED RAE", "code_information": [{"code": "86284", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 3MM NASAL RAE UNCUFFED", "code_information": [{"code": "86283", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 6.5MM UNCUFFED MAGILL", "code_information": [{"code": "86469", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 6MM NASAL RAE CUFFED PREFORMED LF STRL DISP", "code_information": [{"code": "86212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 7.5MM THIN CUFFINTERMED HI LO", "code_information": [{"code": "86451", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH INTERMED HI-LO 4.5 MM 86445", "code_information": [{"code": "86445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH INTERMED HI-LO 5.0 MM 86446", "code_information": [{"code": "86446", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH ORAL RAE 5.5 MM 76255", "code_information": [{"code": "76255", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 4MM NASAL ORAL REINFORCE PVC SILICONE STERILE DISPOSABLE HEAD NECK NEUROSURGICAL", "code_information": [{"code": "86544", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 5MM MICROLARYNGEAL. 86387", "code_information": [{"code": "86387", "type": "CDM"}], "standard_charges": [{"gross_charge": 28.33, "discounted_cash": 9.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 6.0 NIM 8229306", "code_information": [{"code": "8229306", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1002.0, "discounted_cash": 350.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 6MM MICROLARYNGEAL MLK86389H", "code_information": [{"code": "MLK86389H", "type": "CDM"}], "standard_charges": [{"gross_charge": 28.33, "discounted_cash": 9.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 7.0 MM CUFFED DYND43070", "code_information": [{"code": "DYND43070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 7.0 NIM 8229307", "code_information": [{"code": "8229307", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1002.0, "discounted_cash": 350.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 7.0ID X 9.5OD MM MALLINCKRODT CUFFLESS NASAL RAE", "code_information": [{"code": "96370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 7.5ID X 10.2OD MM MALLINCKRODT CUFFLESS NASAL RAE", "code_information": [{"code": "96375", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL HI-LOW CUFFED SIZE 6.0", "code_information": [{"code": "M0460C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ET 6MM CUF MRPH EYE PREFRM CRV NSLRAE STRL LF DISP", "code_information": [{"code": "96360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ET CUF MRPHCRV NSLRAE STRL LF DISP 6.5MM", "code_information": [{"code": "96365", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ET CUFFED ORAL/NASAL W/MURPHY EYE BULL-NOSE TIP 6.5MM DYNJAETC65", "code_information": [{"code": "DYNJAETC65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.31, "discounted_cash": 2.21, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE FDNG 5FR 36IN ROUNDED DIST TIP RADIOPAQUE PVC W/ DEPTH MARKINGS 8IN ARGYLE", "code_information": [{"code": "8888261008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE FEEDING GASTROSTOMY 20FR X 3.5CM 8140-20-3.5", "code_information": [{"code": "8140-20-3.5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.11, "discounted_cash": 104.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE HOLDERS ONGUARD BLOOD COLLECTION DYNDBCHLDR", "code_information": [{"code": "DYNDBCHLDR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE INFLOW AQULEX", "code_information": [{"code": "AQL-110S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 414.0, "discounted_cash": 144.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE JONES 4.0 X 16", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "10000-4016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 33.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NASAL RAE UNCUFFED 5.5 23F ENDO 4YR-5-1/2 YR", "code_information": [{"code": "86288", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NASOGASTRIC 12FR 48IN RADIOPAQUEINTEGRAL IRRIGATION CONNECTORINTEGRAL FUNNE", "code_information": [{"code": "8888264929", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.38, "discounted_cash": 1.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NASOGASTRIC 14FR W/ FILTER", "code_information": [{"code": "46140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NASOGASTRIC 16FR 48IN RADIOPAQUEINTEGRAL IRRIGATION CONNECTORINTEGRAL FUNNE", "code_information": [{"code": "8888264960", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.42, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NASOGASTRIC 18FR 48IN RADIOPAQUE COVIDIEN MEDINTEGRAL IRRIGATION CONNECTORI", "code_information": [{"code": "8888264986", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.42, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NASOGASTRIC 18FR W/ PREVENT FILTER", "code_information": [{"code": "46180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NG 36IN 10FR 2 LUM PRV ANRFLX FLTR SUMP PRV STRL LF", "code_information": [{"code": "46100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NG 48IN 16FR 2 LUM PRV ANRFLX FLTR S SMP PVC STRL LF", "code_information": [{"code": "46160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NG TUBE W/PREVENT FILTER 12FR 0046120", "code_information": [{"code": "46120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ORAL RAE CUFFED W/MURHPY EYE 7.5 43162-475", "code_information": [{"code": "43162-475", "type": "CDM"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ORAL RAE CUFFED W/MURPHY EYE 8.0 MLK86206", "code_information": [{"code": "MLK86206", "type": "CDM"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE OUTFLOW AQUILEX", "code_information": [{"code": "AQL-111S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 32.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE PAPARELLA TYPE 1 VENTILATION WITH NOTCH AND TAB SILICONE GREEN 1.14.MM 1025001", "code_information": [{"code": "1025001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.24, "discounted_cash": 14.78, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE POPE VENT 1.14MM BLUE FLUOROPLASTIC 525-641", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "525-641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25.48, "discounted_cash": 8.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE POPE VENT 530-001", "code_information": [{"code": "530-001", "type": "CDM"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE REAMER 4.5MM REPLACEMENT HOLLOW NONSTERILE", "code_information": [{"code": "309.48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 802.0, "discounted_cash": 280.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE REAMER 6.5-7MM REPLACEMENT HOLLOW NONSTERILE", "code_information": [{"code": "309.068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 802.0, "discounted_cash": 280.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SALEM 14FR X 48IN DOUBLE LUMENINTEGRAL FUNNEL CONNECTOR FIVEIN ONE ADAPTER", "code_information": [{"code": "88-264945", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SALEM SUMP ARGYLE 14FR 48 8888264945", "code_information": [{"code": "8888264945", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.38, "discounted_cash": 1.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SET STERILE A127 PUMP T0449-01", "code_information": [{"code": "T0449-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 58.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SHEATH URETERAL ACCESS NAVIGATOR 11-13FR 36CM", "code_information": [{"code": "M0062502220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SHEPARD GROMMET VENT 520-121", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "520-121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUCTION 12FR UNIVERSAL CONNECTOR FRAZIER CONTROL VENT ERGONOMIC HANDLE LATEX FREE STERILE", "code_information": [{"code": "DYNDFR12S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUMP GASTRIC 36 STERILE EDUCATION 8888264911", "code_information": [{"code": "8888264911", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.21, "discounted_cash": 3.57, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUPPORT FOR BURR 16-0102/03/04", "code_information": [{"code": "16-0102/03/04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 605.25, "discounted_cash": 211.84, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SURGICAL IRRIGATION", "code_information": [{"code": "PD-IT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.06, "discounted_cash": 82.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TEFLON T2 HUMERUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1806-0073S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1117.0, "discounted_cash": 390.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACH ORAL RAE CUFFED 6.5 76265", "code_information": [{"code": "76265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACH ORAL RAE CUFFED 7.5 76275", "code_information": [{"code": "76275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.25, "discounted_cash": 7.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACHEAL 5.5MM CLR UNCFFD STANDARD W/ MAGILL TIP FOR ORAL OR NASAL USE", "code_information": [{"code": "43151-055", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACHEOSTOMY FLEXIBLE CUFFED 7.5 6UN75R", "code_information": [{"code": "6UN75R", "type": "CDM"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 66.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACHEOSTOMY SHILEY FLEXIBLE 6.5MM 4CN65H", "code_information": [{"code": "4CN65H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 44.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACHEOSTOMY SZ 4.0 UNCUFFED W/ DISPOSABLEINNER CANNULA", "code_information": [{"code": "4CFS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 43.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACHEOSTOMY SZ 6 UNCUFFED", "code_information": [{"code": "6CFS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.0, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENT 1.14MM 2.4MM SHEPHARD GROMMET EAR FLUOROPLASTIC TAB 1028015", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1028015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENT 1.14MM POPE GROMMET PR 1.14 1066036", "code_information": [{"code": "1066036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENT 1.27MM GOODE ACTIVENT T-GROMMET ACTIVENT SILICONE/SILVER OXIDE 1026011", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1026011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENT POPE BEVELED GROMMET 1.14MM 1025004", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1025004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION 1.14MM EAR REUTER BOBBIN", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "145225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION 1.14MM GROMMET SHEPPARD FLUOROPLASTIC", "code_information": [{"code": "145003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION 1.14MM PAPARELLA ACTIVENT SILICONE W/ TAB AND NOTCH", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1046001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION 1.14MM PAPARELLA SILICONE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1040006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION 1.14MM SHEPPARD EAR NO WIRE GROMMETT LF", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "140027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION 1.27MM GOODE T GROMMET SILICONE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1016020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION 1.27MM TOUMA T GROMMET BEVELED ACTIVENT SILICONE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1026014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 13.3, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION 3.5 CM X 1.14MM ARMSTRONG BEVELED EAR GROMMET AVNT SILICONE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1026055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION MODIFIED GOODE T TUBE SILICONE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1016040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION MODIFIED GOODE T TUBE SILICONE 50/EA", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1016041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION PAPARELLA SOFT SILIC ULTR 70245780", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "70245780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENTILATION REUTER VENTURI BOBBIN 1.27MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1070031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VNT 1.14MM PAPARELLA TYPE 1 GROMMET ACTIVENT SILICONE W/ TAB AND NOTCH", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1026001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VNT 1.3MM 1.14MM 3.6MM POPE EAR GRMT BVL FLRPLAS GRN", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1040014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 80.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE WATER AUXILIARY", "code_information": [{"code": "MAJ-855", "type": "CDM"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING 9IN STRAW DISPOSABLE SMOKE EVACUATOR", "code_information": [{"code": "6150 LEEP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING ADAPTER 10MM X 122 CM W/ PENADAPT", "code_information": [{"code": "PA2010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING CONNECTING FRAZIER CLAMP 2FT", "code_information": [{"code": "31000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.58, "discounted_cash": 5.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING CUFF 10FT BLACK BLOOD PRESSURE ADLT", "code_information": [{"code": "877235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.0, "discounted_cash": 78.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING CYSTO IRR TURP 80\" Y DYND19142", "code_information": [{"code": "DYND19142", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.18, "discounted_cash": 9.51, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING DUALWAVE OUTFLOW CASSETTE", "code_information": [{"code": "AR-6430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING ENDO 16IN GASTROINTESTINAL 24 HOUR USE FOR OLYMPUS ENDOSCOPES 140/160/180", "code_information": [{"code": "100145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING EXTENSION 20IN HIGH PRESSURE RELIEVA", "code_information": [{"code": "REXT20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING EXTENSION SMARTSITE SET 20019E", "code_information": [{"code": "20019E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING EXTRA SMI-TUBING", "code_information": [{"code": "SMI-TUBING", "type": "CDM"}], "standard_charges": [{"gross_charge": 207.35, "discounted_cash": 72.57, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING FLUID MANAGEMENT GRAVITY", "code_information": [{"code": "281113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING INSUFLATION 23G CANNULAS", "code_information": [{"code": "1279.IA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 111.0, "discounted_cash": 38.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING INSUFLATION 25G CANNULAS", "code_information": [{"code": "1279.IA25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IRR 11FT 2 SPK GRVTY PVC STRL LF DISP", "code_information": [{"code": "C7110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IRRIGATION 102 IN FOR THE EGP 100 IRRIGATION UNIT ENDOGATOR 4005644", "code_information": [{"code": "4005644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IRRIGATION 102IN FOR THE EGP100 IRRIGATION UNIT ENDOGATOR", "code_information": [{"code": "200230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IRRIGATION 11FT SPIKED GRAVITY LFT POLUVINYL CHLORIDE DISP", "code_information": [{"code": "C7111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IRRIGATION MIS POWER MSN50016", "code_information": [{"code": "MSN50016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.5, "discounted_cash": 59.33, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IRRIGATION MR8 MIDAS REX CLEARVIEW SET IRD875", "code_information": [{"code": "IRD875", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 473.0, "discounted_cash": 165.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IRRIGATION SUCTION W/ TIP STRYKEFLOW 2", "code_information": [{"code": "250-070-520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.62, "discounted_cash": 57.97, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IRRIGATION SURG XPS ENT FOR BLADE AND BUR STRAIGHTSHOT TI XPS", "code_information": [{"code": "1895522", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IV 21ML 130IN INFUSION SET ALARIS SMBORE 2 PIECE MALE LUER LOCK", "code_information": [{"code": "2441-0007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IV 36IN SECONDARY SET BAG HANGER SPIN MALE", "code_information": [{"code": "MS3500-15", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IV 36IN SECONDARY SET BAG HANGER SPIN MALE MS3500", "code_information": [{"code": "MS3500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.0, "discounted_cash": 54.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IV 5ML 38IN EXTENSION SET 2 PIECE MALE LUER LOCK", "code_information": [{"code": "10108964", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IV INFUSION SET 20 DROP 153IN", "code_information": [{"code": "10404198", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING LIPOSUCTION", "code_information": [{"code": "SU1160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING LIPOSUCTION .375IN X 10 FOOT", "code_information": [{"code": "B1540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING NONCONDUCTIVE 3/16IN X 6IN STRL", "code_information": [{"code": "36480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING OXYGEN 7FT STANDARD CONNECTOR LF", "code_information": [{"code": "1115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING PCA PUMP MINI BORE W/ UNTEG", "code_information": [{"code": "3559-03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 10.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING PUMP 4.8MM 50 CM IRRIGATION DISP", "code_information": [{"code": "WB920138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 45.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING PUMP 8FT W/ CONNECTOR FOR AR-6400 OR AR-6475 REDEUCE STRL", "code_information": [{"code": "AR-6411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.59, "discounted_cash": 68.11, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING PUMP ALARIS SMARTSITE INFUSON SET", "code_information": [{"code": "2435-0007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SET 10 FT AEU-1000 BAG AE-24-10", "code_information": [{"code": "AE-24-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.55, "discounted_cash": 466.04, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SET FOR JOIMAX SPINE PUMP JTSB350D", "code_information": [{"code": "JTSB350D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SET HYSTEROLUX HYSTEROSCOPIC INFLOW TUBE SET", "code_information": [{"code": "72205028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SMART CAPNOLINE H PLUS OXYGEN 010433", "code_information": [{"code": "10433", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 183.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SMART CAPNOLINE H PLUS OXYGEN 010433", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 679.0, "discounted_cash": 237.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SMART SET 3 S CLAMP NEEDLE FREE", "code_information": [{"code": "2426-0007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.94, "discounted_cash": 13.28, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCT 9/32IN X 10FT CLR NON CONDUCTIVE W/ MAXI GRIP CONNECTORS AND MALE/MA", "code_information": [{"code": "N710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCT ASPIR UTER 6FT 23116", "code_information": [{"code": "23116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.86, "discounted_cash": 12.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCTION .375IN X 6 FOOTINTEGRATED SWIVEL HANDLE SLIP RING STRAIGHT", "code_information": [{"code": "23316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 12.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCTION CONNECTING 1/4X10' STRL", "code_information": [{"code": "DYND50251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.78, "discounted_cash": 1.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUPPLY", "code_information": [{"code": "SMI-XTUBING", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.35, "discounted_cash": 72.57, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING ULTRASOUND 0.9MM 45DEG FLUID MANAGEMENT SYS MINI FLARED W/ ULTRAINFUSION", "code_information": [{"code": "8065751040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 270.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING VFE HI FLOW", "code_information": [{"code": "1362.VFE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBINGINFILTRATION FOR PERISTALTIC PUMP", "code_information": [{"code": "SU1168", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBINGINFILTRATION WELLS JOHNSON", "code_information": [{"code": "AFT-UK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBINGINFLATION 22GA X 20 ML 13IN CLR POLYCARBONATE MONARCH", "code_information": [{"code": "IN2130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBINGINSUFFLATION LAP HIGH FLOW COMPATIBLE W/INSUFFLATOR W/ FLOW CAPACITY OF UP", "code_information": [{"code": "DYNJ011933", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.96, "discounted_cash": 9.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBINGINSUFFLATION LAPAROSCIOPIC COMPATIBLE W/ FLOW CAPACITY UP TO 24 LITERS PER", "code_information": [{"code": "DYNJ05933", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TUMOR CELL DEPLETE OF HARVST", "code_information": [{"code": "38211", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR IMMUNOHISTOCHEM/COMPUT 88361", "code_information": [{"code": "88361", "type": "CPT"}, {"code": "45677579", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 351.0, "discounted_cash": 122.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 130.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 722.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1136.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 115.36, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 122.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 493.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUNNELING TOOL 15IN", "code_information": [{"code": "5100", "type": "CDM"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TUNNELING TOOL 15IN", "code_information": [{"code": "5100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TUNNELING TOOL 50CM", "code_information": [{"code": "ACCK3050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TWIST DRILL /BURR HOLE FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES-CORTICAL 61850", "code_information": [{"code": "61850", "type": "CPT"}, {"code": "1482290", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TWIST DRILL 4.8 A-8001.01", "code_information": [{"code": "A-8001.01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 770.0, "discounted_cash": 269.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TWIST DRILL HOLE", "code_information": [{"code": "61105", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TWN ZYG GEN SEQ ALYS CHRMS2", "code_information": [{"code": "60U", "type": "CPT"}], "standard_charges": [{"minimum": 1093.03, "maximum": 3043.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1935.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3043.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1093.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1093.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TWO-WAY AUDIO AND VIDEO HHS", "code_information": [{"code": "G0320", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.32, "maximum": 64.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 64.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX AMBLYOPIA ASSMT W/REPORT", "code_information": [{"code": "688T", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 381.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX AMBLYOPIA DEV SETUP 1ST", "code_information": [{"code": "687T", "type": "CPT"}], "standard_charges": [{"minimum": 242.59, "maximum": 381.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1 CC/<", "code_information": [{"code": "11950", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1.1-5.0CC", "code_information": [{"code": "11951", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 5.1-10CC", "code_information": [{"code": "11952", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS >10.0 CC", "code_information": [{"code": "11954", "type": "CPT"}], "standard_charges": [{"minimum": 283.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 283.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX FOR OPIOID USE DEMO PROJ", "code_information": [{"code": "G2172", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX GASTRO INTUB W/ASP", "code_information": [{"code": "43753", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX L/R ATRIAL FIB ADDL", "code_information": [{"code": "93657", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 18587.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1967.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3091.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3091.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3091.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 18587.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX PLN MAG FLD ABLTJ PRST8", "code_information": [{"code": "738T", "type": "CPT"}], "standard_charges": [{"minimum": 319.71, "maximum": 502.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 319.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 502.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 502.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 502.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYLENOL SUPPOSITORY 120MG", "code_information": [{"code": "MED0239", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TYLENOL SUPPOSITORY 325MG", "code_information": [{"code": "MED0240", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TYMPANIC MEMBRANE REPAIR-W/ OR W/O SITE PREP.OF PERF. FOR CLOSURE-W/ OR W/O PATCH 69610", "code_information": [{"code": "69610", "type": "CPT"}, {"code": "1482293", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1102.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1102.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOMETRY", "code_information": [{"code": "92567", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOMETRY & REFLEX THRESH", "code_information": [{"code": "92550", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY W/ ANTROTOMY OR MASTOIDOTOMY W/O OSSICULAR CHAIN RECON. 69635", "code_information": [{"code": "69635", "type": "CPT"}, {"code": "1482298", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY W/ ANTROTOMY OR MASTOIDOTOMY W/OSSICULAR CHAIN RECONSTRUCTION 69636", "code_information": [{"code": "69636", "type": "CPT"}, {"code": "1482296", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY W/ ANTROTOMY/ MASTOIDOTOMY W/ OSSICULAR CHAIN RECON. & PROSTHESIS 69637", "code_information": [{"code": "69637", "type": "CPT"}, {"code": "1482295", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY W/ MASTOIDECTOMY RADICAL -W/ OSSICULAR CHAIN RECON. 69646", "code_information": [{"code": "69646", "type": "CPT"}, {"code": "1482305", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY W/ MASTOIDECTOMY W/ INTACT OR RECON. CANAL WALL W/ OSSICULAR CHAIN RECON 69644", "code_information": [{"code": "69644", "type": "CPT"}, {"code": "1482297", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY W/ MASTOIDECTOMY W/ OSSICULAR CHAIN RECONSTRUCTION 69642", "code_information": [{"code": "69642", "type": "CPT"}, {"code": "1482301", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY W/ MASTOIDECTOMY W/O OSSICULAR CHAIN RECON. 69641", "code_information": [{"code": "69641", "type": "CPT"}, {"code": "1482299", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY W/ MASTOIDECTOMY-RADICAL-W/O OSSICULAR CHAIN RECON. 69645", "code_information": [{"code": "69645", "type": "CPT"}, {"code": "1482304", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY W/O MASTOIDECTOMY OR OSSICULAR CHAIN RECON. 69631", "code_information": [{"code": "69631", "type": "CPT"}, {"code": "1482294", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY W/O MASTOIDECTOMY W/ OSSICULAR CHAIN RECON. 69632", "code_information": [{"code": "69632", "type": "CPT"}, {"code": "1482302", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY W/O MASTOIDECTOMY W/ OSSICULAR CHAIN RECON. AND SYNTHETIC PROSTHESIS 69633", "code_information": [{"code": "69633", "type": "CPT"}, {"code": "1482303", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOPLASTY WITH MASTOIDECTOMY W/ INTACT OR RECON. WALL W/O OSSICULAR CHAIN RECON. 69643", "code_information": [{"code": "69643", "type": "CPT"}, {"code": "1482300", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOSTOMY-GENERAL ANESTHESIA 69436", "code_information": [{"code": "69436", "type": "CPT"}, {"code": "1482307", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMS GENE COM VARIANTS", "code_information": [{"code": "81346", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 445.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 700.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 251.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYPHOID VACCINE IM", "code_information": [{"code": "90691", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYPHOID VACCINE ORAL", "code_information": [{"code": "90690", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYROSINEMIA TYP I MNTR QUAN", "code_information": [{"code": "383U", "type": "CPT"}], "standard_charges": [{"minimum": 278.03, "maximum": 437.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Tau, phosphorylated (eg, pTau 181, pTau 217), each", "code_information": [{"code": "84393", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Tau, phosphorylated, pTau217", "code_information": [{"code": "479U", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Tau, phosphorylated, pTau217, by single-molecule array (ultrasensitive digital protein detection), using plasma", "code_information": [{"code": "551U", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Tau, total (tTau)", "code_information": [{"code": "84394", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 69.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Testing Of Autonomic (Parasympathetic And Sympathetic) Nervous System Function", "code_information": [{"code": "95943", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Testost Total", "code_information": [{"code": "84403", "type": "CPT"}, {"code": "633838", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 300.0, "discounted_cash": 105.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 111.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 37.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 37.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Testosterone Free", "code_information": [{"code": "84402", "type": "CPT"}, {"code": "633837", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 61.0, "discounted_cash": 21.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 22.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 36.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 36.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Tetanus/diphtheria/pertuss (Tdap), 7 years or older, intramuscular use 90715", "code_information": [{"code": "90715", "type": "CPT"}, {"code": "13757149", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Theophylline 80198", "code_information": [{"code": "80198", "type": "CPT"}, {"code": "44717129", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 36.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 56.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 56.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Therapeutic Activities Charge", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "752354", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 154.13, "maximum": 8450.0, "gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 210.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 282.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 282.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 282.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Therapeutic Activities Charge - PTA", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "45575345", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 154.13, "maximum": 8450.0, "gross_charge": 415.0, "discounted_cash": 145.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 170.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 210.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 282.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 282.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 282.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Therapeutic Exercise Charges", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "752356", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 138.25, "maximum": 8450.0, "gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 192.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 192.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 236.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 173.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Therapeutic Exercise Charges - PTA", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "45575343", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 138.25, "maximum": 8450.0, "gross_charge": 468.0, "discounted_cash": 163.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 192.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 192.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 236.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 173.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 217.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Therapeutic drug monitoring, 200 or more drugs or substances, LC-MS/MS, plasma, qualitative and quantitative therapeutic minimally effective range of prescribed and non-prescribed medications", "code_information": [{"code": "520U", "type": "CPT"}], "standard_charges": [{"minimum": 379.85, "maximum": 597.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 379.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Therapeutic drug monitoring, 80 or more psychoactive drugs or substances, LC-MS/MS, plasma, qualitative and quantitative therapeutic minimally and maximally effective dose of prescribed and non-prescribed medications", "code_information": [{"code": "517U", "type": "CPT"}], "standard_charges": [{"minimum": 379.85, "maximum": 597.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 379.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Therapeutic drug monitoring, 90 or more pain and mental health drugs or substances, LC-MS/MS, plasma, qualitative and quantitative therapeutic minimally effective range of prescribed and non-prescribed medications", "code_information": [{"code": "518U", "type": "CPT"}], "standard_charges": [{"minimum": 379.85, "maximum": 597.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 379.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Therapeutic drug monitoring, medications specific to pain, depression, and anxiety, LC-MS/MS, plasma, 110 or more drugs or substances, qualitative and quantitative therapeutic minimally effective range of prescribed, non-prescribed, and illicit medication", "code_information": [{"code": "519U", "type": "CPT"}], "standard_charges": [{"minimum": 379.85, "maximum": 597.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 379.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 597.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Therapeutic radiology simulation-aided field setting; complex, including acquisition of PET and CT imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling)", "code_information": [{"code": "G0562", "type": "HCPCS"}], "standard_charges": [{"minimum": 8523.69, "maximum": 13399.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8523.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13399.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13399.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13399.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Thoracic fascial plane block, bilateral; by continuous infusion(s), including imaging guidance, when performed", "code_information": [{"code": "64469", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Thoracic fascial plane block, bilateral; by injection(s), including imaging guidance, when performed", "code_information": [{"code": "64468", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Thoracic fascial plane block, unilateral; by continuous infusion(s), including imaging guidance, when performed", "code_information": [{"code": "64467", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Thoracic fascial plane block, unilateral; by injection(s), including imaging guidance, when performed", "code_information": [{"code": "64466", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Throxine Free", "code_information": [{"code": "84439", "type": "CPT"}, {"code": "1231831", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 15.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Thyroid Stimulating Hormone", "code_information": [{"code": "84443", "type": "CPT"}, {"code": "633844", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 144.0, "discounted_cash": 50.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 53.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Thyroxine Free", "code_information": [{"code": "84439", "type": "CPT"}, {"code": "633846", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 15.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Tissue Culture for neoplastic disorders, bone marrow, blood 88237", "code_information": [{"code": "88237", "type": "CPT"}, {"code": "45366096", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 194.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 366.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 576.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 576.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 576.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 207.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 207.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Totally implantable active middle ear hearing implant; initial placement, including mastoidectomy, placement of and attachment to sound processor", "code_information": [{"code": "951T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Totally implantable active middle ear hearing implant; removal, including removal of sound processor and all implant components", "code_information": [{"code": "955T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Totally implantable active middle ear hearing implant; replacement of sound processor only, with attachment to existing transducers", "code_information": [{"code": "954T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Totally implantable active middle ear hearing implant; revision or replacement, with mastoidectomy and replacement of sound processor", "code_information": [{"code": "952T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Totally implantable active middle ear hearing implant; revision or replacement, without mastoidectomy and replacement of sound processor", "code_information": [{"code": "953T", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 5892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Toxicology Drug Screen Urine", "code_information": [{"code": "80307", "type": "CPT"}, {"code": "633850", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 89.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 158.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Transanal insertion of endoluminal temporary colorectal anastomosis protection device, including vacuum anchoring component and flexible sheath connected to external vacuum source and monitoring system", "code_information": [{"code": "967T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 3827.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Transcatheter implantation of wireless inferior vena cava sensor for long-term hemodynamic monitoring, including deployment of the sensor, radiological supervision and interpretation, right heart catheterization, and inferior vena cava venography, when pe", "code_information": [{"code": "981T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 7663.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Transcatheter implantation of wireless left atrial pressure sensor for long-term left atrial pressure monitoring, including sensor calibration and deployment, right heart catheterization, transseptal puncture, imaging guidance, and radiological supervisio", "code_information": [{"code": "933T", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Transfuse PRBC One Unit P9021", "code_information": [{"code": "P9021", "type": "HCPCS"}, {"code": "1235842", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 282.0, "discounted_cash": 98.7, "setting": "both", "billing_class": "facility"}]}, {"description": "Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to p", "code_information": [{"code": "C7563", "type": "HCPCS"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Transperineal laser ablation of benign prostatic hyperplasia, including imaging guidance; prostate volume greater or equal to 50 mL", "code_information": [{"code": "867T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 6074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Transplantation medicine (allograft rejection, kidney), mRNA, gene expression profiling by quantitative polymerase chain reaction (qPCR) of 139 genes, utilizing whole blood, algorithm reported as a binary categorization as transplant excellence, which ind", "code_information": [{"code": "81558", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Transplantation medicine, quantification of donor-derived cell-free DNA (cfDNA) using next-generation sequencing, plasma, reported as percentage of donor-derived cell-free DNA", "code_information": [{"code": "493U", "type": "CPT"}], "standard_charges": [{"minimum": 8262.0, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Transplantation medicine, quantification of donor-derived cell-free DNA using 40 single-nucleotide polymorphisms (SNPs), plasma, and urine, initial evaluation reported as percentage of donor-derived cell-free DNA with risk for active rejection", "code_information": [{"code": "508U", "type": "CPT"}], "standard_charges": [{"minimum": 8262.0, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Transplantation medicine, quantification of donor-derived cell-free DNA using next-generation sequencing analysis of plasma, reported as percentage of donor-derived cell-free DNA to determine probability of rejection", "code_information": [{"code": "540U", "type": "CPT"}], "standard_charges": [{"minimum": 8262.0, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Transplantation medicine, quantification of donor-derived cell-free DNA using up to 12 single-nucleotide polymorphisms (SNPs) previously identified, plasma, reported as percentage of donor-derived cell-free DNA with risk for active rejection", "code_information": [{"code": "509U", "type": "CPT"}], "standard_charges": [{"minimum": 8262.0, "maximum": 12992.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8262.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12992.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Troponin", "code_information": [{"code": "84484", "type": "CPT"}, {"code": "633853", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 30.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Tympanostomy with local or topical anesthesia and insertion of a ventilating tube when performed with tympanostomy tube delivery device, unilateral (List separately in addition to 69433) (Do not use in conjunction with 0583T)", "code_information": [{"code": "G0561", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Type and Crossmatch 86920", "code_information": [{"code": "86920", "type": "CPT"}, {"code": "1093827", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 174.0, "discounted_cash": 60.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "U/S TRTMT, NOT LEIOMYOMATA", "code_information": [{"code": "C9734", "type": "HCPCS"}], "standard_charges": [{"minimum": 3951.0, "maximum": 3951.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "U2AF1 GENE COMMON VARIANTS", "code_information": [{"code": "81357", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1936.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UCL INTERNAL BRACE IMPLANT SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-7715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2633.0, "discounted_cash": 921.55, "setting": "both", "billing_class": "facility"}]}, {"description": "UGT1A1 GENE COMMON VARIANTS", "code_information": [{"code": "81350", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 292.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 596.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 938.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 938.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 938.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 336.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 336.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ULTRABUTTON QUAD ADJUSTABLE FIXATION DEVICE 72205443", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72205443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3297.0, "discounted_cash": 1153.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ULTRASOUND BREAST COMPLETE", "code_information": [{"code": "76641", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 162.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 172.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND BREAST LIMITED", "code_information": [{"code": "76642", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 126.21, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 134.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND NOT PERF, RNG", "code_information": [{"code": "G8808", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ULTRATAPE 2MM BLUE", "code_information": [{"code": "72203896", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.88, "discounted_cash": 18.16, "setting": "both", "billing_class": "facility"}]}, {"description": "ULTRAVIOLET LIGHT THERAPY", "code_information": [{"code": "96900", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ULTRAVIOLET THERAPY", "code_information": [{"code": "97028", "type": "CPT"}], "standard_charges": [{"minimum": 36.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UMBILECTOMY 49250", "code_information": [{"code": "49250", "type": "CPT"}, {"code": "1482310", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UMBILICAL ARTERY ECHO", "code_information": [{"code": "76820", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 49.84, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 53.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UMBILICAL CORD OCCLUD W/US", "code_information": [{"code": "59072", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "383", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7984.55, "maximum": 13707.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7984.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11419.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12561.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13707.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [{"code": "384", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5430.9, "maximum": 9323.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5430.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7767.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8544.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9323.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNHLTHY ETOH RCVD COUNS", "code_information": [{"code": "G2200", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNIT LOADING SZ 2-0 SZ 3 7IN GRN SNGL STITCH SURGIDAC SUT ENDO STITCH", "code_information": [{"code": "173021", "type": "CDM"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 59.85, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIT RLD SUT ENDO DEV W/ 6IN ETHIBOND EXCEL SZ 2-0 AND EEN CANOE NDL", "code_information": [{"code": "SW112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERS REVERS CUP, 39/ NEUTRAL CAP COATED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9502-39CPC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6953.0, "discounted_cash": 2433.55, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERS REVERS SERM, SIZE 8, CAP COATED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9501-08CPC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7313.0, "discounted_cash": 2559.55, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL HEAD RESTRAINT", "code_information": [{"code": "50601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 28.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL WIRE FIXATION BOLT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DNE-1000-WFB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "UNL THER/PROP/DIAG INJ/INF", "code_information": [{"code": "96379", "type": "CPT"}], "standard_charges": [{"minimum": 168.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTD NONINVAS VASC DX STD", "code_information": [{"code": "93998", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTD PX HEMIC/LYMPHTC SYS", "code_information": [{"code": "38999", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ALL/IMMLG SVC/PX", "code_information": [{"code": "95199", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED AMBULANCE SERVICE", "code_information": [{"code": "A0999", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.37, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 77.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MME", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED ANES PROCEDURE", "code_information": [{"code": "1999", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CHEMISTRY PROCEDURE", "code_information": [{"code": "84999", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CHEMOTHERAPY PX", "code_information": [{"code": "96549", "type": "CPT"}], "standard_charges": [{"minimum": 168.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 168.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CRANIOFACIAL OR MAXILLOFACIAL PROCEDURE 21299", "code_information": [{"code": "21299", "type": "CPT"}, {"code": "8724472", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CT PROCEDURE", "code_information": [{"code": "76497", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CV PX DX NUC MED", "code_information": [{"code": "78499", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED CV SVC/PROCEDURE", "code_information": [{"code": "93799", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOGENETIC STUDY", "code_information": [{"code": "88299", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOPATHOLOGY PX", "code_information": [{"code": "88199", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED DIALYSIS PROCEDURE", "code_information": [{"code": "90999", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED DX GI PROCEDURE", "code_information": [{"code": "91299", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED E&M SERVICE", "code_information": [{"code": "99499", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ENDOCRINE PX DX NUC", "code_information": [{"code": "78099", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED FETAL INVAS PX W/US", "code_information": [{"code": "59897", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED FLUOROSCOPIC PX", "code_information": [{"code": "76496", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED GI PX DX NUC MED", "code_information": [{"code": "78299", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED GU PX DX NUC MED", "code_information": [{"code": "78799", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED HEMATOLOGY&COAGJ PX", "code_information": [{"code": "85999", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HOME VISIT SVC/PX", "code_information": [{"code": "99600", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HYSTEROSCOPY PROCEDURE 58579", "code_information": [{"code": "58579", "type": "CPT"}, {"code": "19648417", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 196.02, "maximum": 8450.0, "gross_charge": 405.0, "discounted_cash": 141.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 196.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED IMMUNE GLOBULIN", "code_information": [{"code": "90399", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED IN VIVO LAB SERVICE", "code_information": [{"code": "88749", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPAROSCOPIC PROCEDURE LIVER 47379", "code_information": [{"code": "47379", "type": "CPT"}, {"code": "4240120", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2530.83, "maximum": 9357.0, "gross_charge": 5229.0, "discounted_cash": 1830.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPAROSCOPY PROCEDURE ABDOMEN/PERITONEUM/OMENTUM 49329", "code_information": [{"code": "49329", "type": "CPT"}, {"code": "2759537", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPAROSCOPY PROCEDURE BLADDER 51999", "code_information": [{"code": "51999", "type": "CPT"}, {"code": "10956153", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 9357.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPAROSCOPY PROCEDURE UTERUS 58578", "code_information": [{"code": "58578", "type": "CPT"}, {"code": "1618458", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPAROSCOPY PROCEDURE-TESTIS 54699", "code_information": [{"code": "54699", "type": "CPT"}, {"code": "1482311", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPAROSCOPY PROCEDURE; HERNIOPLASTY / HERNIORRHAPHY / HERNIOTOMY 49659", "code_information": [{"code": "49659", "type": "CPT"}, {"code": "4240123", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "gross_charge": 6507.0, "discounted_cash": 2277.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3149.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX APPENDIX", "code_information": [{"code": "44979", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX BILIARY TRC", "code_information": [{"code": "47579", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX ENDOC SYS", "code_information": [{"code": "60659", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX ESOPH", "code_information": [{"code": "43289", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX INTESTINE", "code_information": [{"code": "44238", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX LYMPHTC SYS", "code_information": [{"code": "38589", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX OVIDCT OVRY", "code_information": [{"code": "58679", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX RENAL", "code_information": [{"code": "50549", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX SPLEEN", "code_information": [{"code": "38129", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX STOMACH", "code_information": [{"code": "43659", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX URETER", "code_information": [{"code": "50949", "type": "CPT"}], "standard_charges": [{"minimum": 2743.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAAA", "code_information": [{"code": "81599", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAXLFCL PROSTH PX", "code_information": [{"code": "21089", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MICROBIOLOGY PX", "code_information": [{"code": "87999", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PATH TEST", "code_information": [{"code": "89240", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PX DX NUC MED", "code_information": [{"code": "78999", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MODALITY", "code_information": [{"code": "97039", "type": "CPT"}], "standard_charges": [{"minimum": 49.26, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 77.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 77.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 77.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MOLECULAR PATHOLOGY", "code_information": [{"code": "81479", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MR PROCEDURE", "code_information": [{"code": "76498", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 272.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 428.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 428.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 428.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MUSCSKEL PX DX NUC", "code_information": [{"code": "78399", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MUSCULOSKELETAL PROCEDURE-HEAD 21499", "code_information": [{"code": "21499", "type": "CPT"}, {"code": "1482312", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED NECROPSY (AUTOPSY)", "code_information": [{"code": "88099", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED NEUROLOGICAL DX PX", "code_information": [{"code": "95999", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED NRVS SYS PX DX NUC", "code_information": [{"code": "78699", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED OPH SVC/PROCEDURE", "code_information": [{"code": "92499", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ORL SERVICE/PX", "code_information": [{"code": "92700", "type": "CPT"}], "standard_charges": [{"minimum": 101.39, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PHYSCL MED/REHAB PX", "code_information": [{"code": "97799", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PREVENTIVE SERVICE", "code_information": [{"code": "99429", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDUE COLON 45399", "code_information": [{"code": "45399", "type": "CPT"}, {"code": "39297724", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 772.94, "maximum": 8450.0, "gross_charge": 1597.0, "discounted_cash": 558.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 772.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ABDOMEN-PERITONEUM-OMENTUM 22999", "code_information": [{"code": "22999", "type": "CPT"}, {"code": "1482314", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ACCESSORY SINUS 31299", "code_information": [{"code": "31299", "type": "CPT"}, {"code": "1857258", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 975.26, "maximum": 8450.0, "gross_charge": 2015.0, "discounted_cash": 705.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 975.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ANUS 46999", "code_information": [{"code": "46999", "type": "CPT"}, {"code": "12971444", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ARTHROSCOPY 29999", "code_information": [{"code": "29999", "type": "CPT"}, {"code": "1592974", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE CONJUNCTIVA 68399", "code_information": [{"code": "68399", "type": "CPT"}, {"code": "46066511", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1741.43, "maximum": 8450.0, "gross_charge": 3598.0, "discounted_cash": 1259.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1741.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ESOPHAGUS", "code_information": [{"code": "43499", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE EXCISION PRESSURE ULCER 15999", "code_information": [{"code": "15999", "type": "CPT"}, {"code": "21451391", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE FEMALE GENITAL SYSTEM 58999", "code_information": [{"code": "58999", "type": "CPT"}, {"code": "6296907", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE FEMUR OR KNEE 27599", "code_information": [{"code": "27599", "type": "CPT"}, {"code": "1668561", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE FOOT OR TOES 28899", "code_information": [{"code": "28899", "type": "CPT"}, {"code": "1479908", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LARYNX", "code_information": [{"code": "31599", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LEG OR ANKLE 27899", "code_information": [{"code": "27899", "type": "CPT"}, {"code": "10596446", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.8, "maximum": 8450.0, "gross_charge": 2231.0, "discounted_cash": 780.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIPS", "code_information": [{"code": "40799", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIVER", "code_information": [{"code": "47399", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE MALE GENITAL SYSTEM 55899", "code_information": [{"code": "55899", "type": "CPT"}, {"code": "12595066", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.82, "maximum": 8450.0, "gross_charge": 1386.0, "discounted_cash": 485.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE MIDDLE EAR 69799", "code_information": [{"code": "69799", "type": "CPT"}, {"code": "20402088", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 5229.0, "discounted_cash": 1830.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2530.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE NOSE 30999", "code_information": [{"code": "30999", "type": "CPT"}, {"code": "15870411", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.82, "maximum": 8450.0, "gross_charge": 1386.0, "discounted_cash": 485.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ORBIT", "code_information": [{"code": "67599", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE PALATE UVULA 42299", "code_information": [{"code": "42299", "type": "CPT"}, {"code": "1600049", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE PANCREAS", "code_information": [{"code": "48999", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE PHARYNX ADENOIDS OR TONSILS 42999", "code_information": [{"code": "42999", "type": "CPT"}, {"code": "42635802", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 6504.0, "discounted_cash": 2276.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE RECTUM", "code_information": [{"code": "45999", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE STOMACH 43999", "code_information": [{"code": "43999", "type": "CPT"}, {"code": "10710885", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE URINARY SYSTEM 53899", "code_information": [{"code": "53899", "type": "CPT"}, {"code": "1635704", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-ABDOMEN-MUSCULOSKELETAL 49999", "code_information": [{"code": "49999", "type": "CPT"}, {"code": "1482313", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 539.17, "maximum": 8450.0, "gross_charge": 1114.0, "discounted_cash": 389.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 539.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-BREAST 19499", "code_information": [{"code": "19499", "type": "CPT"}, {"code": "1482315", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-DENTOALVEOLAR STRUCTURES 41899", "code_information": [{"code": "41899", "type": "CPT"}, {"code": "1482316", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 801.02, "maximum": 8450.0, "gross_charge": 1655.0, "discounted_cash": 579.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 801.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-FOREAREM OR WRIST 25999", "code_information": [{"code": "25999", "type": "CPT"}, {"code": "1482317", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-HAND OR FINGERS 26989", "code_information": [{"code": "26989", "type": "CPT"}, {"code": "1482318", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-HIP JOINT OR PELVIS 27299", "code_information": [{"code": "27299", "type": "CPT"}, {"code": "1482319", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-HUMERUS/ELBOW 24999", "code_information": [{"code": "24999", "type": "CPT"}, {"code": "1482320", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-MUSCULOSKELETAL SYSTEM 20999", "code_information": [{"code": "20999", "type": "CPT"}, {"code": "1482321", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 2922.0, "discounted_cash": 1022.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1414.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-NERVOUS SYSTEM 64999", "code_information": [{"code": "64999", "type": "CPT"}, {"code": "1482326", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-SHOULDER 23929", "code_information": [{"code": "23929", "type": "CPT"}, {"code": "1482322", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.34, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-SKIN-MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE 17999", "code_information": [{"code": "17999", "type": "CPT"}, {"code": "1482323", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-SPINE 22899", "code_information": [{"code": "22899", "type": "CPT"}, {"code": "1482324", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE; EYELIDS 67999", "code_information": [{"code": "67999", "type": "CPT"}, {"code": "26440559", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PSYC SVC/THERAPY", "code_information": [{"code": "90899", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PULMONARY SVC/PX", "code_information": [{"code": "94799", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ANT SEGMENT EYE", "code_information": [{"code": "66999", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX BILIARY TRACT", "code_information": [{"code": "47999", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CARDIAC SURGERY", "code_information": [{"code": "33999", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CASTING/STRPG", "code_information": [{"code": "29799", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CLIN BRACHYTX", "code_information": [{"code": "77799", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 218.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 536.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 843.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 843.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 843.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DIAPHRAGM", "code_information": [{"code": "39599", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ENDOCRINE SYSTEM", "code_information": [{"code": "60699", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTERNAL EAR", "code_information": [{"code": "69399", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTRAOCULAR MUSC", "code_information": [{"code": "67399", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX INNER EAR", "code_information": [{"code": "69949", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LACRIMAL SYSTEM", "code_information": [{"code": "68899", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LUNGS & PLEURA", "code_information": [{"code": "32999", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MAT CARE&DLVR", "code_information": [{"code": "59899", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MECKEL'S DVRTCLM", "code_information": [{"code": "44899", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MED RADJ PHYSICS", "code_information": [{"code": "77399", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 219.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 553.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 869.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 869.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 869.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MEDIASTINUM", "code_information": [{"code": "39499", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX NECK/THORAX", "code_information": [{"code": "21899", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX POSTERIOR SEGMNT", "code_information": [{"code": "67299", "type": "CPT"}], "standard_charges": [{"minimum": 2554.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SALIVRY GLND/DUX", "code_information": [{"code": "42699", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SMALL INTESTINE", "code_information": [{"code": "44799", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TEMPORAL BONE", "code_information": [{"code": "69979", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX MGMT", "code_information": [{"code": "77499", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX PLNG", "code_information": [{"code": "77299", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 219.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 553.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 869.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 869.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 869.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TONGUE FLR MOUTH", "code_information": [{"code": "41599", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TRACHEA BRONCHI", "code_information": [{"code": "31899", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR NJX", "code_information": [{"code": "36299", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR SURGERY", "code_information": [{"code": "37799", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VESTIBULE MOUTH", "code_information": [{"code": "40899", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED REPROD MED LAB PROC", "code_information": [{"code": "89398", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED RESP PX DX NUC MED", "code_information": [{"code": "78599", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED SPEC DERM SVC/PX", "code_information": [{"code": "96999", "type": "CPT"}], "standard_charges": [{"minimum": 770.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED SPECIAL SVC PX/RPRT", "code_information": [{"code": "99199", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED SURGICAL PATH PX", "code_information": [{"code": "88399", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 74.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED THERAPEUTIC PX", "code_information": [{"code": "97139", "type": "CPT"}], "standard_charges": [{"minimum": 66.77, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED TRANSFUSION MED PX", "code_information": [{"code": "86999", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED URINALYSIS PX", "code_information": [{"code": "81099", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED VACCINE/TOXOID", "code_information": [{"code": "90749", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED VASC ENDOSCOPY PX", "code_information": [{"code": "37501", "type": "CPT"}], "standard_charges": [{"minimum": 2421.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLSTD HEMATOP RET/ENDO LYMP", "code_information": [{"code": "78199", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2529.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX MAT CARE&DLVR", "code_information": [{"code": "59898", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX SPRMATIC CORD", "code_information": [{"code": "55559", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4113.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNPL RET OR W/COMPL W/IN 30D", "code_information": [{"code": "G9308", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNPLND HOSP READM IN 30D", "code_information": [{"code": "G9310", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNSCHED DIALYSIS ESRD PT HOS", "code_information": [{"code": "G0257", "type": "HCPCS"}], "standard_charges": [{"minimum": 2822.53, "maximum": 4435.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2822.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4435.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4435.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4435.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNUSUAL PHYSICIAN TRAVEL", "code_information": [{"code": "99082", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNXPL CNST HRTBL DO GN XPRSN", "code_information": [{"code": "266U", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 4608.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4608.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4608.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPGRADE OF PACEMAKER SYSTEM", "code_information": [{"code": "33214", "type": "CPT"}], "standard_charges": [{"minimum": 2347.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2746.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2347.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY STUDY", "code_information": [{"code": "93930", "type": "CPT"}], "standard_charges": [{"minimum": 745.38, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 745.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1171.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1171.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1171.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY STUDY", "code_information": [{"code": "93931", "type": "CPT"}], "standard_charges": [{"minimum": 465.65, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 465.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 731.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 731.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 731.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER G.I. ENDO INC. ESO/STOM/DOUDENUM/JEJUNUM W/REMOVAL OF FOREIGN BODY 43247", "code_information": [{"code": "43247", "type": "CPT"}, {"code": "7209642", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "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": 10001.67, "maximum": 17170.38, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10001.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14304.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15734.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17170.38, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": 15422.23, "maximum": 26476.14, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15422.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 22057.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24262.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 26476.14, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "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": 7087.91, "maximum": 12168.18, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7087.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10137.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11150.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12168.18, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UPPR GI SCOPE W/SUBMUC INJ", "code_information": [{"code": "43236", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPR/L XTREMITY ART 2 LEVELS", "code_information": [{"code": "93922", "type": "CPT"}], "standard_charges": [{"minimum": 480.82, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPR/LXTR ART STDY 3+ LVLS", "code_information": [{"code": "93923", "type": "CPT"}], "standard_charges": [{"minimum": 500.62, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 500.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 786.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 786.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 786.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UR ALBUMIN QUANTITATIVE", "code_information": [{"code": "82043", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UR ALBUMIN SEMIQUANTITATIVE", "code_information": [{"code": "82044", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 24.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 24.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN SEMI-QUANT", "code_information": [{"code": "84525", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 7.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA-N CLEARANCE TEST", "code_information": [{"code": "84545", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50974", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL EMBOLIZATION/OCCL", "code_information": [{"code": "50705", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL ENDOSCOPY THROUGH URETEROTOMY 50970", "code_information": [{"code": "50970", "type": "CPT"}, {"code": "1482338", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL REFLUX STUDY", "code_information": [{"code": "78740", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 867.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1364.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1364.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1364.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 439.71, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 468.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETEROSCOPE FLEXIBLE LITHOVUE DISP M0067913500", "code_information": [{"code": "M0067913500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3835.0, "discounted_cash": 1342.25, "setting": "both", "billing_class": "facility"}]}, {"description": "URETEROSCOPY THROUGH ESTABLISHED URETEROSTOMY W/ REMOVAL FOREIGN BODY OR CALCULUS 50961", "code_information": [{"code": "50961", "type": "CPT"}, {"code": "1482341", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETEROSCOPY THROUGH ESTABLISHED URETEROSTOMY W/FULGRATION/ INCISION-W/ OR W/O BIOPSY 50957", "code_information": [{"code": "50957", "type": "CPT"}, {"code": "1482337", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETEROSCOPY THROUGH URETEROTOMY W/ REMOVAL OF FOREIGN BODY OR CALCULUS 50980", "code_information": [{"code": "50980", "type": "CPT"}, {"code": "1482340", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETEROSCOPY THROUGH URETEROTOMY W/FULGRATION 50976", "code_information": [{"code": "50976", "type": "CPT"}, {"code": "1482339", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETEROTOMY W/ EXPLORATION OR DRAINAGE 50600", "code_information": [{"code": "50600", "type": "CPT"}, {"code": "1482343", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 457.05, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 457.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "671", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10835.65, "maximum": 18602.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10835.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15497.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17047.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18602.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "672", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6997.88, "maximum": 12013.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6997.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10008.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11009.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHRAL STRICTURE", "code_information": [{"code": "697", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6078.74, "maximum": 10435.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6078.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8693.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9563.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10435.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHROLYSIS TRANSVGINAL SECONDARY OPEN INCLUDING CYSTO URETHROSCOPY 53500", "code_information": [{"code": "53500", "type": "CPT"}, {"code": "5324742", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROMEATOPLASTY W/ MUCOSAL ADVANCEMENT 53450", "code_information": [{"code": "53450", "type": "CPT"}, {"code": "1482345", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROMEATOPLASTY W/ PARTIAL EXCISION DISTAL URETHERAL SEGMENT 53460", "code_information": [{"code": "53460", "type": "CPT"}, {"code": "1482344", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROPLASTY W/ TUBULARIZATION POSTERIOR URETHRA/BLADDER 53431", "code_information": [{"code": "53431", "type": "CPT"}, {"code": "1482348", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROPLASTY-1 STAGE RECONSTRUCTION OF MALE ANTERIOR URETHRA 53410", "code_information": [{"code": "53410", "type": "CPT"}, {"code": "1482349", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROPLASTY-2 STAGE RECON./REPAIR PROSTATIC OR MEMBRANOUS URETHRA; 1ST STAGE 53420", "code_information": [{"code": "53420", "type": "CPT"}, {"code": "1482350", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROPLASTY-2 STAGE RECON./REPAIR PROSTATIC OR MEMBRANOUS URETHRA; 2ND STAGE 53425", "code_information": [{"code": "53425", "type": "CPT"}, {"code": "1482351", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROPLASTY-RECONSTRUCTION OF FEMALE URETHRA 53430", "code_information": [{"code": "53430", "type": "CPT"}, {"code": "1482347", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROPLASTY-TRANSPUBIC/PERINEAL-1 STAGE-FOR RECON./REPAIR URETHRA 53415", "code_information": [{"code": "53415", "type": "CPT"}, {"code": "1482354", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROPLASTY; FIRST STAGE-FOR FISTULA-DIVERTICULUM-OR STRICTURE 53400", "code_information": [{"code": "53400", "type": "CPT"}, {"code": "1482352", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3365.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3058.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROPLASTY; SECOND STAGE-FOR FISTULA-DIVERTICULUM-OR STRICTURE-INC. DIVERSION 53405", "code_information": [{"code": "53405", "type": "CPT"}, {"code": "1482353", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1719.0, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROTOMY/URETHOSTOMY-EXTERNAL 53000", "code_information": [{"code": "53000", "type": "CPT"}, {"code": "1482355", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROTOMY/URETHOSTOMY-PERINEAL URETHRA-EXTERNAL 53010", "code_information": [{"code": "53010", "type": "CPT"}, {"code": "1482356", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URGENT CARE SS", "code_information": [{"code": "G4036", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URGENT SURGERY", "code_information": [{"code": "G9752", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URI EP COMPETE DIAG", "code_information": [{"code": "G8709", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URI NEW RX ANTIBIOTIC 30D", "code_information": [{"code": "G2174", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URI W COMORB 12M OTH DX", "code_information": [{"code": "G2173", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS", "code_information": [{"code": "81005", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS GLASS TEST", "code_information": [{"code": "81020", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS NONAUTO W/O SCOPE", "code_information": [{"code": "81002", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS NONAUTO W/SCOPE", "code_information": [{"code": "81000", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 5.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS VOLUME MEASURE", "code_information": [{"code": "81050", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY BLADDER RETENTION", "code_information": [{"code": "78730", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 313.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 492.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 492.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 492.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 141.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 150.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY REFLEX STUDY", "code_information": [{"code": "51792", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITH MCC", "code_information": [{"code": "693", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8123.85, "maximum": 13946.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8123.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11618.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12780.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13946.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITHOUT MCC", "code_information": [{"code": "694", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4691.21, "maximum": 8053.64, "estimated_discounted_cash": 14665.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4691.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6709.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7380.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8053.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINE FLOW MEASUREMENT", "code_information": [{"code": "51736", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE SCREEN FOR BACTERIA", "code_information": [{"code": "81007", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 37.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 120.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 120.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 120.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 43.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 43.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE SHUNT TO INTESTINE", "code_information": [{"code": "50815", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE SPECIMEN COLLECT MULT", "code_information": [{"code": "P9615", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.75, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY ANTEGRADE RS&I", "code_information": [{"code": "74425", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 263.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 280.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY NFS DRIP&/BLS W/NF", "code_information": [{"code": "74415", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 530.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 834.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 834.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 834.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 304.66, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 324.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY NFS DRIP&/BOLUS", "code_information": [{"code": "74410", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 428.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 673.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 673.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 673.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 279.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 297.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROLIFT 2 HANDLE KIT W/ CARTRIDGE UL2-CHK", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "UL2-CHK", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1850.0, "discounted_cash": 647.5, "setting": "both", "billing_class": "facility"}]}, {"description": "UROLIFT 2 IMPLANT CARTIDGE UL2-C", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "UL2-C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2350.0, "discounted_cash": 822.5, "setting": "both", "billing_class": "facility"}]}, {"description": "UROLOGY SS", "code_information": [{"code": "G4037", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ABDL AORTA SCREEN AAA", "code_information": [{"code": "76706", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 381.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 599.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 599.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 599.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 195.36, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 207.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Abdomen Complete 76700", "code_information": [{"code": "76700", "type": "CPT"}, {"code": "625608", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1491.0, "discounted_cash": 521.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 612.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 612.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 754.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 553.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 767.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 925.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 186.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 198.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Art/Vein Abd/Pelv/Scrotal Comp 93975", "code_information": [{"code": "93975", "type": "CPT"}, {"code": "1748370", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"minimum": 991.72, "maximum": 8450.0, "gross_charge": 3040.0, "discounted_cash": 1064.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 991.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1558.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1558.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1558.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Aspiration/Inject/Biopsy Bl 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "627594", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4309.0, "discounted_cash": 1508.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1768.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1768.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2181.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1600.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2219.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2675.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Aspiration/Inject/Biopsy Left 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "627596", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Aspiration/Inject/Biopsy Right 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "627598", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US BONE DENSITY MEASURE", "code_information": [{"code": "76977", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 12.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US BONE STIMULATION", "code_information": [{"code": "20979", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Abdomen 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "625594", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Breast Bilateral 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "627686", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4309.0, "discounted_cash": 1508.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1768.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1768.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2181.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1600.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2219.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2675.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Breast Left 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "627688", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Breast Right 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "627690", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Liver 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "631303", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Lung/Mediastinum Bilat 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "631345", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4309.0, "discounted_cash": 1508.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1768.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1768.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2181.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1600.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2219.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2675.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Lung/Mediastium Left 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "631340", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Lung/Mediastium Right 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "631336", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Pleura Bilateral 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "631333", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4309.0, "discounted_cash": 1508.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1768.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1768.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2181.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1600.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2219.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2675.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Pleura Left 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "631327", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Pleura Right 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "631323", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Renal Bilateral 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "631311", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4309.0, "discounted_cash": 1508.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1768.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1768.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2181.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1600.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2219.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2675.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Renal Left 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "631306", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Biopsy Renal Right 76942", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "631291", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US COMPL JOINT R-T W/IMG", "code_information": [{"code": "76881", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 253.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 398.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 398.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 398.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 25.72, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 27.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM ABDO BACK WALL COMP", "code_information": [{"code": "76770", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 176.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 187.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM ABDO BACK WALL LIM", "code_information": [{"code": "76775", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 80.37, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 85.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM CHEST", "code_information": [{"code": "76604", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 74.74, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 79.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM INFANT HIPS DYNAMIC", "code_information": [{"code": "76885", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 239.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 254.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM INFANT HIPS STATIC", "code_information": [{"code": "76886", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 178.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM K TRANSPL W/DOPPLER", "code_information": [{"code": "76776", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 266.08, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 283.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM OF HEAD AND NECK", "code_information": [{"code": "76536", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 199.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 212.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM PELVIC LIMITED", "code_information": [{"code": "76857", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 64.3, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 68.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM SCROTUM", "code_information": [{"code": "76870", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 179.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM SPINAL CANAL", "code_information": [{"code": "76800", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 284.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 302.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDE INTRAOP", "code_information": [{"code": "76998", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 285.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 448.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 448.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 448.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US Guidance Parenchymal Ablation 76940", "code_information": [{"code": "76940", "type": "CPT"}, {"code": "44626440", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2156.0, "discounted_cash": 754.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 885.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 461.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 725.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 725.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 725.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1110.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Guidance for Vascular Access 76937", "code_information": [{"code": "76937", "type": "CPT"}, {"code": "2031288", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2155.0, "discounted_cash": 754.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 884.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 884.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1091.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 800.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1109.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1338.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 60.28, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 64.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US LEIOMYOMATA ABLATE <200", "code_information": [{"code": "71T", "type": "CPT"}], "standard_charges": [{"minimum": 3951.0, "maximum": 17161.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10916.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17161.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17161.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17161.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US NRV&ACC STRUX 1XTR COMPRE", "code_information": [{"code": "76883", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 467.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 734.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 734.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 734.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 36.16, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 38.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Pelvis Non-OB Complete 76856", "code_information": [{"code": "76856", "type": "CPT"}, {"code": "630929", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2052.0, "discounted_cash": 718.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 842.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 842.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1038.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 762.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1056.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1274.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 174.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 185.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US REMS B1 DNS HIPS PLVS/SPI", "code_information": [{"code": "815T", "type": "CPT"}], "standard_charges": [{"minimum": 20.5, "maximum": 32.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US TRGT DYN MBUBB 1ST LES", "code_information": [{"code": "76978", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1083.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1703.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1703.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1703.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 284.57, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 302.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US TRGT DYN MBUBB EA ADDL", "code_information": [{"code": "76979", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 790.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1242.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1242.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1242.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 200.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 213.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Transrectal 76872", "code_information": [{"code": "76872", "type": "CPT"}, {"code": "1172020", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 795.0, "discounted_cash": 278.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 326.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 326.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 402.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 295.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 420.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 661.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 661.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 661.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 409.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 493.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 396.31, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 421.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Transvaginal 76830", "code_information": [{"code": "76830", "type": "CPT"}, {"code": "1172019", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1491.0, "discounted_cash": 521.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 612.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 612.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 754.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 553.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 606.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 606.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 606.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 767.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 925.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 204.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 218.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Transvaginal Non-OB", "code_information": [{"code": "76830", "type": "CPT"}, {"code": "630827", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2052.0, "discounted_cash": 718.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 842.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 842.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1038.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 762.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 606.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 606.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 606.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1056.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1274.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 204.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 218.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US UE Nonvascular Limited Left 76882", "code_information": [{"code": "76882", "type": "CPT"}, {"code": "1554230", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 764.0, "discounted_cash": 267.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 313.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 313.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 386.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 283.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 393.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 474.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US URINE CAPACITY MEASURE", "code_information": [{"code": "51798", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE 1ST TARGET LESION", "code_information": [{"code": "76982", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 155.14, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 165.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE EA ADDL TARGET LESION", "code_information": [{"code": "76983", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 235.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 235.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 235.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 87.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 93.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE OF SPEECH DEVICE SERVICE", "code_information": [{"code": "92609", "type": "CPT"}], "standard_charges": [{"minimum": 489.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE PARENCHYMA", "code_information": [{"code": "76981", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 186.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 198.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC", "code_information": [{"code": "742", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10451.2, "maximum": 17942.12, "estimated_discounted_cash": 32267.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10451.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14947.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16442.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17942.12, "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": 6890.82, "maximum": 11829.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6890.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9855.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10840.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11829.83, "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": 10959.13, "maximum": 18814.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10959.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 15673.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17241.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18814.11, "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": 23261.39, "maximum": 39934.03, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23261.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 33268.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 36595.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 39934.03, "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": 7785.63, "maximum": 13366.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7785.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 11135.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12248.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 13366.0, "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": 12519.42, "maximum": 21492.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12519.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17905.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19696.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 21492.74, "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": 25917.84, "maximum": 44494.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25917.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37068.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40774.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 44494.49, "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": 8977.9, "maximum": 15412.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8977.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12840.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14124.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15412.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE 59870", "code_information": [{"code": "59870", "type": "CPT"}, {"code": "11579467", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.71, "maximum": 8450.0, "gross_charge": 3299.0, "discounted_cash": 1154.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UTERINE SUSPENSION 58400", "code_information": [{"code": "58400", "type": "CPT"}, {"code": "1482357", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UVULECTOMY EXCISION OF UVULA 42140", "code_information": [{"code": "42140", "type": "CPT"}, {"code": "1969179", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2989.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2554.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ultrasound Follow-Up Study", "code_information": [{"code": "76970", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ultrasound Measurement Of Bone Density In Shin Bone", "code_information": [{"code": "508T", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Upper gastrointestinal blood detection, sensor capsule, with interpretation and report", "code_information": [{"code": "977T", "type": "CPT"}], "standard_charges": [{"minimum": 4097.14, "maximum": 6441.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4097.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6441.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6441.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6441.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Uric Acid", "code_information": [{"code": "84550", "type": "CPT"}, {"code": "633858", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 39.0, "discounted_cash": 13.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urinalysis", "code_information": [{"code": "81003", "type": "CPT"}, {"code": "1093834", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urinalysis Microscopic", "code_information": [{"code": "81015", "type": "CPT"}, {"code": "633864", "type": "CDM"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urinalysis With Microscopy", "code_information": [{"code": "81001", "type": "CPT"}, {"code": "2302636", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 32.0, "discounted_cash": 11.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urine Culture", "code_information": [{"code": "87086", "type": "CPT"}, {"code": "633907", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 12.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 33.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 32.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 32.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 32.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urine Dipstick", "code_information": [{"code": "81003", "type": "CPT"}, {"code": "1093835", "type": "CDM"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urine Dipstick POC", "code_information": [{"code": "81003", "type": "CPT"}, {"code": "17082559", "type": "CDM"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3.24, "methodology": "fee schedule"}], "billing_class": "facility"}, {"minimum": 0.41, "maximum": 8450.0, "gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 3.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urine Pregnancy Test POC", "code_information": [{"code": "81025", "type": "CPT"}, {"code": "607612", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 47.0, "discounted_cash": 16.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urine Pregnancy Test- Point Of Care", "code_information": [{"code": "81025", "type": "CPT"}, {"code": "607621", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 72.0, "discounted_cash": 25.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 10.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 26.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "V-BAND GASTROPLASTY", "code_information": [{"code": "43842", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VA WHOLE HEALTH PARTNER SERV", "code_information": [{"code": "Q9004", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VACC AIIV4 NO PRSRV 0.5ML IM", "code_information": [{"code": "90694", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VACC IIV4 NO PRSRV 0.25ML IM", "code_information": [{"code": "90689", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VACCINA IG IM", "code_information": [{"code": "90393", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VACCINIA VRS VAC 0.3 ML PERQ", "code_information": [{"code": "90622", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VACURETTE 7MM CURVED 022107", "code_information": [{"code": "22107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.5, "discounted_cash": 8.23, "setting": "both", "billing_class": "facility"}]}, {"description": "VACUUM BARRON TREPHINE 8.0MM", "code_information": [{"code": "K20-2058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 273.0, "discounted_cash": 95.55, "setting": "both", "billing_class": "facility"}]}, {"description": "VACUUM CURETTE 12MM 022112", "code_information": [{"code": "22112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 7.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VACUUM CURETTE 9MM 022109", "code_information": [{"code": "22109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.5, "discounted_cash": 8.23, "setting": "both", "billing_class": "facility"}]}, {"description": "VACUUM TREPHINE 360DEG X 7.0MM OPHT BARRON CORNEAL RADIAL SUCTION CHAMBER", "code_information": [{"code": "K20-2056", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 277.53, "discounted_cash": 97.14, "setting": "both", "billing_class": "facility"}]}, {"description": "VACUUM TREPHINE 360DEG X 7.0MM OPHT BARRON CORNEAL SUCTION CHAMBER", "code_information": [{"code": "K20-2054", "type": "CDM"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "VACUUM TREPHINE 360DEG X 8.5MM OPHT BARRON CORNEAL RADIAL SUCTION CHAMBER", "code_information": [{"code": "K20-2060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "VACUUM TREPHINE 360DEG X 9.0MM OPHT BARRON CORNEAL RADIAL SUCTION CHAMBER", "code_information": [{"code": "k20-2062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC", "code_information": [{"code": "746", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9802.75, "maximum": 16828.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9802.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14020.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15422.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16828.89, "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": 5712.55, "maximum": 9807.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5712.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8170.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8987.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9807.02, "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": 7114.68, "maximum": 12214.13, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 7114.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 10175.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 11193.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 12214.13, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 8016.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 8016.0, "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": 5592.71, "maximum": 9601.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5592.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7998.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8798.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 9601.29, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 8377.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 8377.0, "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": 6513.68, "maximum": 11182.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6513.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9315.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10247.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11182.36, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 8377.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 8377.0, "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": 5033.68, "maximum": 8641.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5033.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7199.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7919.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8641.58, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 8377.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 8377.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [{"code": "806", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4468.57, "maximum": 7671.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4468.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6391.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7030.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7671.43, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 4620.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 4620.0, "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": 4620.0, "maximum": 10755.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6264.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8960.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9856.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10755.25, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 4620.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 4620.0, "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": 3800.0, "maximum": 6707.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3907.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5588.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6146.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6707.54, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 3800.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 3800.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYST.-UTERUS 250 G OR LESS W/ REM. OF TUBE(S) AND/OR OVARY(S) 58262", "code_information": [{"code": "58262", "type": "CPT"}, {"code": "1482361", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYST.-UTERUS 250 G OR LESS W/REM.OF TUBE(S) & OVARY(S) W/ REPAIR ENTEROCELE 58263", "code_information": [{"code": "58263", "type": "CPT"}, {"code": "1482362", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYST.-UTERUS GREATER THAN 250 G W /REM. TUBE(S) AND/OR OVARY(S) 58291", "code_information": [{"code": "58291", "type": "CPT"}, {"code": "1482363", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYST.-UTERUS GREATER THAN 250 G W/REM.TUBE(S)/OVARY(S)-W/ REPAIR ENTEROCELE 58292", "code_information": [{"code": "58292", "type": "CPT"}, {"code": "1482360", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY FOR UTERUS 250 G OR LESS 58260", "code_information": [{"code": "58260", "type": "CPT"}, {"code": "1482366", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY FOR UTERUS 250 G OR LESS W/ COLPO-URETHROCYSTOPEXY 58267", "code_information": [{"code": "58267", "type": "CPT"}, {"code": "1482367", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY FOR UTERUS GREATER THAN 250 G 58290", "code_information": [{"code": "58290", "type": "CPT"}, {"code": "1482369", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY FOR UTERUS GREATER THAN 250 G W/ REPAIR ENTEROCELE 58294", "code_information": [{"code": "58294", "type": "CPT"}, {"code": "1482370", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 9357.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY FOR UTERUS LESS THAN 250 G W/ REPAIR ENTEROCELE 58270", "code_information": [{"code": "58270", "type": "CPT"}, {"code": "1482368", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY W/ TOTAL OR PARTIAL VAGINECTOMY 58275", "code_information": [{"code": "58275", "type": "CPT"}, {"code": "1482365", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY-RADICAL 58285", "code_information": [{"code": "58285", "type": "CPT"}, {"code": "1482371", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINECTOMY PARTIAL W/NODES", "code_information": [{"code": "57109", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43640", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43641", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALIDATE OSMOLALITY 703", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 937.3, "setting": "both", "billing_class": "facility"}]}, {"description": "VALOR NAIL END CAP 4151200003", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4151200003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 538.0, "discounted_cash": 188.3, "setting": "both", "billing_class": "facility"}]}, {"description": "VALUE IN PRIMARY CARE MVP", "code_information": [{"code": "M0005", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALVE ANTI-REFLUX SUMP SALEM ARGYLE 8888266197", "code_information": [{"code": "8888266197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE BIOPSY SNGL CHANNEL ENDO DISP", "code_information": [{"code": "MAJ-1555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE SILICON GLAUCOMA IMPLANT", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "FP7", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1442.0, "discounted_cash": 504.7, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVED ENTRY SYSTEM 25GA 3CT", "code_information": [{"code": "8065751658", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVED ENTRY SYSTEM 27GA 3CT 8065751697", "code_information": [{"code": "8065751697", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 152.6, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVULOPLASTY AORTIC VALVE", "code_information": [{"code": "33390", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY AORTIC VALVE", "code_information": [{"code": "33391", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33463", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33464", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN 1 GRAM VIAL", "code_information": [{"code": "MED0214", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 1GM/NS 250ML IVPB", "code_information": [{"code": "MED0215", "type": "CDM"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 500MG VIAL", "code_information": [{"code": "MED0213", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "VANO MIXTURE (VIGAMOX,ALPHAGAN,NEVANAC,OMNIPRED 0.15ML", "code_information": [{"code": "MED0216", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "VANOMYCIN DNA AMP PROBE", "code_information": [{"code": "87500", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAPR TRIPOLAR 90 DEG SUCTION ELECTRODE", "code_information": [{"code": "225028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 169.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VAR VACCINE LIVE SUBQ", "code_information": [{"code": "90716", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER AG IF", "code_information": [{"code": "87290", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA-ZOSTER ANTIBODY", "code_information": [{"code": "86787", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA-ZOSTER IG IM", "code_information": [{"code": "90396", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ARTERY", "code_information": [{"code": "37242", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE BLEED", "code_information": [{"code": "37244", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ORGAN", "code_information": [{"code": "37243", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE VENOUS", "code_information": [{"code": "37241", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR BIOPSY", "code_information": [{"code": "75970", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 177.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 279.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 279.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 279.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASCULAR FLOW IMAGING", "code_information": [{"code": "78445", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 735.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1156.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1156.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1156.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 356.92, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 380.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93976", "type": "CPT"}], "standard_charges": [{"minimum": 495.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 495.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93978", "type": "CPT"}], "standard_charges": [{"minimum": 670.72, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 670.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1053.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1053.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1053.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93979", "type": "CPT"}], "standard_charges": [{"minimum": 494.27, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 494.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR SURGERY SS", "code_information": [{"code": "G4038", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASECTOMY-UNILATERAL OR BILATERAL-INC. POST OP SEMEN EXAMINATION(S) 55250", "code_information": [{"code": "55250", "type": "CPT"}, {"code": "1482375", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOPNEUMATIC DEVICE THERAPY", "code_information": [{"code": "97016", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOPRESSIN 20 UNITS/1 ML (MEDID)", "code_information": [{"code": "MED0232", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 158.9, "setting": "both", "billing_class": "facility"}]}, {"description": "VASOTOMY 55200", "code_information": [{"code": "55200", "type": "CPT"}, {"code": "1482376", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1596.23, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOVASOSTOMY-VASOVASORRHAPHY 55400", "code_information": [{"code": "55400", "type": "CPT"}, {"code": "1482377", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC CARE AFTER DELIVERY", "code_information": [{"code": "59614", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY", "code_information": [{"code": "59610", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY ONLY", "code_information": [{"code": "59612", "type": "CPT"}], "standard_charges": [{"minimum": 1958.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VCARE LARGE CUP 37MM 60-6085-202A", "code_information": [{"code": "60-6085-202A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "VCARE MEDIUM CUP 34MM 60-6085-201A", "code_information": [{"code": "60-6085-201A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 60.55, "setting": "both", "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR CONT MNTR", "code_information": [{"code": "95713", "type": "CPT"}], "standard_charges": [{"minimum": 2141.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR INTMT MNTR", "code_information": [{"code": "95712", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR UNMONITORED", "code_information": [{"code": "95711", "type": "CPT"}], "standard_charges": [{"minimum": 1116.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1753.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26 HR UNMNTR", "code_information": [{"code": "95714", "type": "CPT"}], "standard_charges": [{"minimum": 2141.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26HR CONT MNTR", "code_information": [{"code": "95716", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4008.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6299.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6299.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6299.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26HR INTMT MNTR", "code_information": [{"code": "95715", "type": "CPT"}], "standard_charges": [{"minimum": 2141.54, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3365.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN BYP FEM-TIBIAL PERONEAL", "code_information": [{"code": "35585", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35583", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN BYP POP-TIBL PERONEAL", "code_information": [{"code": "35587", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN LIGATION AND STRIPPING", "code_information": [{"code": "263", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14071.2, "maximum": 24156.75, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 45.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14071.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20124.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 22137.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 24156.75, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.74, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 49.38, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLAND", "code_information": [{"code": "75840", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 179.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 190.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLANDS", "code_information": [{"code": "75842", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 31575.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7463.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20085.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 213.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 227.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ARM/LEG", "code_information": [{"code": "75820", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1072.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2755.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 139.86, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 148.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ARMS/LEGS", "code_information": [{"code": "75822", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1720.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 547.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 547.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 547.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 155.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 165.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY CHEST", "code_information": [{"code": "75827", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1072.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2755.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 155.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 165.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY EYE SOCKET", "code_information": [{"code": "75880", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1072.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2755.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 179.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 190.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY KIDNEY", "code_information": [{"code": "75831", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 177.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY KIDNEYS", "code_information": [{"code": "75833", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 202.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER", "code_information": [{"code": "75891", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 175.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 186.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/HEMODYNAM", "code_information": [{"code": "75885", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 175.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 186.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/HEMODYNAM", "code_information": [{"code": "75889", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 174.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 185.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/O HEMODYN", "code_information": [{"code": "75887", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1720.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 374.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 589.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 589.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 589.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 175.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 186.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY NECK", "code_information": [{"code": "75860", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 176.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 187.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL", "code_information": [{"code": "75870", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1072.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 546.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 859.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 859.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 859.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 251.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 267.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL EPIDURAL", "code_information": [{"code": "75872", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1072.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2755.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 179.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 190.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SPLEEN/LIVER", "code_information": [{"code": "75810", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1720.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4779.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 7514.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY TRUNK", "code_information": [{"code": "75825", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 147.1, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 156.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R CERVICAL", "code_information": [{"code": "92517", "type": "CPT"}], "standard_charges": [{"minimum": 114.88, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 180.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 180.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 180.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R OCULAR", "code_information": [{"code": "92518", "type": "CPT"}], "standard_charges": [{"minimum": 114.88, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 180.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 180.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 180.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TST I&R CERVICAL&OCULAR", "code_information": [{"code": "92519", "type": "CPT"}], "standard_charges": [{"minimum": 171.84, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 270.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 270.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 270.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN BLOOD COLL SNF/HHA", "code_information": [{"code": "G0471", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.25, "maximum": 20.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 6.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN MECHNL THRMBC REPEAT TX", "code_information": [{"code": "37188", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9675.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN THROMBOSIS IMAGES BILAT", "code_information": [{"code": "78458", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 611.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 730.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1148.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1148.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1148.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 356.92, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 380.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN 1 YR/>", "code_information": [{"code": "36425", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN < 1 YR", "code_information": [{"code": "36420", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS MECH THROMBECTOMY", "code_information": [{"code": "37187", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 6530.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5077.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS SAMPLING BY CATHETER", "code_information": [{"code": "75893", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 31575.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 7463.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20085.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31575.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 193.73, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 206.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS THROMBOSIS IMAGING", "code_information": [{"code": "78457", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 2104.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 694.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1091.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1091.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1091.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 290.17, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 309.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENT MGMT INPAT INIT DAY", "code_information": [{"code": "94002", "type": "CPT"}], "standard_charges": [{"minimum": 2048.58, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2048.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3219.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3219.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3219.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENT MGMT INPAT SUBQ DAY", "code_information": [{"code": "94003", "type": "CPT"}], "standard_charges": [{"minimum": 2048.58, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2048.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3219.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3219.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3219.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENT MGMT NF PER DAY", "code_information": [{"code": "94004", "type": "CPT"}], "standard_charges": [{"minimum": 222.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 222.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 349.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 349.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 349.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENT TUBE PAPARELLA 510-061C", "code_information": [{"code": "510-061C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "VENTILATING TUBE REMOVAL FROM MIDDLE EAR REQUIRING GENERAL ANESTHESIA 69424", "code_information": [{"code": "69424", "type": "CPT"}, {"code": "1482378", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITH CC", "code_information": [{"code": "32", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13482.97, "maximum": 23146.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 13482.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19283.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 21211.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 23146.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "31", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26593.05, "maximum": 45653.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 26593.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 38033.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 41837.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 45653.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "33", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10476.14, "maximum": 17984.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 10476.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14983.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 16481.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 17984.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENTRICULOCISTERNOSTOMY 62180", "code_information": [{"code": "62180", "type": "CPT"}, {"code": "1482379", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENTRICULOCISTERNOSTOMY-THIRD VENTRICLE 62200", "code_information": [{"code": "62200", "type": "CPT"}, {"code": "1482380", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 382.8, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 382.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VER DOC HEAR LOSS", "code_information": [{"code": "G8565", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERSAGRAFT 3.5 VRG-351", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "VRG-351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2657.0, "discounted_cash": 929.95, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSASTEP CAN & DILATOR", "code_information": [{"code": "VS1010051RH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSAWRAP TENDON PROTECTOR VTP2201", "code_information": [{"code": "C9399", "type": "HCPCS"}, {"code": "VTP2201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 2100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VERTEBRAL AXIAL DECOMPRESSIO", "code_information": [{"code": "S9090", "type": "HCPCS"}], "standard_charges": [{"minimum": 731.09, "maximum": 1148.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 731.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1148.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1148.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1148.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL CORPECTOMY ANTERIOR APPROACH-CERVICAL-SINGLE SEGMENT 63081", "code_information": [{"code": "63081", "type": "CPT"}, {"code": "1482386", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 9735.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL CORPECTOMY COMBINED THORACOLUMBAR APPROACH-LOWER THORACIC/LUMBAR 63087", "code_information": [{"code": "63087", "type": "CPT"}, {"code": "1482383", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL CORPECTOMY TRANSPERITONEAL/RETROPERITONEAL APPROACH-LOWER THORACIC/LUMBAR/SACRAL 63090", "code_information": [{"code": "63090", "type": "CPT"}, {"code": "1482384", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL CORPECTOMY TRANSTHORACIC APPROACH-THORACIC-SINGLE SEGMENT 63085", "code_information": [{"code": "63085", "type": "CPT"}, {"code": "1482385", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2145.99, "maximum": 8450.0, "gross_charge": 6503.0, "discounted_cash": 2276.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 3147.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 2145.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESICULECTOMY-ANY APPROACH 55650", "code_information": [{"code": "55650", "type": "CPT"}, {"code": "1482388", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESICULOTOMY 55600", "code_information": [{"code": "55600", "type": "CPT"}, {"code": "1482389", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4957.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESICULOTOMY-COMPLICATED 55605", "code_information": [{"code": "55605", "type": "CPT"}, {"code": "1482390", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1088.34, "maximum": 8450.0, "gross_charge": 3298.0, "discounted_cash": 1154.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1596.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESSEL SEALER 10MM TO 20CM OPEN LIGASURE ATLAS LF STRL DISP", "code_information": [{"code": "LS1020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 979.0, "discounted_cash": 342.65, "setting": "both", "billing_class": "facility"}]}, {"description": "VESTIBULAR DEV IMPLTJ UNI", "code_information": [{"code": "725T", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESTIBULAR NERVE SECTION-TRANSLABYRINTHINE APPROACH 69915", "code_information": [{"code": "69915", "type": "CPT"}, {"code": "1482392", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIAL MBO TINCTURE BENZOIN SKN STERISTRIP C1544", "code_information": [{"code": "C1544", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "VIAL2BAG ADVANCED 20MM 36098150", "code_information": [{"code": "36098150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "VIALINDICATOR BROWN CAP BIOLOGICAL STRL RAPID READOUT ATTEST", "code_information": [{"code": "1292", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.0, "discounted_cash": 108.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VIBRATE QUANT SENSORY TEST", "code_information": [{"code": "107T", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 231.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIGAMOX 0.5% OPHTHALMIC SOLUTION 3ML", "code_information": [{"code": "MED0623", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 307.0, "discounted_cash": 107.45, "setting": "both", "billing_class": "facility"}]}, {"description": "VIPER VENOM PROTHROMBIN TIME", "code_information": [{"code": "85612", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 21.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 70.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 70.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 70.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRAL CULTURE", "code_information": [{"code": "D0416", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITH MCC", "code_information": [{"code": "865", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8989.46, "maximum": 15432.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8989.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 12856.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 14142.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 15432.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [{"code": "866", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5103.64, "maximum": 8761.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5103.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 7299.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 8029.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 8761.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITH CC/MCC", "code_information": [{"code": "75", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9897.04, "maximum": 16990.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9897.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 14154.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 15570.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 16990.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "76", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5991.15, "maximum": 10285.31, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5991.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 8568.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 9425.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 10285.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRUS ANTIBODY NOS", "code_information": [{"code": "86790", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATE EGGS/ANIMAL", "code_information": [{"code": "87250", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 78.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 78.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 78.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATE TISSUE ADDL", "code_information": [{"code": "87253", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 31.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 29.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 29.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATION SHELL VIA", "code_information": [{"code": "87254", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 30.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 49.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 78.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 78.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 78.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 28.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 28.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATION TISSUE", "code_information": [{"code": "87252", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 40.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 104.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 104.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 104.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 37.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 37.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIS ADPT GUIDE LGNP KIT1", "code_information": [{"code": "V0100109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2707.0, "discounted_cash": 947.45, "setting": "both", "billing_class": "facility"}]}, {"description": "VIS FIELD ASSMNT TECH SUPPT", "code_information": [{"code": "379T", "type": "CPT"}], "standard_charges": [{"minimum": 147.43, "maximum": 231.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 231.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 1 PROSTH", "code_information": [{"code": "34845", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 2 PROSTH", "code_information": [{"code": "34846", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 3 PROSTH", "code_information": [{"code": "34847", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 4+ PROST", "code_information": [{"code": "34848", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISCOAT 0.5 ML", "code_information": [{"code": "MED0217", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 154.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VISCOAT/HEALON ENDOCOAT 30MG/ML 0.85ML", "code_information": [{"code": "MED0526", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 155.4, "setting": "both", "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE 56M OR LESS", "code_information": [{"code": "G2082", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.85, "maximum": 177.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 112.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 177.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 177.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 177.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE, > 56M", "code_information": [{"code": "G2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.85, "maximum": 177.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 112.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 177.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 177.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 177.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISIT TO DETERM LDCT ELIG", "code_information": [{"code": "G0296", "type": "HCPCS"}], "standard_charges": [{"minimum": 119.2, "maximum": 187.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 119.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 187.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL ACUITY SCREEN", "code_information": [{"code": "99173", "type": "CPT"}], "standard_charges": [{"minimum": 12.7, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL AUDIOMETRY (VRA)", "code_information": [{"code": "92579", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST CNS W/I&R", "code_information": [{"code": "95930", "type": "CPT"}], "standard_charges": [{"minimum": 222.48, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 222.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 349.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 349.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 349.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST FOR GLAUCOMA", "code_information": [{"code": "464T", "type": "CPT"}], "standard_charges": [{"minimum": 352.79, "maximum": 554.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 352.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 554.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUALIZATION OF WINDPIPE", "code_information": [{"code": "31615", "type": "CPT"}], "standard_charges": [{"minimum": 1279.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT D 1 25-DIHYDROXY", "code_information": [{"code": "82652", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 59.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 154.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 154.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 154.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 55.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 55.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT FOR MEMBRANE DISSECT", "code_information": [{"code": "67043", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAL CAPACITY TEST", "code_information": [{"code": "94150", "type": "CPT"}], "standard_charges": [{"minimum": 610.12, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 610.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAL CARE C-ARM DRAPES 42X74 VAE5603", "code_information": [{"code": "VAE5603", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN B-12", "code_information": [{"code": "82607", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN D SRM MICROSAMP QUAN", "code_information": [{"code": "38U", "type": "CPT"}], "standard_charges": [{"minimum": 42.62, "maximum": 118.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 75.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 118.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 118.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 118.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITRECTOMY WITH ENDOLASER PANRETINAL PHOTOCOAGULATION 67040", "code_information": [{"code": "67040", "type": "CPT"}, {"code": "1482394", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITRECTOMY WITH FOCAL ENDOLASER PHOTOCOAGULATION 67039", "code_information": [{"code": "67039", "type": "CPT"}, {"code": "1482395", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2629.08, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITRECTOMY WITH REMOVAL OF INTERNAL LIMITING MEMBRANE OF RETINA 67042", "code_information": [{"code": "67042", "type": "CPT"}, {"code": "1482396", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2631.5, "maximum": 9357.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITRECTOMY WITH REMOVAL OF PRERETINAL CELLULAR MEMBRANE 67041", "code_information": [{"code": "67041", "type": "CPT"}, {"code": "1482397", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2631.5, "maximum": 9357.0, "gross_charge": 5437.0, "discounted_cash": 1902.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2631.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 8027.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITRECTOMY-MECHANICAL-PARS PLANA APPROACH 67036", "code_information": [{"code": "67036", "type": "CPT"}, {"code": "1482393", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2411.0, "maximum": 9357.0, "gross_charge": 5432.0, "discounted_cash": 1901.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 5161.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2411.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2629.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3777.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIVAER ARC STYLUS CAT410", "code_information": [{"code": "CAT410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2368.0, "discounted_cash": 828.8, "setting": "both", "billing_class": "facility"}]}, {"description": "VIVAER ARC STYLUS CAT500 (each Package CAT178)", "code_information": [{"code": "CAT500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4380.0, "discounted_cash": 1533.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VKORC1 GENE", "code_information": [{"code": "81355", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 224.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 353.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 353.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 353.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 127.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 127.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLCAD LEUK NZM ACTV WHL BLD", "code_information": [{"code": "257U", "type": "CPT"}], "standard_charges": [{"minimum": 56.53, "maximum": 1025.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1025.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1025.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLOC 180 ABS 2-0 CL 18 P-14 VLOCL0125", "code_information": [{"code": "VLOCL0125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 36.4, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC 180 ABSORBABLE 2-0 ESTCH 4 LP VLOCA204L", "code_information": [{"code": "VLOCA204L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC 180 ABSORBABLE 2-0 ESTCH 6 LP VLOCA206L", "code_information": [{"code": "VLOCA206L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 277.0, "discounted_cash": 96.95, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC ESTITCH NON ABS 0 8 LOOP VLOCN008L", "code_information": [{"code": "VLOCN008L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 113.05, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC SUTURE 180 ABS 2-0 GR 24 GS-21 VLOCL0335", "code_information": [{"code": "VLOCL0335", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 38.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VLP MINI MOD 1.5 MM STRAIGHT PL 6H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74441522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2750.0, "discounted_cash": 962.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VLP TI 1.5 MM X 12 MM CTX SCREW T4 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74401512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 114.8, "setting": "both", "billing_class": "facility"}]}, {"description": "VLVT PV CLSD HRT VIA P-ART", "code_information": [{"code": "33471", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD ANOM/PERSIST SVC", "code_information": [{"code": "93584", "type": "CPT"}], "standard_charges": [{"minimum": 256.17, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 256.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 402.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 402.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 402.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD AZYGS/HEMIAZYGS", "code_information": [{"code": "93585", "type": "CPT"}], "standard_charges": [{"minimum": 241.4, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 241.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 379.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 379.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 379.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD CORONARY SINUS", "code_information": [{"code": "93586", "type": "CPT"}], "standard_charges": [{"minimum": 305.07, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 305.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 479.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 479.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 479.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD VNVN CLTRL AT/ABV", "code_information": [{"code": "93587", "type": "CPT"}], "standard_charges": [{"minimum": 450.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 450.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 707.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 707.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 707.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD VNVN CLTRL BELOW", "code_information": [{"code": "93588", "type": "CPT"}], "standard_charges": [{"minimum": 454.61, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 454.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 714.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 714.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 714.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VOL REDUCTION OF BLOOD/PROD", "code_information": [{"code": "86960", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 365.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 575.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLTAGE-GTD CA CHNL ANTB EA", "code_information": [{"code": "86596", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLUME DEPLETE OF HARVEST", "code_information": [{"code": "38214", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLUN SERVICE AT HOSPICE", "code_information": [{"code": "G9476", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOYANT LAPAROSCOPIC MARYLAND FUSION 37CM", "code_information": [{"code": "EB215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1081.0, "discounted_cash": 378.35, "setting": "both", "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC OTH PHY 1ST", "code_information": [{"code": "773T", "type": "CPT"}], "standard_charges": [{"minimum": 346.36, "maximum": 544.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 346.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC OTH PHY EA", "code_information": [{"code": "774T", "type": "CPT"}], "standard_charges": [{"minimum": 93.76, "maximum": 147.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC SM PHY 1ST", "code_information": [{"code": "771T", "type": "CPT"}], "standard_charges": [{"minimum": 346.36, "maximum": 544.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 346.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 544.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC SM PHY EA", "code_information": [{"code": "772T", "type": "CPT"}], "standard_charges": [{"minimum": 93.76, "maximum": 147.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT 8+ SEG", "code_information": [{"code": "657T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 7663.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT <7 SEG", "code_information": [{"code": "656T", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 7663.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VULVECTOMY RADICAL COMPLETE WITH UNILATERAL INGUINOFEMORAL LYMPHADENECTOMY 56634", "code_information": [{"code": "56634", "type": "CPT"}, {"code": "1482402", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 14796.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VULVECTOMY SIMPLE; COMPLETE 56625", "code_information": [{"code": "56625", "type": "CPT"}, {"code": "1482406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 5964.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VULVECTOMY SIMPLE; PARTIAL 56620", "code_information": [{"code": "56620", "type": "CPT"}, {"code": "1482407", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2374.5, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 3527.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 6125.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2743.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 4299.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6074.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VULVECTOMY-RADICAL -COMPLETE 56633", "code_information": [{"code": "56633", "type": "CPT"}, {"code": "1482399", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 14796.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VULVECTOMY-RADICAL COMPLETE-WITH INGUINOFEMORAL-ILIAC-AND PELVIC LYMPHADENECTOMY 56640", "code_information": [{"code": "56640", "type": "CPT"}, {"code": "1482401", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VULVECTOMY-RADICAL-COMPLETE WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY 56637", "code_information": [{"code": "56637", "type": "CPT"}, {"code": "1482400", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 14796.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VULVECTOMY-RADICAL-PARTIAL 56630", "code_information": [{"code": "56630", "type": "CPT"}, {"code": "1482403", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 8450.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 8312.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 7111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VULVECTOMY-RADICAL-PARTIAL WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY 56632", "code_information": [{"code": "56632", "type": "CPT"}, {"code": "1482404", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 14796.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VULVECTOMY-RADICAL-PARTIAL WITH UNILATERAL INGUINOFEMORAL LYMPHADENECTOMY 56631", "code_information": [{"code": "56631", "type": "CPT"}, {"code": "1482405", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1618.98, "maximum": 14796.0, "gross_charge": 4906.0, "discounted_cash": 1717.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 2374.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "standard_charge_dollar": 1618.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2B EVAL PLSM", "code_information": [{"code": "283U", "type": "CPT"}], "standard_charges": [{"minimum": 26.5, "maximum": 73.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2N EVAL PLSM", "code_information": [{"code": "284U", "type": "CPT"}], "standard_charges": [{"minimum": 24.86, "maximum": 91.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.86, "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": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vasc emb/occ w/prs cath", "code_information": [{"code": "C9797", "type": "HCPCS"}], "standard_charges": [{"minimum": 1958.0, "maximum": 14796.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2518.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1958.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 14796.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12660.0, "methodology": "fee schedule"}], "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": 618.68, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 618.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 972.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 972.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 972.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Venipuncture", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "1235826", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.55, "maximum": 8450.0, "gross_charge": 37.0, "discounted_cash": 12.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 3.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.72, "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": 860.79, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 860.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1352.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1352.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1352.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vessel mapping hemo access", "code_information": [{"code": "G0365", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.0, "maximum": 518.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 518.0, "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": 198.76, "maximum": 312.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 198.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 312.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 312.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 312.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vitamin D 25 Hydroxy Level", "code_information": [{"code": "82306", "type": "CPT"}, {"code": "633872", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 45.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 15.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 75.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 118.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 118.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 118.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 42.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 42.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "W/IN 2YR DXA NOT ORDER", "code_information": [{"code": "G9471", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WALKER 32-39 300LB 5 CSTR ALUM DUA CWAL0008T", "code_information": [{"code": "CWAL0008T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WALKER 33-43IN 500LBS DBL FRONT SNGL RELEASE", "code_information": [{"code": "CWAL0010B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND ABLATION 90DEG SM JOINT COOLCUT", "code_information": [{"code": "AR-9809SJ-90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 132.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND APOLLORFSJ50 ASPIRATING ABLATOR 50DG AR-9845", "code_information": [{"code": "AR-9845", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 672.5, "discounted_cash": 235.38, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND ARTHRO TOPAZ 0.0DEG 0.8MM MICRODEBRIDER FINGER SWITCH", "code_information": [{"code": "ACH4040-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1116.35, "discounted_cash": 390.72, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND ARTHROSCOPY 3.75MM ARTHROWAND MULTIVAC SUCTION 50DEG ANGLE SHAFT", "code_information": [{"code": "ASH4830-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND COLBLATOR II 15MM X 30MM", "code_information": [{"code": "EICA4845-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 822.82, "discounted_cash": 287.99, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND DEBRIDEMENT 3MM 2.3MM TIP ARTICULAR CARTILAGE 15 DEGREE ANGLE PARAGON T2 AR", "code_information": [{"code": "AC5531-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND ELECTRODE 2.3MM 140MM 21DEG WEDGE VAPRINSTR", "code_information": [{"code": "225203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 231.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND ELECTRODE 3.3MM X 3.70MM 90DEG VAPR PREMIERINSTR", "code_information": [{"code": "227204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND ELECTRODE 90DEG SUCTION VAPR SINSTR", "code_information": [{"code": "225370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 831.0, "discounted_cash": 290.85, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND LIMB 1.4MM SHAFT SM JOINT WRIST ELBOW ANKLE ICW ARTHROWAND", "code_information": [{"code": "AC4050-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 637.0, "discounted_cash": 222.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND LIMB 2.3MM SHAFT SM JOINT WRIST ELBOW ANKLE SHRT BEVEL ICW ARTHROWAND", "code_information": [{"code": "AC2823-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 331.0, "discounted_cash": 115.85, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND LIMB 3MM SHAFT KNEE SHOULDER ICW 30 DEGREE ANGLE SABER ARTHROWAND", "code_information": [{"code": "AC4330-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND PLASMA AMBIENT 90 IFS SUPER TURBOVAC", "code_information": [{"code": "ASHA4250-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND PLASMA NOSE COBLATION COBLATOR W/INTERGRATED CABLE REFLEX 55 PEDI ADLT DISP", "code_information": [{"code": "EIC4855-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 165.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND PLASMA PROCISE", "code_information": [{"code": "EIC8898-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 180.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SUCT 3.75MM DIA KNEE ICW 50 DEGREE ANGLE SUPER MULTI VAC FOR RAPID REMOVAL", "code_information": [{"code": "ASC4830-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SUCT 3.75MM SHAFT KNEE SHOULDER IFS 90 DEGREE ANGLE SUPER TURBO VAC ARTHROW", "code_information": [{"code": "ASH4250-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 471.0, "discounted_cash": 164.85, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SUCTION 3MM 50DEG REPROCESS TRISTAR 50", "code_information": [{"code": "ASC463001R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 226.0, "discounted_cash": 79.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SUCTION 5.5MM 90DEG IFS REPROCESSED ARTHROWAND STARVAC", "code_information": [{"code": "ASC4251-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SUCTION STARVAC 90 DEG 5.5MM GREY REP", "code_information": [{"code": "ASC4250-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SURG 100 ML TONSILLECTOMY ADENOIDECTOMY EAR NOSE THROAT COBLATOR II 70 EXTR", "code_information": [{"code": "EIC5872-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 97.65, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SURG 2.3MM 35DEG SHRT BEVELINTEGRATED CABLE WAND REPROCESSINSTR", "code_information": [{"code": "AC2823-01R", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SURG 2.5MM 60DEG DOMEINTEGRATED CABLE WAND REPROCESSINSTR", "code_information": [{"code": "AC3525-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.0, "discounted_cash": 73.85, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SURG 3.6MM 90DEGINTEGRATED CABLE WAND REPROCESS LOPRO", "code_information": [{"code": "AC1336-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 82.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SURG 3MM 30DEG SABERINTEGRATED CABLE WAND REPROCESSINSTR", "code_information": [{"code": "AC4330-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SURG 50DEG ELECTRODE REPROCESS VAPR PREMIERE IMP", "code_information": [{"code": "227504R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 89.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SURG 90DEG ELECTRODE REPROCESS VAPR PREMIEREINSTR", "code_information": [{"code": "227204R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 92.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SURG 90DEG SUCTION ELECTRODE REPROCESS VAPR SINSTR", "code_information": [{"code": "225370R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1025.0, "discounted_cash": 358.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND SURG MED TURBINATE REDUCTION EAR NOSE THROAT COBLATOR IIINSTR", "code_information": [{"code": "EIC4845-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 297.0, "discounted_cash": 103.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WANDINTEGRATED TABLE 70 DEGREEE XTRA EVAC", "code_information": [{"code": "EICA5872-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 913.2, "discounted_cash": 319.62, "setting": "both", "billing_class": "facility"}]}, {"description": "WARF OR OTHER FDA DRUG PRESC", "code_information": [{"code": "G8967", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.41, "maximum": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN RESPON GENETIC TEST", "code_information": [{"code": "G9143", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 484.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 186.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 307.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 484.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 484.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 484.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 173.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 173.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARMER HEEL ARGYLE LATEX FREE ATTACHMENT TAB NONSTERILE INFANT 105DEG 3.5 X 5IN", "code_information": [{"code": "MH00002T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WARMER MBO HEEL INFANT TAPE 4X4 11460 010T", "code_information": [{"code": "11460-010T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WASH HARVEST STEM CELLS", "code_information": [{"code": "38209", "type": "CPT"}], "standard_charges": [{"minimum": 1723.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER 3.0MM/3.5MM/4.0MM/4.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OSW-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER 8MM O.D. 4MM I.D 71120006", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71120006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 224.0, "discounted_cash": 78.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER ASNIS III 4.5-8MM CANN", "code_information": [{"code": "390016S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 241.0, "discounted_cash": 84.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER BICONCAVE 2.5/2.8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4750.70/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 114.0, "discounted_cash": 39.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER BONE 14MM DIA SPIKED ORTHO TITANIUM ASTM F-136 ALLOY FOR CANCELLOUS SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 306.0, "discounted_cash": 107.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER EVOS 3.5MM SCREWS 72442135", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72442135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 93.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER EVOS DOUBLE - 3.5MM SCREWS 72442235", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72442235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 467.0, "discounted_cash": 163.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER FOR 2.7MM SN SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72442127N", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 98.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER FOR 4.0MM-4.5MM SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSW04045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER FOR 6.5/8.0 SCREWS TI ANIS III 619904", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "619904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 32.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER MONSTER 4.5MM FLAT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "P20-045-WF00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 394.0, "discounted_cash": 137.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW 11MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NCS-W611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW 12.7MM X 6.5MM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "121680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 95.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW 13MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "219.99", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW 13MM TORN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NCS-W613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW 2.5MM THREADED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1312-20-025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW 7MM FOR SM SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "219.98", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW BONE ASNIS 3.0MM MICRO SS CANN STR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-30900S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW FOR 1.7 MM BONE SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "59-17049E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW FOR 2.3 MM BONE SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "59-23049E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW PATELLA 4.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "619905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREW PATELLA 4.0MM STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "619905S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER STAINLESS STEEL 7.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8870W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 69.6, "discounted_cash": 24.36, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SURG 4MM DIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "316-0226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SURG 7MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 36.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER USE WITH 2.0MM X 2.5MMMM SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSW02025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 85.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WATER STERILE FOR INJECTION USP 1000 2B0304X", "code_information": [{"code": "2B0304X", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WATER STERILE FOR IRRIGATION 3000M 2B7117", "code_information": [{"code": "2B7117", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 41.18, "discounted_cash": 14.41, "setting": "both", "billing_class": "facility"}]}, {"description": "WATERJET PROSTATE ABLTJ CMPL", "code_information": [{"code": "421T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WAVE WRITER MRI 32 CONTACT IMPLANTABLE PULSE GENERATOR", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61800.0, "discounted_cash": 21630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WAVEWRITER IPG AND CHARGING KIT", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1060A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35638.0, "discounted_cash": 12473.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WAVEWRITER IPG/CHARGING KIT", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "SC-1062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35638.0, "discounted_cash": 12473.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WAX BONE 2.5 GRAMS W31G", "code_information": [{"code": "W31G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.69, "discounted_cash": 15.99, "setting": "both", "billing_class": "facility"}]}, {"description": "WAX BONE 2.5G NON-ABSORBABLE", "code_information": [{"code": "BW25G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 8.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WAX BONE WHITE STERILE 903", "code_information": [{"code": "903", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WB CONFIDENT EMBOSS POLY SNAP ADULT 500/CASE ORANGE", "code_information": [{"code": "WBEMBA-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WBC ALKALINE PHOSPHATASE", "code_information": [{"code": "85540", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 34.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 34.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 34.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WBC ANTIBODY IDENTIFICATION", "code_information": [{"code": "86021", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WCD DEVICE INTERROGATE", "code_information": [{"code": "93292", "type": "CPT"}], "standard_charges": [{"minimum": 159.86, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 251.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE 18X18 6.5MM OSTEOTOMY TRUSS SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EOTS-SM1806", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6489.0, "discounted_cash": 2271.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE BIOFOAM COTTON 20X14X10X4.5 47S02045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "47S02045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4496.0, "discounted_cash": 1573.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE CALC-CUBOID 8MM 203932-016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "203932-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6077.0, "discounted_cash": 2126.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE COTTON MEDIUM 5.5MM COTS-MD2005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "COTS-MD2005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7931.0, "discounted_cash": 2775.85, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE COTTON SMALL FOOTPRINT 5MM THICKNESS 1100-16140507", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1100-16140507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9672.0, "discounted_cash": 3385.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE ENOPHTHALMOS RIGHT ORBITAL WEDGE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "9542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1314.0, "discounted_cash": 459.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE EVANS 22 X 20 X 12MM ALLOPURE 10MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "8666-1200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4026.26, "discounted_cash": 1409.19, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE EVANS MEDIUM 10MM EOTS-MD2010", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "EOTS-MD2010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8549.0, "discounted_cash": 2992.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE FEMORAL 10MM SZ4 SCREW ON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2214.0, "discounted_cash": 774.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE FOOT LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EVFWC-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6336.0, "discounted_cash": 2217.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE OSSEON RECONSTRUCTIVE PROFILE 1 110003770", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110003770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4440.0, "discounted_cash": 1554.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG ADD-ON", "code_information": [{"code": "32506", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG DIAG", "code_information": [{"code": "32507", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG INITIAL", "code_information": [{"code": "32505", "type": "CPT"}], "standard_charges": [{"minimum": 3565.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 5892.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE TIBIAL SZ 5-6 10MM LT-MED/ RT-LAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4450.0, "discounted_cash": 1557.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE UNICORTICAL 10 X 5 X 22 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "UCW-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6159.0, "discounted_cash": 2155.65, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGING OF CAST", "code_information": [{"code": "29740", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGING OF CLUBFOOT CAST", "code_information": [{"code": "29750", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEIGHT EYE LID 1.0G", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "SGP10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 622.0, "discounted_cash": 217.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WEIGHT EYE LID 1.2G", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "SGP12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 622.0, "discounted_cash": 217.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS AB IGM", "code_information": [{"code": "86788", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS ANTIBODY", "code_information": [{"code": "86789", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WESTERN BLOT TEST", "code_information": [{"code": "84181", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 68.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 68.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 68.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WET MOUNTS/ W PREPARATIONS", "code_information": [{"code": "Q0111", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 60.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR MNGMENT TRAINING", "code_information": [{"code": "97542", "type": "CPT"}], "standard_charges": [{"minimum": 149.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 149.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHIRLPOOL THERAPY", "code_information": [{"code": "97022", "type": "CPT"}], "standard_charges": [{"minimum": 81.06, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 127.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 127.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 127.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHISKER SLOTTED 4.2MM STERLING", "code_information": [{"code": "C9274", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WHOLE BODY PHOTOGRAPHY", "code_information": [{"code": "96904", "type": "CPT"}], "standard_charges": [{"minimum": 289.25, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 289.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 454.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 454.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 454.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE MITOCHONDRIAL GENOME", "code_information": [{"code": "81460", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1608.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3281.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 5160.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 5160.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 5160.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1853.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1853.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE MITOCHONDRIAL GENOME", "code_information": [{"code": "81465", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2386.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3753.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3753.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3753.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1347.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1347.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WICK EAR 9MM X 15MM POPE", "code_information": [{"code": "425141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 99.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WILSON FRAME TABLE COVER", "code_information": [{"code": "A-70810-A4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 92.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WINDOWING OF CAST", "code_information": [{"code": "29730", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIPE CLEANSING 4IN X 4IN SURGINSTR X RAY DETECT MEROCEL", "code_information": [{"code": "2218535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 9.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WIPE DISINFECTANT XL 10 X 12IN MULTI PURP CANISTER CAVIWIPES", "code_information": [{"code": "13-1155", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIPE GERMICIDAL AF3 SANI-WIPE", "code_information": [{"code": "P13872", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WIPEINSTR WICK MEROCEL", "code_information": [{"code": "400207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE .045 X 2.5\" 2 PACK STERILE OLIVE P04 S0221", "code_information": [{"code": "P04 S0221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 523.37, "discounted_cash": 183.18, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE .062 OLIVE 340-60-005", "code_information": [{"code": "340-60-005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE 1.00X10MM CERCLAGE", "code_information": [{"code": "291.05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE 1.25X10MM CERCLAGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "291.06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 56.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE 1.4 OLIVE P99-200-1406", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "P99-200-1406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE ALIGNMENT 1ST SET", "code_information": [{"code": "K100-165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE BALL TIPPED 3 X 800MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1806-0080S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 442.0, "discounted_cash": 154.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE BAYONET ANKLE DISTRACTION ARTHROPLASTY W/ STOPPER TRUELOK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "54-1215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 395.0, "discounted_cash": 138.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE BONE KIRSCHNER STAINLESS STEEL SMOOTH TROCAR POINT DUAL .035 X 6IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-26-35", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE BONE KIRSCHNER STAINLESS STEEL SMOOTH TROCAR POINT DUAL .045 X 6IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-26-45", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE BONE KIRSCHNER STAINLESS STEEL SMOOTH TROCAR POINT DUAL .062 X 6IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-26-62", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE CERCLAGE 0.8 X 10MM COIL", "code_information": [{"code": "291.09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE CERCLAGE 16GA 291.13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "291.13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE FIBER 4 TO 0 19IN W/ POINT NDL", "code_information": [{"code": "AR-7248", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 26.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE FIBER NUMBER 2 COLLAGEN COATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-7200B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 115.0, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE FIXATION 100MM .8MM KIRSCHNER APTUS STAINLESS STEEL TROCAR TIP NONSTERILE A-5040.00/1", "code_information": [{"code": "A-5040.00/1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 44.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE FX 4IN .028IN KRSH SS SMTH TROC PNT BOTH ENDS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-26-28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GD .035IN X 150 CM 3 CM STRAIGHT TIP STANDARD STIFFNESS NITINOL HYDROPHILIC", "code_information": [{"code": "M006630205B1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GD .38IN X 150 CM 3 CM TIP NITINOL CORE STANDARD BODY ANGLED TIP HI WIREINS", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "HWA-038150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 417.0, "discounted_cash": 145.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GD 0.38IN 150 CM STRAIGHT TIP URETHRAL REG SHAFT NITINOL HYDROPHILIC COATIN", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "150NFS38", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GD 1.1MM X 150MM NON THREADED TRIANGULAR TROCAR TIP FOR CANNULATED SCREW SS", "code_information": [{"code": "292.623", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 22.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GD 1.1MM X 150MM THREADED TIP W/ OR TRIANGULAR TROCAR FOR CANNULATED SCREW", "code_information": [{"code": "292.622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GD 1.4MM X 150MM THREADED FEMORAL CANNULATED SCREW SYS ASNIS III STRL", "code_information": [{"code": "702459S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 284.0, "discounted_cash": 99.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GD 2.6MM X 80 CM BEAD TIPINSERTED TRANS CALCANEALLY THROUGH THE TALUSINTO T", "code_information": [{"code": "14-410002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 308.0, "discounted_cash": 107.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .025IN 150 CM 3 CM STRAIGHT FLEX TIP GLDWER HDRPH", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "M0066300921", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .035IN 0.89MM", "code_information": [{"code": "M0066300980", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 53.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .035IN 150 CM 3 CM STRAIGHT FLEX TIP PTFE MOV COR", "code_information": [{"code": "M0066201300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .035IN 150 CM 3 CM STRAIGHT FLEX TIP PTFE URETERAL", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "M0066201200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .035IN 150 CM 8 CM STRAIGHT FLEX TIP VASC", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "M0066300981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 53.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .035IN 150 CM ANGLE FLEX TIP SHFT GLDWR", "code_information": [{"code": "M0066301021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .035IN 150 CM STRAIGHT FLEX TIP GLDWR HDRPH", "code_information": [{"code": "M0066301001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .035IN 150 CM STRAIGHT FLEX TIP SNSR NTNL", "code_information": [{"code": "M0066703011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 49.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .035IN 150 CM STRAIGHT TIP ENDO PTFE", "code_information": [{"code": "M0066703081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 50.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .035IN X 150 CM NITINOL STRAIGHT URO", "code_information": [{"code": "M0066703080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 50.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .035IN X 4IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "316-0107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.5, "discounted_cash": 18.38, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .035IN X 6IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "316-0106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 18.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .038IN 150 CM 3 CM STRAIGHT FLEX TIP GLDWR PU", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "M0066301011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 47.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .038IN 150 CM STRAIGHT FLEX TIP SNSR HDRPH ST", "code_information": [{"code": "M0066703021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 49.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .038IN X 150 CM 3 CM TAPERED STRAIGHT TIP STANDARD STIFFNESS NITINOL HYDROPHILIC ZIPWIRE", "code_information": [{"code": "M006630208B1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .045IN X 4IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "316-0003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .045IN X 6IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "316-0004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .062IN X 12IN LNG SHOULDER", "code_information": [{"code": "AR-8941-12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .062IN X 6IN KIRSCHNER ACU LOC II", "code_information": [{"code": "WS-1607ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.16, "discounted_cash": 21.76, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .062IN X 6IN LNG SHOULDER", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-8941-6", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .062IN X 7IN LNG SHOULDER", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-8941-7", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .62IN X 6IN", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "316-0118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE .86MM THREADED WITH LASER LINE STAINLESS STEEL INSTRUMENT", "code_information": [{"code": "AR-8737-22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.5, "discounted_cash": 25.73, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 0.035IN X 150 CM STANDARD STRAIGHT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "M006630214B1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 29.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 0.045IN DIA BIOCOMPRESSION SURGINSTR W/ TROCAR TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-5025K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 0.38IN 150 CM STRAIGHT FLEX TIP DLFLX SNSR", "code_information": [{"code": "M0066703121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 51.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 0.86MM DIA THREADED DISP", "code_information": [{"code": "AR-13240KT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 19.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 0.91MM X 80MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "451-1136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.1MM W/ TROCAR TIP W/ LASER LINE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-8737-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.1MM X 100MM KIRSCHNER TROCAR IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5040.10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.25MM X 150MM THREADED COBALT BASED ALLOY ST", "code_information": [{"code": "900.722", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.35MM DUAL TROCAR", "code_information": [{"code": "AR-5050-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 143.0, "discounted_cash": 50.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.35MM THREADED W/ TROCAR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-8737-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 23.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.4MM OLIVE", "code_information": [{"code": "P99-250-1608", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 429.0, "discounted_cash": 150.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.4MM X 150MM THREADED FEMORAL CANNULATED SCREW SYS ASNIS III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "702459", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 158.0, "discounted_cash": 55.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.5MM BLUNT STBTALAR K300-15", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K300-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.6MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "NC5-GD16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.6MM X 150MM THREADED TIP FOR CANNULATED 4.5 SCREW SS", "code_information": [{"code": "292.72", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 45.85, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.6MM X 9.25IN INSTRUMENT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "80-0950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.9MM DIA", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "CSS-040-19", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 100MM 1 1 2 5 TO 4.0 SCREW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "K100-11S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 136MM 200MM DRILL TIP", "code_information": [{"code": "2.113.001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.0, "discounted_cash": 55.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 2.2MM X 800MM SMOOTH TIP STRL", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "1806-0093S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 2.3MM BLUE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "CSS-040-23", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 2.5MM", "code_information": [{"code": "NK012527", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 2.5MM X 200MM DRILL TIP SSINSTR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "310.243", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 261.0, "discounted_cash": 91.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 2.8MM X 150MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-9165K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 3.2MM X 300MM THREADED", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "702462S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 63.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 3035IN 150 CM STRAIGHT FLEX YIP SNSR HDPRH", "code_information": [{"code": "M0066703051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "discounted_cash": 54.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 8IN THREADED W/ TROCAR TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "AR-8967KT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE BEADED TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "14-110002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 242.0, "discounted_cash": 84.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE J TIPPED", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "CS1015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 45.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE NITANOL", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "GLC114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE PARTIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "316-0023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE SHARP FOR RODINSERTION SYS CD HORIZON SEXTANT II", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8670001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 146.0, "discounted_cash": 51.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE TIP ANGLE 20DEG SINUS RELIEVA VIGOR", "code_information": [{"code": "GW35080V", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 432.0, "discounted_cash": 151.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE K .9 CK09115", "code_information": [{"code": "CK09115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.8, "discounted_cash": 31.08, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE K 1.4MM X 228MM 500036", "code_information": [{"code": "500036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE K- DOUBLE ENDED TROCAR TIP 0.9X150MM P99-292-0915", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-292-0915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 30.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE K- OLIVE TIP 1.6 MM / 100 MM 542036", "code_information": [{"code": "542036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 599.87, "discounted_cash": 209.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE K- SMOOTH 2X150MM P99-192-2015", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-192-2015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE K- \u00c3\u02dc1.4X152.4MM VKW01001", "code_information": [{"code": "VKW01001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.58, "discounted_cash": 26.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .028IN X 4IN ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K14028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .028IN X 6IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K16028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .035 9MM 229MM SMOOTH TROCAR ORTH SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18604600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .035IN DBL END", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210-24-006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .035IN STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210-24-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .045 1.1MM 22.9 CM TROCAR POINT BOTH END SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18606200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .045IN DIA SMOOTH PLAIN DOUBLE TROCAR STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-26-45S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .045IN STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210-40-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .045IN TIGER", "code_information": [{"code": "210-40-006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 11.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .045MM X 9MM DIAMOND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IN0027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .054IN X 4IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K14054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .062 1.6MM 22.9 CM TROCAR POINT BOTH END ORTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18607800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .062IN X 6IN STANDARD PARTIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210-60-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .062IN X 6IN TROCAR POINT", "code_information": [{"code": "1642-06-062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 30.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .062IN X 7.25IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-0122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .8MM X 100MM DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45-20015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 46.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .8MM X 100MM STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45-20015S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 35.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER .99MM X 70MM TROCAR TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AGK09070M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 69.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 0.045IN X 50MM STRAIGHT TI", "code_information": [{"code": "310-40-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 0.8MM X 120MM BIODRIVE MICRO", "code_information": [{"code": "BR101DT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 0.8MM X 70MM PIERRE ROBIN SEQUENCE THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PA009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 0.9MM CANNULATED SCREW SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1040-4001-0.9", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.1MM CANNULATED SCREW SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1040-4001-1.1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.1MM SS STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-450350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 217.0, "discounted_cash": 75.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.1MM X 120MM PHALINX MD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.20MM MINI CANNULATED SCREW SYS DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KN1117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.25MM 150MM W/ TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "292.12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 8.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.25MM IMPLANT", "code_information": [{"code": "390157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.84, "discounted_cash": 17.09, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.25MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "492.12E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.25MM X 150MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71161012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 407.82, "discounted_cash": 142.74, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.25MM X 150MM THREADED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "292.62", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.25MM X 150MM TROCAR TIP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "492.12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.2MM 65MM TIP TROCAR SMOOTH WITH OLIVE", "code_information": [{"code": "XBR001002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 430.0, "discounted_cash": 150.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.2MM TEMPORARY FIXATION CLAW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DC4212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.92, "discounted_cash": 75.92, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.2MM X 100MM ASNIS MICRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45-30015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 25.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.2MM X 100MM ASNIS MICRO STER PKG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45-30015S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 187.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.2MM X 70MM TROCAR TIP SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AGK0212070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 117.0, "discounted_cash": 40.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.4MM DIA 6IN SMOOTH TROCAR/TROCAR NONSTERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KM172-26-54", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.4MM X 150MM SMOOTH TIP", "code_information": [{"code": "390162", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.5MM STRL", "code_information": [{"code": "950092", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 143.0, "discounted_cash": 50.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.6MM 150MM W/ TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "292.16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 224.0, "discounted_cash": 78.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.6MM HELIX IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MFT-040-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 15.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.6MM PERILOC IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71161016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 407.0, "discounted_cash": 142.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.6MM ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KW06255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 10.85, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.6MM X 127MM SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KW062SS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.6MM X 150MM", "code_information": [{"code": "390164", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.84, "discounted_cash": 17.09, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.6MM X 150MM 5MM THREAD LEN TROCAR POINT THREADED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "292.71", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 14.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.6MM X 150MM TROCAR POINT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "492.16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 86.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.6MM X 150MM TROCAR TIP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AGK16150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 145.77, "discounted_cash": 51.02, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.6MM X 150MM TROCAR TIP STAINLESS STEEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5040.41/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 18.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.6MM X 6IN ALPS LOCKING SM FRAGMENT SYS DISP", "code_information": [{"code": "14425-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.8MM SS STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-450360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1.8MM X 305MM GUIDE BLUNT SUB TALAR LOK SS IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ST5003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 100MM LEN 0.9MM DIA FOR SNGL TROCAR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "K100-09S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 100MM X 1.6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K100-16S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 160MM 1.1MM ZEBRA STRIPED DIST RADIUS FOR VARIAX DIST RADIUS LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7-40281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "390142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 1MM X 150MM TROCAR POINT", "code_information": [{"code": "292.1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 17.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2.0 AND 2.5 0.9MM X 100MM TC SERIES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KW1102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2.0MM SS STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14-450355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 113.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2.2MM X 150MM TROCAR TIP STAINLESS STEEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5040.00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2.3MM X 23CM SMOOTH TROCAR TIP SINGLE END", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-194-2323", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309.0, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2.5MM NON THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KN1115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2.8MM NON THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "292.81", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 88.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2MM DS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "703818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2MM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71171020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 33.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2MM ST", "code_information": [{"code": "390192", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 17.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2MM STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "702460S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 202.0, "discounted_cash": 70.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2MM X 150MM IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71161020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 407.82, "discounted_cash": 142.74, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 2MM X 150MM TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "292.2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 3.0 AND 4.0 1.1MM X 120MM TC SERIES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KW1103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 11.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 3.0/4.0 1.1MM X 120MM THREADED CANNULATED IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KW1104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 31.85, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 3.0MM NON THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KN1116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 25.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 3.0MM X 285.0MM", "code_information": [{"code": "1806-0050s", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 459.36, "discounted_cash": 160.78, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 3.0MM X 285MM STRL", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "1806-0083S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 211.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 3.2MM X 450.0MM", "code_information": [{"code": "1210-6450S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 408.88, "discounted_cash": 143.11, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 300 MM LEN 2 MM DIAMETER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K300-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 16.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 4IN X 0.035IN TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K14035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 4IN X 0.045IN TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K14045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 4IN X 0.062IN TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K14062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 6IN X .035IN PARTIALLY THREADED", "code_information": [{"code": "210-24-005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 20.65, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 6IN X 0.035IN STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K16035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 6IN X 0.045IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K16045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 6IN X 0.045IN STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K16054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 6IN X 0.062IN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K16062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER 70MM TROCAR TIP FIXOS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AGK10070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 26.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER AVS ARIA", "code_information": [{"code": "48755007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 49.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER LUXOR CANNULATED BLUNT TIP SS DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48230231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 28.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER MEDIUM 1.1 X 102MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45302002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER OLIVE STOP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "56-40281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 107.0, "discounted_cash": 37.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER TRAUMA 160MM X 1MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7-40280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 24.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSHNER 0.062IN X 3IN CLAVICLE SYS ARTHROSCOPIC", "code_information": [{"code": "AR-2663", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.5, "discounted_cash": 25.73, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSHNER 1.6 X 150MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "321-0123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE LEAD CLIP ON 302773-200", "code_information": [{"code": "302773-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1135.18, "discounted_cash": 397.31, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE OLIVE .062IN X 4.5IN PARTIALLY THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "310-60-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 39.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE OLIVE 0.062\" X 4.65\" PARTIALLY THREADED", "code_information": [{"code": "320-60-005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 126.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE OLIVE 1.3MM THREADED P99-201-1306", "code_information": [{"code": "P99-201-1306", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 127.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE OLIVE CD-SB-0055", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CD-SB-0055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 814.0, "discounted_cash": 284.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE OLIVE SMOOTH 1.6X 100MM TOWERWIRE LONG P99-250-1610", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-250-1610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 79.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE PECA TARGETING CKW06001", "code_information": [{"code": "CKW06001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 867.0, "discounted_cash": 303.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE SHARP BAYONET 1.8X400MM DS-K400-18BN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DS-K400-18BN", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 224.0, "discounted_cash": 78.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE SHARP BAYONET OLIVE 1.8X400MM DS-K400-18BNP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DS-K400-18BNP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 498.0, "discounted_cash": 174.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE SHORT 1.5MM PROVISIONAL FIXATION 74462026", "code_information": [{"code": "74462026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 626.77, "discounted_cash": 219.37, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE SMOOTH TIPPED 3X800MM", "code_information": [{"code": "1806-0090S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 583.73, "discounted_cash": 204.31, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE STENT PLACING H965180011", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "H965180011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 77.7, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE SURG 1.6MM X 150MM DRILL TIP", "code_information": [{"code": "71101502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 87.85, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE SUT PASSING STRL", "code_information": [{"code": "AR-1255-18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE THREADED 100/15", "code_information": [{"code": "M426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 182.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE ZIP ANGLED .035 X 150", "code_information": [{"code": "630-206B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5660 6 8 180 2.8", "code_information": [{"code": "FW24075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5661 8 8 180 2.8", "code_information": [{"code": "FW24085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5662 10 8 180 2.8", "code_information": [{"code": "FW24095", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5663 12 8 180 2.8", "code_information": [{"code": "FW24105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5664 15 8 180 2.8", "code_information": [{"code": "FW24125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5665 18 8 180 2.8", "code_information": [{"code": "FW24145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5666 20 8 180 2.8", "code_information": [{"code": "FW24155", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 71.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WITHDRAWAL OF ARTERIAL BLOOD", "code_information": [{"code": "36600", "type": "CPT"}], "standard_charges": [{"minimum": 1886.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G ADDL CM", "code_information": [{"code": "15005", "type": "CPT"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1939.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOND COVLATION TOPAZ EZ IFS MICRODEBRIDER", "code_information": [{"code": "ACH4041-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1311.64, "discounted_cash": 459.07, "setting": "both", "billing_class": "facility"}]}, {"description": "WORK HARDENING", "code_information": [{"code": "97545", "type": "CPT"}], "standard_charges": [{"minimum": 413.22, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 413.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 649.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 649.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 649.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WORK HARDENING ADD-ON", "code_information": [{"code": "97546", "type": "CPT"}], "standard_charges": [{"minimum": 208.2, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 208.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 327.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 327.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 327.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WORK RELATED DISABILITY EXAM", "code_information": [{"code": "99455", "type": "CPT"}], "standard_charges": [{"minimum": 1080.76, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1080.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1698.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1698.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1698.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND CLOSURE ADHESIVE SYL-WC-32-010", "code_information": [{"code": "SYL-WC-32-010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.3, "discounted_cash": 78.16, "setting": "both", "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": 18102.4, "maximum": 31077.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18102.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 25890.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 28479.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 31077.32, "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": 32667.53, "maximum": 56082.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32667.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 46721.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51393.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 56082.04, "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": 11217.66, "maximum": 19257.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11217.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 16043.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 17648.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19257.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [{"code": "902", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11948.84, "maximum": 20513.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11948.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 17089.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 18798.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 20513.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH MCC", "code_information": [{"code": "901", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25966.5, "maximum": 44578.03, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 25966.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 37137.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 40851.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 44578.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "903", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6906.03, "maximum": 11855.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6906.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 9877.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 10864.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 11855.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND MATRIX RESTRATA\u00c2\u00ae 2.5CM X 2.5CM RWM1-1X1", "code_information": [{"code": "C1849", "type": "HCPCS"}, {"code": "RWM1-1X1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 665.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND MATRIX RESTRATA\u00c2\u00ae 2.5CM X 5CM RWM1-1X2", "code_information": [{"code": "C1849", "type": "HCPCS"}, {"code": "RWM1-1X2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2575.0, "discounted_cash": 901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND MATRIX RESTRATA\u00c2\u00ae 2.5CM X 7.5CM RWM1-1X3", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "RWM1-1X3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4532.0, "discounted_cash": 1586.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND MATRIX RESTRATA\u00c2\u00ae 5.0CM X 5.0CM RWM1-2X2", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "RWM1-2X2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6493.0, "discounted_cash": 2272.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND MATRIX RESTRATA\u00c2\u00ae 7.5CM X 7.5CM RWM1-3X3", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "RWM1-3X3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6953.0, "discounted_cash": 2433.55, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND THERAPY DEVICE PICO 7 NEGATIVE PRESSURE 4 X 8IN DISPOSABLE LATEX FREE", "code_information": [{"code": "66022002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 213.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND(S) CARE NON-SELECTIVE", "code_information": [{"code": "97602", "type": "CPT"}], "standard_charges": [{"minimum": 770.56, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1210.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRAP BIOSHIELD REGULAR 40X40", "code_information": [{"code": "4040", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP BONDED BLUE PINK 30X30 GEM4 GEM4130T", "code_information": [{"code": "GEM4130T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP KIMGUARD KC500QC 45X45 34198", "code_information": [{"code": "34198", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP NERVE 3.5 X 20MM", "code_information": [{"code": "C9361", "type": "HCPCS"}, {"code": "AG0320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4275.0, "discounted_cash": 1496.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERI 2 COLOR 36X36 CH6G0036", "code_information": [{"code": "CH6G0036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERI 2 COLOR CH100 24X24 CH1G0024", "code_information": [{"code": "CH1G0024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERI 2 COLOR CH500 18X18 CH5G0018", "code_information": [{"code": "CH5G0018", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERI 2 COLOR CH500 36X36 CH5G0036", "code_information": [{"code": "CH5G0036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERI 2 COLOR CH500 45X45 CH5G0045", "code_information": [{"code": "CH5G0045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERI 2COLOR 40X40 CH6G0040", "code_information": [{"code": "CH6G0040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATIN 2COLOR CH500 48X48 CH5G0048", "code_information": [{"code": "CH5G0048", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION 1 LAYR CH500 BL 36X36 CH510036", "code_information": [{"code": "CH510036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION 1 LAYR CH500 BL 45X45 CH510045", "code_information": [{"code": "CH510045", "type": "CDM"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION 2 CLR CH100 12X12 CH1G0012", "code_information": [{"code": "CH1G0012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION 2 COLOR 54X54 DISPOS CH4G0054", "code_information": [{"code": "CH4G0054", "type": "CDM"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION 20X20", "code_information": [{"code": "CH1G0020", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION 30X30 TWO LAYERED CH5G0030", "code_information": [{"code": "CH5G0030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION CH100 18X18 CH1G0018", "code_information": [{"code": "CH1G0018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION DUAL CH300 36X36", "code_information": [{"code": "CH300036", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION DUAL CH500 54X5 CH5G0054", "code_information": [{"code": "CH5G0054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 3.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION ONE-STEP LATEX FREE SMS FABRIC SIMULTANEOUS HEAVY 24 X 24IN", "code_information": [{"code": "62124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH100 12X12", "code_information": [{"code": "CH110012", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH100 18X18", "code_information": [{"code": "CH110018", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH100 24X24", "code_information": [{"code": "CH110024", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH100 36X36", "code_information": [{"code": "CH110036", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH100 40X40", "code_information": [{"code": "CH110040", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH100 54X54", "code_information": [{"code": "CH110054", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH200 30X30", "code_information": [{"code": "CH210030", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH200 48X48", "code_information": [{"code": "CH210048", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH300 24X24", "code_information": [{"code": "CH310024", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH300 36X36", "code_information": [{"code": "CH310036", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH300 45X45", "code_information": [{"code": "CH310045", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH300 48X48", "code_information": [{"code": "CH310048", "type": "CDM"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH300 54X54", "code_information": [{"code": "CH310054", "type": "CDM"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH400 36X36", "code_information": [{"code": "CH410036", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH400 45X45", "code_information": [{"code": "CH410045", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SINGLES CH400 54X54", "code_information": [{"code": "CH410054", "type": "CDM"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION SNGL LAYER 30X30 BLUE CH110030", "code_information": [{"code": "CH110030", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH100 15X15", "code_information": [{"code": "CH1G0015", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH100 30X30", "code_information": [{"code": "CH1G0030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH100 36X36", "code_information": [{"code": "CH1G0036", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH100 40X40", "code_information": [{"code": "CH1G0040", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH100 48X48", "code_information": [{"code": "CH1G0048", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH100 54X54", "code_information": [{"code": "CH1G0054", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH200 12X12", "code_information": [{"code": "CH2G0012", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH200 24X24", "code_information": [{"code": "CH2G0024", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH200 30X30", "code_information": [{"code": "CH2G0030", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH200 36X36", "code_information": [{"code": "CH2G0036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH200 48X48", "code_information": [{"code": "CH2G0048", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH300 24X24", "code_information": [{"code": "CH3G0024", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH300 30X30", "code_information": [{"code": "CH3G0030", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH300 40X40", "code_information": [{"code": "CH3G0040", "type": "CDM"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH300 45X45", "code_information": [{"code": "CH3G0045", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH300 48X48", "code_information": [{"code": "CH3G0048", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH400 40X40", "code_information": [{"code": "CH4G0040", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH400 45X45", "code_information": [{"code": "CH4G0045", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH400 48X48", "code_information": [{"code": "CH4G0048", "type": "CDM"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH500 24X24", "code_information": [{"code": "CH5G0024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH500 60X60", "code_information": [{"code": "CH5G0060", "type": "CDM"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH600 45X45", "code_information": [{"code": "CH6G0045", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 2.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH600 54X54 CH6G0054", "code_information": [{"code": "CH6G0054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STRL 36IN X 36IN CSR HEAVY WT ONE PLY GEMINI", "code_information": [{"code": "GEM4136", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STRL 45IN X 45IN BLUE CSR ONE PLY GEMINI LF", "code_information": [{"code": "GEM5145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP TENOWRAP TENDON COLLAGEN ABS-16050", "code_information": [{"code": "C9356", "type": "HCPCS"}, {"code": "ABS-16050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2167.1, "discounted_cash": 758.49, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH 3MM ALLEN", "code_information": [{"code": "10.012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.0, "discounted_cash": 55.3, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH BLADE TORQUE LOCK FOR HARMONIC SCALPEL CLEAR PLASTIC SLEEVE", "code_information": [{"code": "TLB01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.0, "discounted_cash": 47.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH COMBO 10MM DF-915-CW-10", "code_information": [{"code": "DF-915-CW-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1917.0, "discounted_cash": 670.95, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH HEX 3IN", "code_information": [{"code": "SC-4276", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH HEX FOR PRECISION SPINAL CORD SIMULATOR SYSSINSTR", "code_information": [{"code": "SC-4275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 61.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WRLS SKN SNR ANISOTROPY MEAS", "code_information": [{"code": "639T", "type": "CPT"}], "standard_charges": [{"minimum": 270.17, "maximum": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 270.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 424.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 424.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 424.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Wet Prep", "code_information": [{"code": "87491", "type": "CPT"}, {"code": "1099844", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 301.0, "discounted_cash": 105.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 111.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 140.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Wound Matrix 3-Layer 7 x 10 cm", "code_information": [{"code": "Q4166", "type": "HCPCS"}, {"code": "WSR0710", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 3843.0, "discounted_cash": 1345.05, "setting": "both", "billing_class": "facility"}]}, {"description": "X-LINKED INTELLECTUAL DBLT", "code_information": [{"code": "81470", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2330.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3665.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3665.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3665.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1316.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1316.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-LINKED INTELLECTUAL DBLT", "code_information": [{"code": "81471", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 1.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2330.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3665.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3665.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3665.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 1316.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1316.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY AORTA LEG ARTERIES", "code_information": [{"code": "75630", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 19038.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 4362.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19038.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 153.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 163.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY ASSAY CALCULUS", "code_information": [{"code": "82370", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 50.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 50.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 50.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY BILE DUCT DILATION", "code_information": [{"code": "74363", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 192.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 302.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 302.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 302.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY BILE DUCT ENDOSCOPY", "code_information": [{"code": "74328", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY BILE/PANC ENDOSCOPY", "code_information": [{"code": "74330", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 203.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 319.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 319.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 319.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY CONSULTATION", "code_information": [{"code": "76140", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 72.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 113.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 113.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 113.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM BREASTBONE 2/>VWS", "code_information": [{"code": "71120", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 61.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ENTIRE SPI 1 VW", "code_information": [{"code": "72081", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 73.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 78.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ENTIRE SPI 2/3 VW", "code_information": [{"code": "72082", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 133.45, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 141.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ENTIRE SPI 4/5 VW", "code_information": [{"code": "72083", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 258.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 406.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 406.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 406.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 151.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 161.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ENTIRE SPI 6/> VW", "code_information": [{"code": "72084", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 302.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 475.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 475.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 475.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 188.91, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 201.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM HIP UNI 4/> VIEWS", "code_information": [{"code": "73503", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 114.14, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 121.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF ARM INFANT", "code_information": [{"code": "73092", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.07, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF BODY SECTION", "code_information": [{"code": "76100", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 146.31, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 155.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF EYE SOCKETS", "code_information": [{"code": "70190", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 64.3, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 68.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF EYE SOCKETS", "code_information": [{"code": "70200", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 82.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 88.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF FISTULA", "code_information": [{"code": "76080", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2104.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 85.21, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 90.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF JAW <4VIEWS", "code_information": [{"code": "70100", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF JAW JOINT", "code_information": [{"code": "70328", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 61.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF JAW JOINT", "code_information": [{"code": "70332", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 142.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF JAW JOINTS", "code_information": [{"code": "70330", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 100.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 107.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF KIDNEY LESION", "code_information": [{"code": "74470", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2104.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF LEG INFANT", "code_information": [{"code": "73592", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.07, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF MASTOIDS", "code_information": [{"code": "70120", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 71.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF MASTOIDS", "code_information": [{"code": "70130", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 110.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 118.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF MIDDLE EAR", "code_information": [{"code": "70134", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2104.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 106.91, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 113.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PENIS", "code_information": [{"code": "74445", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PERINEUM", "code_information": [{"code": "74775", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1007.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1584.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1584.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1584.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PERITONEUM", "code_information": [{"code": "74190", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 851.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2104.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SALIVARY DUCT", "code_information": [{"code": "70390", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 229.1, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 243.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SALIVARY GLAND", "code_information": [{"code": "70380", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 75.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SHOULDER BLADE", "code_information": [{"code": "73010", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 36.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 39.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SHOULDERS", "code_information": [{"code": "73050", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 48.23, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 51.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SINUSES", "code_information": [{"code": "70210", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 61.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SINUSES", "code_information": [{"code": "70220", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 65.91, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 70.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEAR DUCT", "code_information": [{"code": "70170", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEETH", "code_information": [{"code": "70300", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEETH", "code_information": [{"code": "70310", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 78.77, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 83.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM PITUITARY SADDLE", "code_information": [{"code": "70240", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.07, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM RIBS/CHEST4/> VWS", "code_information": [{"code": "71111", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 89.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 95.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM SI JOINTS", "code_information": [{"code": "72200", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 61.09, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 65.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM SI JOINTS 3/> VWS", "code_information": [{"code": "72202", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.12, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM SURGICAL SPECIMEN", "code_information": [{"code": "76098", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 851.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2104.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3308.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 67.51, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 72.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM THORACOLMB 2/> VW", "code_information": [{"code": "72080", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 59.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 63.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY FALLOPIAN TUBE", "code_information": [{"code": "74742", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 217.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY FEMALE GENITAL TRACT", "code_information": [{"code": "74740", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 174.45, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 185.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY FOR PANCREAS ENDOSCOPY", "code_information": [{"code": "74329", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 159.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE FOR GI TUBE", "code_information": [{"code": "74340", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 121.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 190.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 190.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 190.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE GI DILATION", "code_information": [{"code": "74360", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 125.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 198.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 198.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE INTESTINAL TUBE", "code_information": [{"code": "74355", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 170.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 267.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 267.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 267.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY HEAD FOR ORTHODONTIA", "code_information": [{"code": "70350", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 23.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY MALE GENITAL TRACT", "code_information": [{"code": "74440", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 187.31, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 199.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY NOSE TO RECTUM", "code_information": [{"code": "76010", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 49.84, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 53.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY OF MAMMARY DUCTS", "code_information": [{"code": "77054", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 116.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 124.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY SM INT F-THRU STD", "code_information": [{"code": "74248", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 209.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 329.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 329.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 329.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 116.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 124.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY STRENOCLAVIC JT 3/>VWS", "code_information": [{"code": "71130", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 73.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 78.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY URETHRA/BLADDER", "code_information": [{"code": "74455", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1018.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1600.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 207.4, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM COLON 1CNTRST STD", "code_information": [{"code": "74270", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 246.8, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 262.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM COLON 2CNTRST STD", "code_information": [{"code": "74280", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 376.22, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 400.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM ESOPHAGUS 1CNTRST", "code_information": [{"code": "74220", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 163.19, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 173.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM ESOPHAGUS 2CNTRST", "code_information": [{"code": "74221", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 180.87, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 192.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM PHRNX&/CRV ESOPH C+", "code_information": [{"code": "74210", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 156.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 166.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM SM INT 1CNTRST STD", "code_information": [{"code": "74250", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 197.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 210.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM SM INT 2CNTRST STD", "code_information": [{"code": "74251", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 711.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 755.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM SWLNG FUNCJ C+", "code_information": [{"code": "74230", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 233.12, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 247.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM UPR GI TRC 1CNTRST", "code_information": [{"code": "74240", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 199.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 211.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM UPR GI TRC 2CNTRST", "code_information": [{"code": "74246", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1251.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 227.5, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 241.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS AT SURGERY ADD-ON", "code_information": [{"code": "74301", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 47.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 74.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 74.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 74.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE LENGTH STUDIES", "code_information": [{"code": "77073", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 77.98, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 83.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY COMPLETE", "code_information": [{"code": "77075", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 176.05, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 187.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY INFANT", "code_information": [{"code": "77076", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 177.66, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 189.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY LIMITED", "code_information": [{"code": "77074", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 107.72, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 114.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS FOR BONE AGE", "code_information": [{"code": "77072", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 40.19, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 43.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS TRANSCATH THERAPY", "code_information": [{"code": "75894", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 324.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 510.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 510.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 510.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X3 TRIATHLON CS INS SIZE4 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3403.0, "discounted_cash": 1191.05, "setting": "both", "billing_class": "facility"}]}, {"description": "X3 TRIATHLON CS INS SIZE6 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1736.0, "discounted_cash": 607.6, "setting": "both", "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL CPLX W/ECP", "code_information": [{"code": "66987", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL W/ECP", "code_information": [{"code": "66988", "type": "CPT"}], "standard_charges": [{"minimum": 3471.0, "maximum": 9357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4464.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 7663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3471.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3951.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8003.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XENOGRAFT IMPLTJ ARTCLR SURF", "code_information": [{"code": "737T", "type": "CPT"}], "standard_charges": [{"minimum": 1719.0, "maximum": 9735.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 3827.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1719.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3565.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 48.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XEROGEL DISOLVABLE CO-POLYMER BX/2", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "XG-102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 90.3, "setting": "both", "billing_class": "facility"}]}, {"description": "XEROGEL DISOLVABLE CO-POLYMER BX/8", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "XG-108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 143.85, "setting": "both", "billing_class": "facility"}]}, {"description": "XK GNOTYP XK EXONS 1-3", "code_information": [{"code": "200U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 395.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XM ARCHIVE TISSUE MOLEC ANAL", "code_information": [{"code": "88363", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 92.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XOME TUM & NML SPEC SEQ ALYS", "code_information": [{"code": "36U", "type": "CPT"}], "standard_charges": [{"minimum": 6883.2, "maximum": 19167.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 19167.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 19167.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 19167.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 6883.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6883.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Abdomen 1 View 74018", "code_information": [{"code": "74018", "type": "CPT"}, {"code": "45383619", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 148.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 247.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 51.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 54.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Abdomen 2 Views 74019", "code_information": [{"code": "74019", "type": "CPT"}, {"code": "45383622", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 148.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 247.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Abdomen 3 or More Views 74021", "code_information": [{"code": "74021", "type": "CPT"}, {"code": "45382986", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 148.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 247.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Abdomen 3 or More Views 74021", "code_information": [{"code": "74021", "type": "CPT"}, {"code": "45383637", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 148.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 247.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Abdomen Series w/ Chest 1 View 74022", "code_information": [{"code": "74022", "type": "CPT"}, {"code": "625630", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 148.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 247.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 83.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 89.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Ankle 2 Views Bilateral 73600", "code_information": [{"code": "73600", "type": "CPT"}, {"code": "625716", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1032.0, "discounted_cash": 361.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 423.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 383.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 531.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 640.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Ankle 2 Views Left 73600", "code_information": [{"code": "73600", "type": "CPT"}, {"code": "625718", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 518.0, "discounted_cash": 181.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 262.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 192.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 266.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 321.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Ankle 2 Views Right 73600", "code_information": [{"code": "73600", "type": "CPT"}, {"code": "625720", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 518.0, "discounted_cash": 181.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 262.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 192.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 266.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 321.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Ankle Complete Left 73610", "code_information": [{"code": "73610", "type": "CPT"}, {"code": "625724", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 518.0, "discounted_cash": 181.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 262.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 192.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 266.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 321.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 67.51, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 72.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Ankle Complete Right 73610", "code_information": [{"code": "73610", "type": "CPT"}, {"code": "625726", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 518.0, "discounted_cash": 181.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 212.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 262.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 192.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 266.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 321.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 67.51, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 72.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrogram Hip Bilateral 73525", "code_information": [{"code": "73525", "type": "CPT"}, {"code": "630777", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 4044.0, "discounted_cash": 1415.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1660.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1660.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2047.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1501.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 2082.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 2511.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 233.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 248.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrogram Hip Left 73525", "code_information": [{"code": "73525", "type": "CPT"}, {"code": "630773", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1022.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 749.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1039.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1253.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 233.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 248.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrogram Hip Right 73525", "code_information": [{"code": "73525", "type": "CPT"}, {"code": "630771", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1022.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 749.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1039.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1253.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 233.94, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 248.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrogram SI Joint Left 73542", "code_information": [{"code": "73542", "type": "CPT"}, {"code": "711786", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1022.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 749.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrogram SI Joint Right 73542", "code_information": [{"code": "73542", "type": "CPT"}, {"code": "711787", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2019.0, "discounted_cash": 706.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 828.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1022.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 749.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrogram Shoulder Bilateral 73040", "code_information": [{"code": "73040", "type": "CPT"}, {"code": "630749", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1347.0, "discounted_cash": 471.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 552.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 552.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 681.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 500.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 693.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 836.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 247.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 263.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrogram Shoulder Left 73040", "code_information": [{"code": "73040", "type": "CPT"}, {"code": "630745", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 276.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 276.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 341.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 250.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 347.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 418.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 247.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 263.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrogram Shoulder Right 73040", "code_information": [{"code": "73040", "type": "CPT"}, {"code": "630741", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 674.0, "discounted_cash": 235.9, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 276.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 276.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 341.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 250.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 347.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 418.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 247.59, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 263.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrogram Wrist Bilateral 73115", "code_information": [{"code": "73115", "type": "CPT"}, {"code": "630735", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 869.0, "discounted_cash": 304.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 356.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 356.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 439.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 322.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 447.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 539.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 250.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 266.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrogram Wrist Left 73115", "code_information": [{"code": "73115", "type": "CPT"}, {"code": "630730", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 221.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 162.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 271.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 250.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 266.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrogram Wrist Right 73115", "code_information": [{"code": "73115", "type": "CPT"}, {"code": "630725", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 437.0, "discounted_cash": 152.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 179.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 221.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 162.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1668.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2623.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 271.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 250.82, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 266.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrography Inj Shoulder 23350", "code_information": [{"code": "23350", "type": "CPT"}, {"code": "1748388", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Arthrography Injection Hip 27093", "code_information": [{"code": "27093", "type": "CPT"}, {"code": "1748392", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 4.41, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Bl SI Jt Injs Fluroguided 27096", "code_information": [{"code": "27096", "type": "CPT"}, {"code": "9418708", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1079.32, "maximum": 8450.0, "gross_charge": 2230.0, "discounted_cash": 780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 1079.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 3937.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Chest 1 View Frontal 71045", "code_information": [{"code": "71045", "type": "CPT"}, {"code": "629716", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 279.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 205.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 41.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 44.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Chest 2 View (Frontal & Lat) 71046", "code_information": [{"code": "71046", "type": "CPT"}, {"code": "1171907", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 492.0, "discounted_cash": 172.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 249.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 182.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 253.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 305.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Chest 2 View (Frontal & Lat) 71046", "code_information": [{"code": "71046", "type": "CPT"}, {"code": "1171907", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 492.0, "discounted_cash": 172.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 249.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 182.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 253.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 305.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Chest 2 View w/ Apical Lordotic 71047", "code_information": [{"code": "71047", "type": "CPT"}, {"code": "629720", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 279.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 205.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Chest 2 View w/Fluoro 71046", "code_information": [{"code": "1748422", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"gross_charge": 492.0, "discounted_cash": 172.2, "setting": "both", "billing_class": "facility"}]}, {"description": "XR Chest 2 Views", "code_information": [{"code": "71046", "type": "CPT"}, {"code": "689607", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 492.0, "discounted_cash": 172.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 249.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 182.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 253.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 305.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Chest 2 Views 71046", "code_information": [{"code": "71046", "type": "CPT"}, {"code": "629718", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 492.0, "discounted_cash": 172.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 249.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 182.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 253.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 305.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Cholangiogram in OR 74300", "code_information": [{"code": "74300", "type": "CPT"}, {"code": "629736", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 933.0, "discounted_cash": 326.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 382.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 382.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 472.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 346.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 480.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 579.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Clavicle Bilateral 73000", "code_information": [{"code": "73000", "type": "CPT"}, {"code": "629750", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 742.0, "discounted_cash": 259.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 304.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 304.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 375.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 275.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 382.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 460.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 59.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 63.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Clavicle Left 73000", "code_information": [{"code": "73000", "type": "CPT"}, {"code": "629752", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 153.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 153.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 188.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 138.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 192.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 231.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 59.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 63.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Clavicle Right 73000", "code_information": [{"code": "73000", "type": "CPT"}, {"code": "629754", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 373.0, "discounted_cash": 130.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 153.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 153.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 188.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 138.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 192.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 231.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 59.49, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 63.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Elbow 2 Views Bilateral 73070", "code_information": [{"code": "73070", "type": "CPT"}, {"code": "630691", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1001.0, "discounted_cash": 350.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 410.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 410.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 506.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 371.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 515.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 621.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 51.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 54.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Elbow 2 Views Left 73070", "code_information": [{"code": "73070", "type": "CPT"}, {"code": "630689", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 204.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 204.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 252.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 185.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 256.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 309.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 51.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 54.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Elbow 2 Views Right 73070", "code_information": [{"code": "73070", "type": "CPT"}, {"code": "630687", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 499.0, "discounted_cash": 174.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 204.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 204.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 252.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 185.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 256.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 309.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 51.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 54.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Elbow Complete Bilateral 73080", "code_information": [{"code": "73080", "type": "CPT"}, {"code": "630685", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 685.0, "discounted_cash": 239.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 346.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 254.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 352.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 425.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Elbow Complete Left 73080", "code_information": [{"code": "73080", "type": "CPT"}, {"code": "630683", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Elbow Complete Right 73080", "code_information": [{"code": "73080", "type": "CPT"}, {"code": "630679", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Facial Bones < 3 Views 70140", "code_information": [{"code": "70140", "type": "CPT"}, {"code": "630666", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 53.86, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 57.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Facial Bones Minimum 3 Views 70150", "code_information": [{"code": "70150", "type": "CPT"}, {"code": "630663", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 82.79, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 88.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Femur 2 views Bilateral 73550", "code_information": [{"code": "1554489", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 1142.0, "discounted_cash": 399.7, "setting": "both", "billing_class": "facility"}]}, {"description": "XR Femur 2 views Left 73550", "code_information": [{"code": "1171959", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "billing_class": "facility"}]}, {"description": "XR Femur 2 views Right 73550", "code_information": [{"code": "1171958", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "billing_class": "facility"}]}, {"description": "XR Finger 2nd Digit Left 73140", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "630649", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Finger 2nd Digit Right 73140", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "630647", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Finger 3rd Digit Left 73140", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "630641", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Finger 3rd Digit Right 73140", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "630633", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Finger 4th Digit Left 73140", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "630625", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Finger 4th Digit Right 73140", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "630622", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Finger 5th Digit Left 73140", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "630618", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Finger 5th Digit Right 73140", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "630609", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Finger Thumb Left 73140", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "630603", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Finger Thumb Right 73140", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "630599", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Flouro Guid CVA Device Replace 77001", "code_information": [{"code": "77001", "type": "CPT"}, {"code": "1715700", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1001.0, "discounted_cash": 350.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 410.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 410.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 506.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 371.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 318.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 500.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 500.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 500.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 515.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 621.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 190.52, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 202.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Fluorescein Angio Interp&Report 92235", "code_information": [{"code": "92235", "type": "CPT"}, {"code": "1891082", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 216.13, "maximum": 8450.0, "gross_charge": 631.0, "discounted_cash": 220.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 216.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 339.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 339.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 339.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Fluoro Guidance Needle Place 77002", "code_information": [{"code": "77002", "type": "CPT"}, {"code": "630586", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2055.0, "discounted_cash": 719.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1040.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 763.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 326.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1058.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1276.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 210.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 223.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Fluoro Guidance for Joint Asp 77002", "code_information": [{"code": "77002", "type": "CPT"}, {"code": "1748414", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2055.0, "discounted_cash": 719.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1040.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 763.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 326.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1058.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1276.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 210.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 223.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Fluoro Guide & Loc Spine Inj 77003", "code_information": [{"code": "77003", "type": "CPT"}, {"code": "1554507", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2055.0, "discounted_cash": 719.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1040.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 763.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 300.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 472.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1058.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1276.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 180.08, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 191.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Fluoroscopy Up to 1 Hour 76000", "code_information": [{"code": "76000", "type": "CPT"}, {"code": "1171963", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 507.0, "discounted_cash": 177.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 208.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 208.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 256.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 188.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 140.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 220.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 220.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 220.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 261.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 314.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 67.51, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 72.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Foot 2 Views Bilateral 73620", "code_information": [{"code": "73620", "type": "CPT"}, {"code": "630565", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1069.0, "discounted_cash": 374.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 438.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 438.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 541.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 397.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 550.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 663.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 50.63, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 54.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Foot 2 Views Left 73620", "code_information": [{"code": "73620", "type": "CPT"}, {"code": "630559", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 271.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 276.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 333.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 50.63, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 54.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Foot 2 Views Right 73620", "code_information": [{"code": "73620", "type": "CPT"}, {"code": "630555", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 271.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 276.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 333.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 50.63, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 54.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Foot Complete Bilateral 73630", "code_information": [{"code": "73630", "type": "CPT"}, {"code": "630552", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1071.0, "discounted_cash": 374.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 439.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 439.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 542.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 397.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 551.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 665.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Foot Complete min 3 views Left 73630", "code_information": [{"code": "73630", "type": "CPT"}, {"code": "1171901", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 271.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 276.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 333.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Foot Complete min 3 views Rt 73630", "code_information": [{"code": "73630", "type": "CPT"}, {"code": "1171900", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 271.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 276.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 333.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Forearm 2 Views Bilateral 73090", "code_information": [{"code": "73090", "type": "CPT"}, {"code": "630527", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 964.0, "discounted_cash": 337.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 395.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 395.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 488.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 358.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 496.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 598.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 55.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Forearm 2 Views Left 73090", "code_information": [{"code": "73090", "type": "CPT"}, {"code": "630523", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 481.0, "discounted_cash": 168.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 197.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 197.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 243.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 178.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 247.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 298.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 55.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Forearm 2 Views Right 73090", "code_information": [{"code": "73090", "type": "CPT"}, {"code": "630519", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 481.0, "discounted_cash": 168.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 197.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 197.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 243.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 178.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 247.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 298.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 55.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hand 2 Views Bilateral 73120", "code_information": [{"code": "73120", "type": "CPT"}, {"code": "630498", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 685.0, "discounted_cash": 239.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 346.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 254.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 352.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 425.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hand 2 Views Left 73120", "code_information": [{"code": "73120", "type": "CPT"}, {"code": "630493", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hand 2 Views Right 73120", "code_information": [{"code": "73120", "type": "CPT"}, {"code": "630489", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hand Complete Bilateral 73130", "code_information": [{"code": "73130", "type": "CPT"}, {"code": "630483", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 685.0, "discounted_cash": 239.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 346.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 254.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 352.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 425.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hand Complete Left 73130", "code_information": [{"code": "73130", "type": "CPT"}, {"code": "630479", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hand Complete Right 73130", "code_information": [{"code": "73130", "type": "CPT"}, {"code": "630473", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hand Left 2 views 73120", "code_information": [{"code": "73120", "type": "CPT"}, {"code": "1171951", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hand Right 2 views 73120", "code_information": [{"code": "73120", "type": "CPT"}, {"code": "1171950", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 1 View Left 73501", "code_information": [{"code": "73501", "type": "CPT"}, {"code": "42931958", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 1 View Left 73501", "code_information": [{"code": "73501", "type": "CPT"}, {"code": "42931967", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 1 View Left w/ Pelvis 73501", "code_information": [{"code": "73501", "type": "CPT"}, {"code": "42926102", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 1 View Left w/ Pelvis 73501", "code_information": [{"code": "73501", "type": "CPT"}, {"code": "42926164", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 1 View Right 73501", "code_information": [{"code": "73501", "type": "CPT"}, {"code": "42931959", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 1 View Right 73501", "code_information": [{"code": "73501", "type": "CPT"}, {"code": "42931970", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 1 View Right w/ Pelvis 73501", "code_information": [{"code": "73501", "type": "CPT"}, {"code": "42926103", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 1 View Right w/ Pelvis 73501", "code_information": [{"code": "73501", "type": "CPT"}, {"code": "42926167", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2 Views Bilateral 73521", "code_information": [{"code": "73521", "type": "CPT"}, {"code": "42926122", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 73.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 78.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2 Views Bilateral 73521", "code_information": [{"code": "73521", "type": "CPT"}, {"code": "42926170", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 73.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 78.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2 Views Bilateral w/Pelvis 73521", "code_information": [{"code": "73521", "type": "CPT"}, {"code": "42931964", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 73.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 78.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2 Views Bilateral w/Pelvis 73521", "code_information": [{"code": "73521", "type": "CPT"}, {"code": "42931973", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 73.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 78.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2-3 Views Left 73502", "code_information": [{"code": "73502", "type": "CPT"}, {"code": "42931960", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 89.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 95.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2-3 Views Left 73502", "code_information": [{"code": "73502", "type": "CPT"}, {"code": "42931976", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 89.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 95.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2-3 Views Right 73502", "code_information": [{"code": "73502", "type": "CPT"}, {"code": "42931961", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 89.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 95.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2-3 Views Right 73502", "code_information": [{"code": "73502", "type": "CPT"}, {"code": "42931979", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 89.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 95.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2-3 Views w/ Pelvis Left 73502", "code_information": [{"code": "73502", "type": "CPT"}, {"code": "42926104", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 89.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 95.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2-3 Views w/ Pelvis Left 73502", "code_information": [{"code": "73502", "type": "CPT"}, {"code": "42926173", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 89.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 95.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2-3 Views w/ Pelvis Right 73502", "code_information": [{"code": "73502", "type": "CPT"}, {"code": "42926105", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 89.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 95.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 2-3 Views w/ Pelvis Right 73502", "code_information": [{"code": "73502", "type": "CPT"}, {"code": "42926176", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 89.24, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 95.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 3-4 Views Bilat w/Pelvis 73522", "code_information": [{"code": "73522", "type": "CPT"}, {"code": "42931965", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 96.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 102.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 3-4 Views Bilat w/Pelvis 73522", "code_information": [{"code": "73522", "type": "CPT"}, {"code": "42931982", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 96.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 102.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 3-4 Views Bilateral 73522", "code_information": [{"code": "73522", "type": "CPT"}, {"code": "42926123", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 96.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 102.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip 3-4 Views Bilateral 73522", "code_information": [{"code": "73522", "type": "CPT"}, {"code": "42926179", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 96.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 102.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip Bilateral w/Pelvis 73520", "code_information": [{"code": "630461", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "XR Hip Complete Bilateral 73523", "code_information": [{"code": "73523", "type": "CPT"}, {"code": "42926182", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 187.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 113.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 120.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip Min 5v Bilateral 73523", "code_information": [{"code": "73523", "type": "CPT"}, {"code": "42926124", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 187.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 113.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 120.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip Min 5v Bilateral w/Pelvis 73523", "code_information": [{"code": "73523", "type": "CPT"}, {"code": "42931966", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 187.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 113.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 120.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip Min 5v Bilateral w/Pelvis 73523", "code_information": [{"code": "73523", "type": "CPT"}, {"code": "42931991", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 242.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 219.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 187.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 303.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 366.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 113.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 120.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Hip Operative Bilateral 73530", "code_information": [{"code": "630445", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 1181.0, "discounted_cash": 413.35, "setting": "both", "billing_class": "facility"}]}, {"description": "XR Hip Operative Left 73530", "code_information": [{"code": "630443", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "XR Hip Operative Right 73530", "code_information": [{"code": "630439", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "XR Hip Unilateral 1 view Right 73500", "code_information": [{"code": "1171941", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 206.5, "setting": "both", "billing_class": "facility"}]}, {"description": "XR Humerus Minimum 2 Views Bl 73060", "code_information": [{"code": "73060", "type": "CPT"}, {"code": "630433", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1120.0, "discounted_cash": 392.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 459.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 459.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 567.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 415.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 576.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 695.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Humerus Minimum 2 views Left 73060", "code_information": [{"code": "73060", "type": "CPT"}, {"code": "1171937", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 559.0, "discounted_cash": 195.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 229.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 229.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 283.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 207.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 287.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 347.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Humerus Minimum 2 views Right 73060", "code_information": [{"code": "73060", "type": "CPT"}, {"code": "1171936", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 559.0, "discounted_cash": 195.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 229.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 229.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 283.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 207.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 287.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 347.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Humerus Right 73060", "code_information": [{"code": "73060", "type": "CPT"}, {"code": "630427", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 559.0, "discounted_cash": 195.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 229.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 229.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 283.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 207.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 287.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 347.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Inj SI Joint w/ or w/o Arth G0260", "code_information": [{"code": "G0260", "type": "HCPCS"}, {"code": "8773208", "type": "CDM"}, {"code": "409", "type": "RC"}], "standard_charges": [{"minimum": 561.44, "maximum": 2881.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 1996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2827.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2421.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Jt Survey 1 View 2/more Joints 77077", "code_information": [{"code": "77077", "type": "CPT"}, {"code": "1172006", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 507.0, "discounted_cash": 177.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 208.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 208.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 256.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 188.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 261.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 314.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Knee 1 or 2 Views Bilateral 73560", "code_information": [{"code": "73560", "type": "CPT"}, {"code": "630365", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1050.0, "discounted_cash": 367.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 431.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 431.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 531.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 389.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 540.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 652.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Knee 1 or 2 Views Left 73560", "code_information": [{"code": "73560", "type": "CPT"}, {"code": "630361", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 525.0, "discounted_cash": 183.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 215.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 215.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 265.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 194.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 270.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 326.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Knee 1 or 2 Views Right 73560", "code_information": [{"code": "73560", "type": "CPT"}, {"code": "630355", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 525.0, "discounted_cash": 183.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 215.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 215.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 265.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 194.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 270.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 326.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Knee 3 Views Bilateral 73562", "code_information": [{"code": "73562", "type": "CPT"}, {"code": "630415", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 685.0, "discounted_cash": 239.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 346.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 254.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 352.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 425.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Knee 3 Views Left 73562", "code_information": [{"code": "73562", "type": "CPT"}, {"code": "630403", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Knee 3 Views Right 73562", "code_information": [{"code": "73562", "type": "CPT"}, {"code": "630395", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR L-Spine Bending Films 72114", "code_information": [{"code": "72114", "type": "CPT"}, {"code": "1748424", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 673.0, "discounted_cash": 235.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 276.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 276.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 340.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 249.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 346.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 417.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 112.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 119.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Lumbosacral Compl w/Bending 72114", "code_information": [{"code": "72114", "type": "CPT"}, {"code": "1172008", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 673.0, "discounted_cash": 235.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 276.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 276.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 340.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 249.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 346.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 417.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 112.54, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 119.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Mandible Complete Min 4 V Lt 70110", "code_information": [{"code": "70110", "type": "CPT"}, {"code": "1171909", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 510.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 258.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 189.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 262.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 316.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Mandible Complete Min 4 V Rt 70110", "code_information": [{"code": "70110", "type": "CPT"}, {"code": "1171908", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 510.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 258.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 189.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 262.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 316.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Mandible Complete Minimum 4V 70110", "code_information": [{"code": "70110", "type": "CPT"}, {"code": "630339", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 510.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 258.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 189.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 262.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 316.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Nasal Bones Minimum 3 Views 70160", "code_information": [{"code": "70160", "type": "CPT"}, {"code": "630309", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 492.0, "discounted_cash": 172.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 201.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 249.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 182.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 253.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 305.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 75.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Neck Soft Tissue 70360", "code_information": [{"code": "70360", "type": "CPT"}, {"code": "630307", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 510.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 209.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 258.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 189.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 262.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 316.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Needle Localization 77002", "code_information": [{"code": "77002", "type": "CPT"}, {"code": "1171949", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2055.0, "discounted_cash": 719.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1040.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 763.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 326.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1058.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1276.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 210.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 223.89, "methodology": "fee schedule"}], "billing_class": "facility"}, {"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2092.0, "discounted_cash": 732.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 858.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 858.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1059.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 776.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 326.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 512.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1077.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1299.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 210.61, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 223.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Pelvis 1 or 2 Views 72170", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "630285", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 151.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 151.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 186.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 137.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 190.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 229.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 47.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 50.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Pelvis AP Only 72170", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "1171956", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 369.0, "discounted_cash": 129.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 151.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 151.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 186.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 137.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 190.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 229.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 47.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 50.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Ribs 2 Views Left 71100", "code_information": [{"code": "71100", "type": "CPT"}, {"code": "630229", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 279.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 205.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Ribs 2 Views Right 71100", "code_information": [{"code": "71100", "type": "CPT"}, {"code": "630227", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 279.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 205.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Ribs 3 Views Bilateral 71110", "code_information": [{"code": "71110", "type": "CPT"}, {"code": "630231", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 551.0, "discounted_cash": 192.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 226.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 226.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 278.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 204.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 283.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 342.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Ribs Unilat incl PA Chest Rt 71101", "code_information": [{"code": "71101", "type": "CPT"}, {"code": "1572795", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 109.0, "discounted_cash": 38.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 44.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 44.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 55.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 40.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 56.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 67.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 75.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Ribs Unilateral 2 View Left 71100", "code_information": [{"code": "71100", "type": "CPT"}, {"code": "1171940", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 279.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 205.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Ribs Unilateral 2 View Right 71100", "code_information": [{"code": "71100", "type": "CPT"}, {"code": "1171939", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 552.0, "discounted_cash": 193.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 279.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 205.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Sacrum/Coccyx Minimum 2 Views 72220", "code_information": [{"code": "72220", "type": "CPT"}, {"code": "630186", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 62.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Shoulder 1 View Bilateral 73020", "code_information": [{"code": "73020", "type": "CPT"}, {"code": "630150", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 685.0, "discounted_cash": 239.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 346.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 254.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 352.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 425.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 34.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 37.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Shoulder 1 View Left 73020", "code_information": [{"code": "73020", "type": "CPT"}, {"code": "630146", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 34.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 37.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Shoulder 1 View Right 73020", "code_information": [{"code": "73020", "type": "CPT"}, {"code": "630142", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 34.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 37.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Shoulder Comp Min 2 View BL 73030", "code_information": [{"code": "73030", "type": "CPT"}, {"code": "630130", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 685.0, "discounted_cash": 239.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 346.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 254.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 352.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 425.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 61.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Shoulder Comp Min 2 View Left 73030", "code_information": [{"code": "73030", "type": "CPT"}, {"code": "630126", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 61.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Shoulder Comp Min 2 View Right 73030", "code_information": [{"code": "73030", "type": "CPT"}, {"code": "630121", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 61.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Shoulder Complete Bilateral 73030", "code_information": [{"code": "73030", "type": "CPT"}, {"code": "32650069", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 685.0, "discounted_cash": 239.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 346.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 254.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 352.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 425.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 61.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Skull Complete Minimum 4 Views 70260", "code_information": [{"code": "70260", "type": "CPT"}, {"code": "1171923", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 75.56, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 80.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Skull Less Than 4 Views 70250", "code_information": [{"code": "70250", "type": "CPT"}, {"code": "630096", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 65.91, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 70.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine 1 View Cervical 72020", "code_information": [{"code": "72020", "type": "CPT"}, {"code": "629692", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 271.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 276.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 333.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 40.19, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 43.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine 1 View Lumbar 72020", "code_information": [{"code": "72020", "type": "CPT"}, {"code": "630080", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 271.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 276.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 333.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 40.19, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 43.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine 1 View Thoracic 72020", "code_information": [{"code": "72020", "type": "CPT"}, {"code": "630076", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 271.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 276.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 333.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 40.19, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 43.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine 1 view Specify Level 72020", "code_information": [{"code": "72020", "type": "CPT"}, {"code": "1171931", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 537.0, "discounted_cash": 187.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 271.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 276.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 333.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 40.19, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 43.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine Cervical 2 or 3 Views 72040", "code_information": [{"code": "72040", "type": "CPT"}, {"code": "629600", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine Cervical Comp w/ Obliques 72052", "code_information": [{"code": "72052", "type": "CPT"}, {"code": "629602", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 780.0, "discounted_cash": 273.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 394.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 289.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 401.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 484.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 114.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 122.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine Cervical Flexion + Ext 72052", "code_information": [{"code": "72052", "type": "CPT"}, {"code": "711795", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 780.0, "discounted_cash": 273.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 394.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 289.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 401.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 484.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 114.96, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 122.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine Cervical Minimum 4 Views 72050", "code_information": [{"code": "72050", "type": "CPT"}, {"code": "629612", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 975.0, "discounted_cash": 341.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 400.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 400.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 493.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 362.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 502.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 605.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 98.86, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 105.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine Lumbosacral 2 or 3 Views 72100", "code_information": [{"code": "72100", "type": "CPT"}, {"code": "630048", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 327.0, "discounted_cash": 114.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 165.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 203.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.93, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine Lumbosacral Bending 2/3V 72120", "code_information": [{"code": "72120", "type": "CPT"}, {"code": "1668322", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 698.0, "discounted_cash": 244.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 286.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 286.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 353.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 259.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 359.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 433.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine Lumbosacral Bending 4V 72120", "code_information": [{"code": "72120", "type": "CPT"}, {"code": "1668329", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 698.0, "discounted_cash": 244.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 286.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 286.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 353.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 259.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 359.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 433.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 72.35, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 77.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine Lumbosacral Minimum 4 V 72110", "code_information": [{"code": "72110", "type": "CPT"}, {"code": "630022", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 926.0, "discounted_cash": 324.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 380.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 380.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 468.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 343.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 476.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 575.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 94.86, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 101.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine Thoracic 2 Views 72070", "code_information": [{"code": "72070", "type": "CPT"}, {"code": "630002", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 741.0, "discounted_cash": 259.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 304.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 304.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 375.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 275.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 381.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 460.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine Thoracic 3 Views 72072", "code_information": [{"code": "72072", "type": "CPT"}, {"code": "629997", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 803.0, "discounted_cash": 281.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 329.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 329.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 406.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 298.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 413.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 498.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 69.12, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Spine Thoracic Minimum 4 Views 72074", "code_information": [{"code": "72074", "type": "CPT"}, {"code": "1171924", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 741.0, "discounted_cash": 259.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 304.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 304.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 375.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 275.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 381.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 460.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 79.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 84.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Steroid Inj w/Guidance 20610/77002", "code_information": [{"code": "20610", "type": "CPT"}, {"code": "41480154", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Steroid Inj w/Guidance 20610/77002", "code_information": [{"code": "20610", "type": "CPT"}, {"code": "41581409", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1160.0, "discounted_cash": 406.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Steroid Injection Bursa 20610", "code_information": [{"code": "20610", "type": "CPT"}, {"code": "34966589", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 225.0, "maximum": 8450.0, "gross_charge": 1385.0, "discounted_cash": 484.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 2881.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1723.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMO", "standard_charge_dollar": 670.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA HMOX", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 2204.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Tibia/Fibula 2 Views Bilateral 73590", "code_information": [{"code": "73590", "type": "CPT"}, {"code": "1668347", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1142.0, "discounted_cash": 399.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 468.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 468.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 578.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 424.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 588.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 709.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 61.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Tibia/Fibula 2 Views Left 73590", "code_information": [{"code": "73590", "type": "CPT"}, {"code": "1668348", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 234.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 234.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 289.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 212.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 294.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 354.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 61.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Tibia/Fibula 2 Views Right 73590", "code_information": [{"code": "73590", "type": "CPT"}, {"code": "1668349", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 234.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 234.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 289.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 212.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 294.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 354.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 61.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Tibia/Fibula Bilateral", "code_information": [{"code": "73590", "type": "CPT"}, {"code": "629946", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1142.0, "discounted_cash": 399.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 468.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 468.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 578.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 424.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 588.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 709.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 61.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Tibia/Fibula Left", "code_information": [{"code": "73590", "type": "CPT"}, {"code": "629942", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 234.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 234.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 289.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 212.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 294.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 354.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 61.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Tibia/Fibula Right", "code_information": [{"code": "73590", "type": "CPT"}, {"code": "629936", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 571.0, "discounted_cash": 199.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 234.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 234.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 289.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 212.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 294.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 354.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 57.89, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 61.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Toes 2nd Digit Left 73660", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "629918", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 211.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 155.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 215.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 259.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Toes 2nd Digit Right 73660", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "629912", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 211.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 155.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 215.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 259.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Toes 3rd Digit Left 73660", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "629908", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 211.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 155.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 215.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 259.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Toes 3rd Digit Right 73660", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "629899", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 211.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 155.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 215.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 259.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Toes 4th Digit Left 73660", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "629896", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 211.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 155.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 215.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 259.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Toes 4th Digit Right 73660", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "629890", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 211.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 155.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 215.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 259.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Toes 5th Digit Left 73660", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "629882", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 211.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 155.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 215.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 259.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Toes 5th Digit Right 73660", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "629876", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 211.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 155.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 215.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 259.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Toes Great Left 73660", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "629866", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 211.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 155.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 215.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 259.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Toes Great Right 73660", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "629858", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 418.0, "discounted_cash": 146.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 171.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 211.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 155.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 215.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 259.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 54.65, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Urography Retrograde 74420", "code_information": [{"code": "74420", "type": "CPT"}, {"code": "613610", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 2092.0, "discounted_cash": 732.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 858.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 858.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 1059.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 798.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 776.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 203.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 319.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 319.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 319.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1077.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1299.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 129.42, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 137.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Urography w/ Inf w/ Tomography 74400", "code_information": [{"code": "74400", "type": "CPT"}, {"code": "613612", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1537.0, "discounted_cash": 537.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 630.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 630.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 778.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 570.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 418.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 658.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 658.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 658.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 791.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 954.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 264.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 281.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Urography w/ Inf w/o Tomography 74400", "code_information": [{"code": "74400", "type": "CPT"}, {"code": "613614", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 1537.0, "discounted_cash": 537.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 630.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 630.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 778.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 570.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 418.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 658.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 658.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 658.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 791.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 954.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 264.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 281.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Wrist 2 Views Bilateral 73100", "code_information": [{"code": "73100", "type": "CPT"}, {"code": "613630", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 685.0, "discounted_cash": 239.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 346.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 254.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 352.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 425.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 61.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Wrist 2 Views Left 73100", "code_information": [{"code": "73100", "type": "CPT"}, {"code": "613632", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 61.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Wrist 2 Views Right 73100", "code_information": [{"code": "73100", "type": "CPT"}, {"code": "613634", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 61.88, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Wrist Complete Bilateral 73110", "code_information": [{"code": "73110", "type": "CPT"}, {"code": "611598", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 685.0, "discounted_cash": 239.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 346.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 254.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 352.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 425.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 79.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 84.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Wrist Complete Left 73110", "code_information": [{"code": "73110", "type": "CPT"}, {"code": "611596", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 79.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 84.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR Wrist Complete Right 73110", "code_information": [{"code": "73110", "type": "CPT"}, {"code": "611594", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 341.0, "discounted_cash": 119.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 172.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 175.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 79.58, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 84.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR abdomen 1 view 74018", "code_information": [{"code": "74018", "type": "CPT"}, {"code": "45382984", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 148.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 548.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 247.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 51.44, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 54.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR abdomen 2 views 74019", "code_information": [{"code": "74019", "type": "CPT"}, {"code": "45382985", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "gross_charge": 399.0, "discounted_cash": 139.65, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 163.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 200.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 148.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 489.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 769.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 205.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 247.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 66.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XRAY CONTROL CATHETER CHANGE", "code_information": [{"code": "75984", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 299.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 470.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 470.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 470.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "EHN - EMPLOYEE HEALTH NETWORK", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "BAYLOR SCOTT AND WHITE QUALITY ALLIANCE -BSWQA", "standard_charge_dollar": 146.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XRAY ENDOVASC THOR AO REPR", "code_information": [{"code": "75956", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1546.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2431.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2431.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2431.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XRAY ENDOVASC THOR AO REPR", "code_information": [{"code": "75957", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1327.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2087.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2087.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2087.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XRAY PLACE DIST EXT THOR AO", "code_information": [{"code": "75959", "type": "CPT"}], "standard_charges": [{"minimum": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 768.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1208.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1208.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1208.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "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": 0.51, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 41.05, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1301.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.63, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1028.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 1543.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 881.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 1386.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 51.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 62.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "KELSEY-SEYBOLD CLINIC HIX UHC", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XYLOSE TOLERANCE TEST", "code_information": [{"code": "84620", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 51.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 51.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 51.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 18.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 18.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "YANKAUER FLANGE TIP FINE CAP FLX", "code_information": [{"code": "DYND50144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "YANKAUER SUCTION 12FR METAL W/ EXTENDED DISPOSABLE TIP VITAL VUE", "code_information": [{"code": "8886828206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 152.6, "setting": "both", "billing_class": "facility"}]}, {"description": "YANKAUER W TUBING BULB TIP W O VENT 6", "code_information": [{"code": "DYND50135", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "YELLOW FEVER VACCINE SUBQ", "code_information": [{"code": "90717", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "YERSINIA ANTIBODY", "code_information": [{"code": "86793", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 52.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "YT GNOTYP ACHE EXON 2", "code_information": [{"code": "201U", "type": "CPT"}], "standard_charges": [{"minimum": 48.07, "maximum": 266.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 75.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 266.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZAIRE EBOLAVIRUS VAC LIVE IM", "code_information": [{"code": "90758", "type": "CPT"}], "standard_charges": [{"minimum": 3596.0, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZIKA VIRUS DNA/RNA AMP PROBE", "code_information": [{"code": "87662", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 79.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 205.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 73.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 73.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZIKA VIRUS IGM ANTIBODY", "code_information": [{"code": "86794", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 26.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZRSR2 GENE COMMON VARIANTS", "code_information": [{"code": "81360", "type": "CPT"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.14, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1936.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 3045.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 278.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZYNRELEF (200mg and 6mg)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0668", "type": "HCPCS"}, {"code": "MED0881", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 76.63, "discounted_cash": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "ZYNRELEF (400mg and 12mg)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0668", "type": "HCPCS"}, {"code": "MED0882", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 84.91, "discounted_cash": 29.72, "setting": "both", "billing_class": "facility"}]}, {"description": "ZZ PACK CUSTOM DR MAZHARUDDIN PPK13547", "code_information": [{"code": "ZZ PPK13547", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 563.12, "discounted_cash": 197.09, "setting": "both", "billing_class": "facility"}]}, {"description": "ZZ PACK CUSTOM DR URSO", "code_information": [{"code": "ZZ PPK3284-03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.0, "discounted_cash": 218.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ZZ PACK CUSTOM PPK 13548", "code_information": [{"code": "ZZ PPK 13548", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 567.72, "discounted_cash": 198.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ZZ PACK CUSTOM PPK153547", "code_information": [{"code": "ZZ PPK153547", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 563.12, "discounted_cash": 197.09, "setting": "both", "billing_class": "facility"}]}, {"description": "ZZZCATHETER URETHRAL RED RUBBER 10FR", "code_information": [{"code": "ZZZ009410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ZZZDILATOR BALLOON ENDO 6.0FR 15.0-16.5-18.0MM PEBAX FIXED WIRE", "code_information": [{"code": "M00558371", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 172.55, "setting": "both", "billing_class": "facility"}]}, {"description": "iPTH", "code_information": [{"code": "83970", "type": "CPT"}, {"code": "1233825", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.41, "maximum": 8450.0, "gross_charge": 357.0, "discounted_cash": 124.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA POS/EPO", "standard_charge_dollar": 4620.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA PPO", "standard_charge_dollar": 8450.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WALMART ACO", "standard_charge_dollar": 63.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3596.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 132.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 105.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 165.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 165.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 165.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC", "standard_charge_dollar": 59.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 59.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "miSOPROStol 100 mcg Tab", "code_information": [{"code": "MED0852", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "screw 3.5 x 40 mm lag screw", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5820x3540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 216.3, "setting": "both", "billing_class": "facility"}]}, {"description": "zzepinephrine 1 mg/mL Inj Sol 1 mL578", "code_information": [{"code": "1831246", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 6.65, "setting": "both", "billing_class": "facility"}]}, {"description": "zzepinephrine 1 mg/mL Inj Sol 30 mL579", "code_information": [{"code": "1831310", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "zzocular lubricant Oint1219", "code_information": [{"code": "1871204", "type": "CDM"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "zzzBUPIVACAINE 0.25% PF 10ML", "code_information": [{"code": "MED0353", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "zzzCATHETER IV 18GA 1.25IN GRN RADPQ OCRLN SAFESHIELD PROTECTIVE STRL", "code_information": [{"code": "zzz3065", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "zzzPLUG CATH BRD CAP STRL LF", "code_information": [{"code": "zzz000076 (D)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "zzzSYRINGE BULB 50CC IRRIGATION ASPIRATION", "code_information": [{"code": "zzzz35280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "zzzzDRAPE GENERAL 17IN X 23IN UNDERBUTTOCK LG TOWEL ADHSV STRIP STERI-DRAPE", "code_information": [{"code": "M1010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "zzzzSCISSOR CURVED 5.0MM ENDOPATH", "code_information": [{"code": "zzzz5DCSbx", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 372.0, "discounted_cash": 130.2, "setting": "both", "billing_class": "facility"}]}, {"description": "\u03b2-amyloid (Abeta42) and phospho tau (181P) (pTau181), electrochemiluminescent immunoassay (ECLIA), cerebral spinal fluid, ratio reported as positive or negative for amyloid pathology", "code_information": [{"code": "445U", "type": "CPT"}], "standard_charges": [{"minimum": 1379.52, "maximum": 2169.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1379.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "\u03b2-amyloid (Abeta42) and total tau (tTau), electrochemiluminescent immunoassay (ECLIA), cerebral spinal fluid, ratio reported as positive or negative for amyloid pathology", "code_information": [{"code": "459U", "type": "CPT"}], "standard_charges": [{"minimum": 1379.52, "maximum": 2169.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1379.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS TRADITIONAL INDEMNITY HOUSTON", "standard_charge_dollar": 2169.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}]}